Real Emergency in A&E

It’s has been 1 week since I was in Accident & Emergency Department and it was almost calm as the peaceful water in a stagnant pool. Does that mean a good thing? Well, certainly not for me to learn anything to be a practical doctor in the future.

Anyway, I was really seeing an emergency happening in the Accident and Trauma Unit !!!! Well, I am not saying I haven’t seen any emergency in Emergency department but it’s just not the kind of emergency where everyone will rush to patient, surround the patient in rescuing the patient. Luckily enough, I finally saw one yesterday.

Way before the emergency case coming in, there was a lady who presented with End Stage Renal Failure in the critical zone mostly likely due to noncompliance in fluid restriction. Just about half an hour after that, the double siren was alarmed indicating red zone case coming.. A young unconscious patient which most likely suffering from Motor Vehicle Accident come in with severe head injury and bleeding from the head and nose. All the doctors, nurses and medical assistant came in rushing in attending to the patient; cervical collar was already in place in order to prevent cervical injury. He was then transferred carefully onto another bed for the whole resuscitation process.

Normal saline and later Gelafusine was given for fluid resuscitation in order to revive patient’s Blood Pressure which has fallen into 90/30 (Normal ~ 120/80). Laryngoscopy was performed for intubation with great difficulty and carefully as the patient tongue was protruding out and obstructing the mouth. Then, we also helped out in the pumping the air into the patient and suctioning of blood which kept on gushing out from the mouth of the patient. Almost 1/5 of the patient blood was suctioned out throughout the process. And each time before the blood is be suck out, it will splash on towards the surrounding which is severely distressing as it mean massive bleeding which was happening inside the patient body.

Besides that, the L chest was hyperexpanded with evidence of pneumothorax (air in the lung) and probably subcutaneous emphysema also. So, a large bore needle was inserted through the chest to allow the portion of the air to flow out before a chest tube was attached to the left chest in the safety area to drain out the air in the lung. The bulging of the left chest became lessened by about 20% however not so fully.

The whole condition became very messy as the patient kept on having bleeding flowing and gushing out from the mouth and thus splashing on most of the apron we wore. The floor also stained red because of that.

After a while, the patient was having Ventricular Fibrillation and Defibrillator was needed to bring the patient back onto normal rhythm. All of us have to stay far away from the patient body in order not to be the next patient lying on the floor.Haha..

After 2 time of defibrillation, patient doesn’t show much positive response. And, the heart became asystole which we proceeded for CPR. The patient was announced dead after a short while.

To be honest, this is the first time I seen a “real emergency” and I really learned a lot about it. Hopefully, I myself will be competent enough to handle every case with care.

A & E – Accident and Emergency

MVA- Motor vehicle accident/ Road Traffic Accident