On ventilator

I saw this cute little 3½ year old yesterday.He was lying in a bed in our neurosurgery ICU, attached to a ventilator. He had been travelling in the front seat of a car when he stuck his head out of the window. An auto passing by, hit his head. His skull fractured and a piece of his skull was driven into his brain. he was unconscious when he reached pediatric casualty where he stopped breathing. He was intubated and resuscitated and transferred to neurosurgery ICU and hooked to a ventilator.A CT scan was done which revealed that the piece of bone was driven in to the brain to a depth of about 1.5-2 cm with some bleeding below it.The boy was immediately shifted to the OT. The surgery lasted 3½ hours, the fractured bone pieces were removed and the underlying damaged brain tissue was removed and the bone pieces were fixed in their normal position.

The child is now in the critical care unit, still on a ventilator. We hope he will gain consciousness soon. No one can say what damage has been done to his brain. But children's brain in enormously plastic. The function of the damaged area can be taken up by surrounding area. But no one knows how complete his recovery will be, if he recovers at all.

It is at times like this when i feel grateful for my body that i take for granted. To stand on my own two legs, see through my eyes, and have an unclouded mind to enjoy the world.

PS: now you know why they say in buses to not stick your arms of head outside. Be safe.

Express Delivery

Recently i came across this and was reminded of my own experiences delivering babies. My first delivery during house surgeoncy happened while i was posted in gen surgery. 
      There was this young lady who was admitted with about 50% burns to her body and she was about 7 months pregnant. About 2-3 days after her admission she complained of vague abdominal pains. An O&G consultation was sent and the obstetrician examined her and was of the opinion that the abdominal pain was not related to the pregnancy.
  That night I was the house surgeon on duty and at about 11pm the duty nurse called me up informing me that the lady was in full blown labour. Now the last time i'd taken a delivery was way back in 4th year! So i gathered up my wits, called the house surgeon from the next ward and went to the patient. 

      On examination i found that the baby was already crowning. Things happened very fast and i found myself holding this tiny baby! It wasn't moving or breathing. I hadn't expected a baby this preterm to survive. I clamped and cut the cord, kept the baby on the bed and turned back to the mother to deliver the placenta when suddenly I heard a noise and turned to find the baby struggling to breathe. I asked the nurse for a suction catheter to clear the airway. Since it was an adult ward there were no small sized suction catheters and the one I got wouldn't fit the tiny baby's nostril. 

      At that point i realised that if the baby was to survive i would have to get it to the NICU. So i handed the mother over to the other house surgeon, bundled up the baby in a sterile towel and ran. Our O&G and pediatric depts were in another building across a road from the med and surgery building. I ran about 200 metres with the kid's father following me and handed over my precious cargo to the neonatologist in the NICU, where they successfully resuscitated him. I collapsed in to a chair and couldn't speak for 10 minutes, at which point my fatigue was replaced by a warm glow of success. My first unsupervised delivery as a house surgeon was a success!

Resuscitation

Large Bore cannulae in both arms

Saline infusions started on both cannulae

Inj Atropine iv stat

Inj Adrenaline iv stat

Checking airway

Head tilt, chin lift, jaw thrust

Positioning larygoscope

Suctioning airway

Inserting no.8 endotracheal tube.

checking air entry

ET cuff inflated, ET tube fixed

AMBU ventilation commenced

chest compressions started

Defibrillation at 200J

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Defibrillation at 300J.

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Defibrillation at 360J.

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Sinus rhythm

BP recordable 

This blog has been successfully resuscitated.