venerdì, agosto 19, 2005
:: anaesthetic anxieties ::situation 1:
student approaches patient with trepidation cuz she knows that she's going to POKE the poor patient with this HUGE needle (the needle has a bore wide enough to thread a string through). and she also knows that she might have to poke the patient MORE THAN 2 times... heh.
tie on tourniquet... tap tap tap... pats/hits/slaps the dorsum of the hand, looking for nice big bouncy veins... sometimes we go for the one right on the inner side of the wrist... big bouncy but looks damn painful to poke. give LA injection, so lessen the pain when the BIG BIG needle goes in...
ARGH, the LA causes a wheal... blocks out the anatomy of the vein... but no fear... so... advance with HUGE needle (warn pt first), poke in DECISIVELY, LIFT the needle, skin up, then can see vein... hehe it looks barbaric, all this burrowing and advancing, withdrawing, mucking around under the patient's skin, but best to do it then let the plug fail... just make sure no haematoma... finally, get FLASH BACK! advance just one mm.... then push the cannula (straw) in while pulling the needle out together... nice and smooth... better hope it doesn't get jammed halfway, cuz tt probably means you're OUTTA vein!
and if unfortunately, u don't get the plug in, u have to poke the pt on another vein again!
so can u imagine, if on two consecutive tries u can't get the plug in, it'll be sooo stressful by the time it's the third attempt.
an MO told me, once she did up to 10 tries on this patient, on all four limbs, cuz it was so hard to set a plug for him! oh dear...
situation 2:
con: medical student? year four rite? ah... good good... you must ask questions...
con to his reg: hey, medical student here, good!
reg: ... ... ...
con to reg: don't keep so quiet, you must ask questions! now is a good time to practice!
mo: you dang2 for me, i siam.
me: (:S and feels very stupid)
so in the OT that day, it was rather funny, everytime the con appears, the reg will scurry over to my side and ask me all kinds of questions... lolz... but i like that... heh. i like this kind of question-answer viva like teaching. especially if i dunno the answer, and the doc refuses to tell me but makes me think it out myself! yeah... i like this kind of stress! haha...
situation 3:
endotracheal intubation!! sometimes done under scrutiny of yr tutor, yr tutor's superior, ALL the OT nurses, sometimes the porters too, and worst of all, PLUS the surgeons!
open patients mouth: careful not to get bitten
put in laryngoscope: careful not to chip or cause loose teeth to fall out, cuz that's like a mountain of paperwork + $17 000 AND the whole OT going : orh.... u die. (haha... just a joke)
pull up... up and up..... : arm trembles.... where's the CORDS?!?!?! floppy epiglottis and whatnots...
finally when u see the dark hole between those two vocal cords, u slide the ETT in... once in a while, the stupid tube gets jammed... (especially since no one really uses the stylet anyway)...
situation 4:
ETT is in already, BUT... u can't hear the lung sounds! oops... or u hear one side more than the other....
thankfully, this hasn't happened. yet.
situation 5:
you're holding the mask, the doc is injecting the muscle relaxant and propofol... pt STOPS breathing... u quickly do yr head tile, jaw thrust, chin lift and watnots... and bag bag bag... BUT... no end tidal CO2 ah! or worse, major leak from all sides (maybe cuz pt has got hollow cheeks).. hehe... so u desperately tr y to cover all the holes and bag at the same time... looks v gang2 kor4 actually... and is in fact v uncomfortable.
situation 6:
WHAT THE HELL AM I BLOGGING ABOUT ANAESTHESIA RIGHT AFTER THE TEST?!?! I'M SUCH A LOSER!!! I GOT NO LIFE!!!
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francesca chiu
2 eyebags & 5 wrinkles
on long-term dormicum drip
KIV IMH
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