Medical, Here I Comes

It is very rare to get a 'chill' day in the labor room.
Something is always happening.
There is always something to do.

But that day was different.
There really wasn't anything to do.
Even the MO found it weird, but hey, enjoy the moment while it lasts, right?

So, there I was, trying to complete my log book.

Then, I saw my specialist walking in, with a nurse pushing a patient in a wheelchair into suite 1.
Now, suite 1 is our 'special' suite - we only put 'critical' patients in there - patients with severe PE (pre-eclampsia) or IE(impending eclampsia) or patient's with heart disease.

My friend immediately went into suite 1 to see what she can do and do the necessary.
Everyone who comes in will need blood investigations, so I started taking all the tubes necessary (I assumed that it was a PE case) for the blood tests.

I was about to enter the suite when I saw drops of blood on the flood. I stopped, went back to where we kept all the tubes and took another bottle, which was necessary for any patients who are bleeding.

2 others started setting branulas and taking blood.
1 pushed in the scan machine for the specialist.
I started filling up the blood forms.

Specialist scanned - confirmed an abruptio placenta (placenta separated from the uterus wall) and (as we would do in any emergency situation) we prepared for LSCS.

One HO ran for blood, one HO scrubbed in OT.
Baby was out in less than 10 minutes.
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Right now, I can't think of any more stories.
Tomorrow will be my last day in O&G.
I am going to start my medical posting.
As much as I hate tagging, hate starting a new department (it is like learning a new subject alltogether) I am glad I have not been extended.

EMERGENCY!

It was a busy day in the labor room.
All 8 suites were full.
There are 4 beds in the ABC - we even had to put patients in active labor there.

One MO was in the OT.
Another one was running around in the labor room.

Then, suite 7 had prolonged 2nd stage (basically, the baby was not coming out as fast as it was supposed to).

MO consulted specialist, decided for vacuum.
While the vacuum was being done for suite 7, one patient in ABC had fetal bradycardia.
MO was busy, told one of us to call the specialist.

Called specialist, specialist came over.
Suite 7 delivered by then.
Specialist decided that the patient in ABC should go for vacuum.
She started to prepare for vacuum, but we couldn't really get a CTG reading for the baby.

The ultrasound machine was pushed in.
The fetal heart rate was really slow.
Specialist decided then and there - LSCS NOW!

Preparations were made for LCSC (thank God the other LSCS in the OT was over).
Patient was pushed in as fast as possible.
Paeds team told to standby.
Baby was out in less than 5-10minutes I think.
Baby born crying.
Hurray!!

Came out to labor suite - suite 1 also had prolonged 2nd stage - another vacuum delivery.

That day, we had SO many deliveries that there were about 12 babies in the baby room at one time (usually we have about 4).
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It was 4am. I was oncall.

The CTG for patient in suite 7 showed some fetal deceleration (I think it was Type II).
My friend did everything that was necessary, but nothing worked.
And patient had some bleeding.

My MO was in the VE room.
I decided that we shouldn't wait for him to come in.
I tore off the CTG and went straight to him.

MO wasn't very worried, but he attended to patient.
Hmm..why was patient bleeding, he wondered out loud.

He did a VE.
His face changed.
2 words - cord prolapse (basically the umbilical cord has fallen out).
Everyone rushed to do whatever necessary - inflate bladder, raise buttock, prepare for LSCS.
I ran and called the other MO who was oncall.
Ran into OT.
Baby delivered within 5 minutes - not crying at first, but was eventually OK.

The Labor Room

O&G was not like the other postings.
There were more emergencies. More excitement.

It's because in the other 2 postings that I went through, Paeds and Ortho, all cases are screened in the A&E before they come to the ward. If the patient is unstable, they are stabilized before being sent to the ward.

In O&G, the labor room is our A&E. All pregnant ladies are sent there (very few are sent to the A&E). So, you see and play a part in managing emergencies in the labor room.

It's not to say that you see an emergency very often, but you see it enough.

There are some stories that I would like to share..these are the things I saw, my experiences. They are better stories, but then I wasn't part of it, so can't really tell those stories properly, so most probably won't be telling them.
(I will try my best to tell it as simple as possible, but am not going to explain everything (cos then it would take very long), so if you are curious enough, please google for it)
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My MO was doing a Caesarean Section (LSCS) in the OT. Our specialist(S) was doing rounds in the labor room. S received a call and was on the phone, so I decided to go to the VE room (where we clerk patients before deciding whether to admit them to the labor room or to the ward or to discharge them) to see if there were any patients to clerk.

One lady was there, doing CTG (cardiotocography - to see the fetal heart activity). It was her 5th pregnancy, and she had already delivered 4 children via SVD (vaginal delivery). She came due to contraction pain.

I asked her all the questions I needed to ask, and then left her to finish the CTG (which takes about 20 minutes) and started writing down the clerking. She came after completing her CTG and looked quite uncomfortable, so I decided to do a VE first before proceeding with the clerking.

I did all the necessary examination and then did the VE (vaginal examination). I was shocked!! I felt a feet, and I could feel the whole feet. I panicked, and told my friend to call the MO.

I waited for my friend for what I felt like eternity. Then, I decided that I can't wait any longer. I told the lady to just lie down and not push and ran into the labor suite myself. Then I was told that there were no MOs around, only the S.

I went straight to the S, and told, Dr. L, there is a patient in the VE room, feet presentation. The S immediately came with me and attended to the patient. Confirming the presentation, she said prepare for LSCS (which mean you have to take her blood, set line, get the op consent and blood consent and send the booking slip).

But we only have one MOT. Dr. L decided that she would go into the OT to finish up the op that was going on so that this lady can be pushed in faster, before this baby decides to come out. At the same time, there was another emergency inside the labor room, a fetal distress. That makes it 2 LSCS waiting with one OT occupied.

The solution - fetal distress was sent to GOT (an ambulance will bring the patient to the main building for that) and feet presentation will go in after either of the LSCS (whether in MOT or GOT) is done.
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I didn't expect 1 story to be that long!
Although now, I feel it's not as exciting as when it was happening.
Will try a different story tomorrow.
Hopefully that will sound better once written down.
Good night!

Emergency?

When one is on call (on a weekday), there are only certain types of cases that one expects to see.

For instance, in Paeds, you expect children to come with fits, asthma attacks, sudden high fever, severe diarrhoea and vomiting - things like that.

In Ortho, you expect people to come due to fractures due to accident or falls.

However, that is not the case.

Can you imagine clerking a case of sacral sore at 3am?
The sore would have been there for a few weeks or even months.
Why do they have to come in at 3am?

Better still - diarrhoea for the past 1 week, decreasing in frequency.
Getting admitted in the middle of the night.
If the diarrhoea did not have to be checked for the last 7 days, why can't it wait for another 7 hours?

My friend said she once clerked a patient who came for menorrhagia for the past 3 months.
She came to the hospital in the middle of the night because the husband only had time to bring her to the hospital then.
The husband must be a really, really busy man to not have any spare time for 3 whole months, don't you think?

I recently clerked a patient who had dry gangrene of the toe for the past one week.
What prompted him to come to the hospital at 11pm and not earlier?
I have no idea.

If we get such cases in the ward, imagine just what the A+E people see each day.
People come to the A+E for every minor thing that can wait.

The A+E is for accidents and emergency.

If your leg has hurt for the past two years and you suddenly decide to get it checked up, you can wait until the next day, when the outpatient department will be open.

You do NOT have to come to the hospital at 2am for a wound that you have had for the past month; it can wait a few more hours.

People, be considerate.

Today I learnt that wedding banns are announced (?read) for 3 consequtive weeks before a couple gets married. So, if anyone has any objections regarding the marriage, they have 3 whole weeks to bring up the matter.