Saturday, June 19, 2010

AAA

People keep coming.My watch showed 2.15 o’clock am.It was so cold that night, my coat still could not bear it.The chills that flow through the whole body made me sometimes dveloped rigors.

It was the time I just was to close up my eyes for a little while, then my ears cought a sound that stopped me to go into sleep.A man, around 60 years old, medium built was being pushed on a bed into yellow zone.He kept screaming in pain, as if trying to tell others that he realy need help.

He looked restless.I couldn’t get the proper history if he continued to be like that.My senior medical officer then told me to give him injection of Tramal (pain killer ) first.Until then, I managed to find out what is actually the reason that brought this patient to the hospital in that middle of night.

He was a 59 years old man, chronic active smoker with no known medical illness before.The main complaint was abdominal pain and left lower limb pain and weakness.He described the abdominal pain as a generalised, and the limb pain radiated from the loin area down to the thigh and calf.He couldn’t move even a little of his left lower limb.He looked very ill,restless,realy in poor perfusion, but not pale. The abdomen was so distended, generalised guarding and the left lower limb was colder and dusky in colour.There was hardly pulse palpable even left femoral artery. My senior didn’t feel good with his condition then he was immediately transfer into red zone -for critical ill patient.

FAST done.The liver is floating ! fluid accumulated in the Mourison’s pouch and splenorenal area.Aorta measured, and the diameter measured 5 cm.Now, condition looked worsening.My senior started thinking about aortic aneurysm.Blood pressure remained normal.Suprisingly, hemoglobin count came out as much as 20 ! This certainly made us confused.If leaking aneurysm was all about, the count should not be as high as that, it should be the other way around.

At this level, we could hardly think more to come towards diagnosis.Without hesitatation, specialist was called on the spot.Presenting all the progress, the only thing that could explain was still possibility of aneurysm.The dilatation of the aorta might be already spreading down to the Iliac vessels and this could interrupt the blood flow to the lower limb, either affecting one limb or both.Thus, his left lower limb now was in danger ! The vascular surgeon need to be consulted at once, if not, he might loss his limb in just few hours.

He was then be referred to the HUSM for further evaluation, KIV for angiogram.During passing over at 8 o’clock am on the same day, he was still in red zone.My duty on that day almost finished.However I felt quite guilty to leave him with this current condition.But my eyes could hardly opened anymore.I have to...

People always coming...and people always leaving.