Had a very bad call yesterday..
Really2 bad that i wish i dont have to work anymore..
Those patients that i saw in red zone were very sick..most of them were referred from district hospitals.few was already admitted there for at least few days..
I had at least 3 patients with cardiogenic shock..the first one was a referred case from hospital pasir mas..was already admitted for 4days..initially treated as decompensated congestive cardiac failure.. Developed worsening sob since a day ago and referred to hrpz..at hrpz noted evolving ecg changes with raised cardiac enzymes..i treated him as non st elevation mi..he desaturated that i need to intubate him for impending resp collapse..post intubation bp lowish despite triple inotropes..he passed away after 6hrs admission in HDW.. The other one was a female lady, chronic smoker, first presentation with typical chest pain at hosp tumpat.. Was treated as acute coronary syndrome in failure..upon arrival noted she actually has st elevation myocardial infarction at posterior leads..we managed to give her iv streptokinase..unfortunately she developed short run ventricular tachycArdia and desaturated..intubate her and post intubation she requiring triple inotropes as well..a friend of mine told me she passed away today..innalilillah..the other pt with. Cardiogenic shock stable...
I had a 17y.o pAtient referred case from pasir mas as st elevation myocardial infarction..17 years old!!!was given iv streptokinase at hosp pasir mas..he didnt have myocardial infarction actually..it was a saddle shape st elevation..its actually pericarditis..luckily pt didnt develop any complication towards streptokinase..
Thats among the cases..x termasuk hypovolaemic shock secondary to upper gastrointestinal bleed, symptomatic bradycardia, sepsis, cap with bronchospasm, fluid overload bla bla bla..