Hidup mulia

Hi everyone .. last night was my second night posted in emergency department… As usuall working in the emergency department you’ll see various kinds of cases.. MOst of the cases I saw so far were asthmatic patient came in for nebulizer….
I started working at 7.45 pm after having dinner with the boys and maghrib.. As i enter the red zone there was an old man complaint of vomiting feacal matter .. wow can you imagine .. Dr. Ben was there at that time reviewing the patient abdominal plain radiograph .. Yup ,,, there was intestinal obstruction but I was unsure of the diagnosis .. I’ll just came in so i don’t want to bother anyone .. After a whlie the siren rang twice which mean another patient will be brough in the red zone ( one rang means patient will be brough in to the yellow zone) .. I was thinking of middle age man with multiple fracture and bleeding all over his body … Instead there were a chinese couple with thier son .. Generally the Loh (the boy) looks weak .. Otherwise he is perfectly fine to me .. As usuall we examine the boy and asses his blood pressure, monitor his heart rate and oxygen saturation .. While the medical assistant prepared the patient, I took the opportunity to glance trough the Loh’s health recod .. He came in complaint of palpitation about one hour ago together with chest pain .. At that moment I was a bit shock actually but as Mr. paul said .. “No matter how wierd things may be seen, remain calm and organize your thoughs .. you are the doctor in charge of this patient” .. The first thing comes to my mind was how can such a young child suffer symptoms suggestive of a heart failure ..
The pulse rate of this child was more then 200 beat per minute (nomally 80-110 bpm) and the ecg showed absent P wave which indicate this child had a paroxysmal supraventricular tachycardia .. It just means that his heart suddenly pump very fast .. We need to reduce his heart rate as it may cause myocardial infarct and arrthymia or basicly leads to heart failure ..
There are a few way to reduce heart rate .. The first thing we did was massage his carotid sinus .. for those of you who watch grey anatomy, there was an episode where grey mother was admitted and she suddenly had tachycardia and Dr Yeng was there massaging her carotid, well thats what we did .. Secondly we brake an ice cube and put it in the cloth and applied it to the patient for head and face … LAstly a valsalva maneuver( we didn’t do this) it is done by asking the patient to blow in his mouth and close his nose… The method was so effective that Loh heart rate drop from 200 to to 90 which is the recomended pulse .. For a moment there we were releived .. However.. It doesn’t last long, a few minutes later, his pulse rate raised again .. we had no choice but to admit Loh .. A portable ecg moniter was attached to him and he was send to the peads ward..
In the ward, the Loh’s heart rate rises to more then 200 again .. This time ice pack and carotid sinus massage was not as effective as before.. My right hand was holding the ice pack on his forehead and my right hand was massaging his carotid .. Dr. Ka Kan was attempting to insert a cannula to the child and the specialist was looking at the ecg moniter thinking and planning i guess..
This time we need the second approach.. which is medical treatment.. IV adenosin was given intravenously .. I was unsure of the dosage but the first dose was not effective enough eventhough the pulse rate decreses .. HOwever after some time and lots of adenosin infused.. finally the pulse rate settle at 111 beat perminute ..
The time was 8.30 pm and I went back to the emergency department and continue my work there ..
This morning I went to see the Loh in the ward .. He look a lot better then last night, jumping up and down the his bed .. His pulse rate has come down to 80 beat per minutes..
The plan for him was if pulse rate rises again, oral propanolol 10 mg 8hrly and amiodarone 25mg/kg/min for 4 hrs ..
If he develop SVT again and again after he was discharge then we had to place a pacemaker to fixed his heart rate ..