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Friday, January 12, 2007

New Unit New Issues

Hello hello.
I am back and I wish I could say new and improved but lets just stick with new for now.
I was transferred to another unit as a temporary measure since they have a shortage there.

Emerg yesterday got this intresting case to us in the morning around 11 with a moderate head injury, he was unconscious, with haemothorax (blood in his chest) and ? Haemoperitoneum (blood in his abdomen) on USG.

Now our USG dept failed to mention which organ they thought was bleeding with the result that there was major confusion regarding whether we should open up this patient or not. He seemed to be haemodynamically stable so we decided to conserve him but we had to do a CT for his head to refer him to neurosurgery.
Dr. Cellular (my junior colleague) calls me and tells me that I have to take the patient for a CT and transfer. I plainly refused saying that he was out of his mind if he thought that I would take a transfer of a patient after completing 4 posts against his 1...After all I am the senior resident.

Anyway the transfer didn't happen in the morning because we tapped his abdomen and got blood to confirm the USG and then it was a matter of stabilising his pulse and BP so that he could live and probably open him up in case he did not improve.
At this point let me add that the lecturer in this unit didn't really help by asking for a CT Abdomen. This pt was an unknown and to get money for the CT abdomen would be really difficult. The evening passed with minor ot which will be another blog after this but at night I was instructed to write to the administration for the money while there was another patient being operated for a stab wound in the abdomen to check if he too was bleeding inside ( I tell you its hectic doing emergencies but ppl refuse to believe)

Anyway that pt was fine and we closed him up and got the news that I was called by the AMO (Administration) for the sweet note I had put down on paper regarding the CT

He quite blew it and couldn't think of how to respond since our poor box fund is just that POOR
There was no money in it for the unknown pt and he couldn't admit that cause this was a medicolegal case and if anything happened to the pt it would be the admin's fault for not doing a CT.
He advised us to transfer the pt to Maike (Larger Hosp) and we told him that when we tried calling them they refused to take the pt if the abdomen was not looked into. He called the head of our unit and asked him what to do and was promptly told to make arrangements for the transfer as he could not be managed here.
So the AMO calls Maike and gets the royal boot from the CMO Amo and TR (Trauma Reg) and finally manages to con them into accepting the patient which my colleague had to take at 1.30 in the morning.

Moral of the story - Don't ever go to a municipal hospital if you have a choice!

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