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Hi... I am back.
i didnt have any june post.. no time to update blog :)
Just finished my night duty.
1st ND- 2 bld transfussion, sent down 1 DIL active pt for CT brain
2nd ND - sent down 1 DIL active case down for urgent MRI brain, ended up doin resus there
3rd ND - 3 bld transfussion , 1 admission

I am considered 1 of the "good" luck sn in the ward. get shit most of the time. but from every piece of it, i gained more experience.

Benjamin was on call. sent Mr Tan down for urgent MRI brain as he was deteriorating (getting slurred speech, decreased power movements, drooling out saliva, sweating ++)
he was for active mgt. we brought AED, ETT and 1st line drugs along.
Fiona sent the case down with me, plus Ben.
GCS was 14 , vital sign was stable when we sent down.
before he went into the MRI room, i told him it would ony be awhile, asked him whether he has any chest pain (cos trop I was 6.9) He nodded hi head to acknowledge tt he understood me and claimed no chest pain.

he was on cardiac monitoring throughout. but half way during the scan, the pulse went up and down (lowest 20+ highest 110+) I was not in any peace at all.
I was asking Ben whether pt will have MI goin on without he/she realising it. He said its possible. but for his case, he is recovering from MI (cos trop I did decreased)
suddenly cardiac monitor showed asystole, I jumped, alerted the staff of the reading.
she went in to check, he was still alright.
at least relieved for that minute.
discussing our night before (me n fiona), last time when she was still a student, we had 2 active resus (1 to ICU and 1 coroner)

again the cardiac monitor showed pulse went dow to 20+ then asystole.
the staff went in to check again, from outside I saw the staff shaking the pt. didnt look good.
they pushed out the pt immediately, pt was in pale looking, foam came out from the mouth.
I was really panicked, trying to search for things to start resuscitation.
connected pt to AED, but it was asystole.
for now i really believed that u have to stay cool and calm throughout the whole resus.

"prepare adrenaline", ???? adrenaline, oh, must do drug dilution.
my hand was shaking. 1st time after my 1 yr as a SN doin drug dilution.
thought of calling loderly to come down.
cos I was not familiar with the other drug. but upthere we got at least 4 DIL active pt.
I was hoping that they didnt asked for any drug other than adrenaline and atropine
"atropine 2.4" i draw out 0.6 and handed to the DR. he asked me "how much is this"
I told him "0.6" He then told me to draw full 2.4 together.
CPR started, adrenaline given x9 ampoules (9mls), adrenaline 2.4
they dint transfer the pt to our own bed. so we got very limited space to do CPR
the MO had to climb up the stairs to do CPR.
"prepare ETT" #?#?!?
attempted 2x intubation but failed cos secreation ++++
concluded resus 30 mins later, cos pt heart dint manage to beat back.

the pt turned out to be coroner's case (unknown cause of death, cos MRI shows normal)
photocopied his case notes 4 cm thicked (1 n 1/2 months of stay)
till 6 plus am.
his wife was totally not aware tt his husband alre passed away when she went in to the cubicle to see him. until the dr told her so.

learnt from my lesson tt

1. i have to stay calm throughout resus eventhough u only have 2 sn around.
2. to know all dilution and method of delivering for 1st line drugs
3. must keep recalling how to fixed AED once in awhile. cos during resus, we cant afford to have any delay.
4. bring more saline, cos have to dilute and flushed every drugs interval.
5. have to familiarise myself with e-trolley
6. coroner's case procedure- photocpoy all document, DR to prepare d/c summary, fill up yellow cardx3, notification of police form, tell family tt they cant claimed the body yet, the police will give them a call when to collect. to bring i/c during collection time.
to submit original document to police post b4 6 am so that family can claimed the body on the day itself. police will then call u for the case.

Sis K was not happy that the meds trolley is not up to her standard.
inside pt's each meds drawer, u are not supposed to put any ward stock meds inside (like panadol, ferrous fumarate, cloxacillin, frusemide, maxalon, senna)
i have been putting all tt for 1 yr. only yest, i discovered that we are nt supposed to put tt in.
she was very angry cos am tidy up for 4 hrs, pm she herself tidy up for 1 n 1/2 hr still cant make it perfect. she really upset everyone.
noone is perfect. i still found some things tt are not supposed to be inside even after she tidy up

Jas told me tt i shld post more good things on my blog. lol..

miss assh to the max.