Indexing Title: NALUDINOs Medical Anecdotal Report [05-01]
MAR Title: The right decisions
Date of Medical Observation: February 8, 2005
Narration:
It just had to happen on my duty. A young man entered the ER complex, IV bottle in hand and in apparent respiratory distress. Upon closer inspection, we found a 2cm wound on the 3rd ICS, RMCL. The patient was apparently a stabbed by an unknown assailant. He was immediately rushed to the Seamen’s Hospital in Intramuros and was ordered to transfer to OMMC after the wound was packed an IV line was inserted.
At our emergency room, with the patient showing signs respiratory distress, with decreased breath sounds on the right lung field, I decided to insert a chest tube. I instructed the nurses to prepare the needed materials. To my dismay, I found out that we didn’t have the proper chest tube. What was presented to me was a F24 chest tube. I had to decide whether or not we had the luxury to ask the patient to buy a F36 tube or to insert a small caliber chest tube.
Looking at the patient, I decided that I had to act now or I might lose him. I proceeded to insert the chest tube and evacuated 350cc of fresh non-clotted blood. Post CTT CXR revealed complete resolution of the pneumohemothorax. Patient was admitted and discharged on the 5th hospital day, without any complications.
Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements):
Looking back at my experience, I could not fathom why the patient had to be transferred to our institution, in his condition. It is our duty as physicians to make sure that a patient be given the best quality of care. If I was the first physician to see this patient, I would have taken a different course of action. I would have inserted a chest tube and made sure that the patient was stable prior to transfer. Maybe they had other reasons why they let the patient go.
Although I completely evacuated the hemothorax of the patient, part of me tells me that I was just lucky. I was lucky that the patient did not develop a retained hemothorax. Lucky that I was able to relieve the patient of his respiratory distress.