Post call today.
At 1am last night, never been more frustrated. Ever.
A lady was sent in for C-Section because of hypertensive crisis at term and with 1 previous scar and suspicious CTG. I say it is suspicious because personally i think it was reactive. But then the intravenous antihypertensives was given without reservation just to get the blood pressures low enough for her to be 'stable for op'. stability can be pretty subjective, especially if you're at my hospy. Always running out of 'high risk consent' form.
At some point, the mother's diastolic dipped down to 60. And once blade to the uterus, muddy greenish meconium pooring out. Paediatric colleague was alarmed. She was at the other end of the hospital. I shouted 'thick meconium' and reminded the recipient nurse to prepare meconium aspirator. Both of her hands only with towel, giving me the blind look.
Once baby was out, not much of breathing effort. I quickly delivered the placenta and clamped the bleeders. Attempted to do direct suction.
"Switch on the light,please"
"Err... Dunno which is the switch."
"Give me the meconium aspirator..."
"I'll go get it"
"WHat?!?!? ETT and laryngoscope?"
"Getting it... " (went to other OT)
Before baby taking deeper breath, all was left was vigorous oral nasal suction and supplementary oxygen. Suction revealed thick meconium.
Couldn't wait any longer, re-scrubbed quickly and sutured up. 200cc blood loss.
Last seen, baby breathed rapidly, attended by my Paed colleagues and admitted neonatal ICU for observation.
Professional nurse with maternity post basic couldn't even make sure the warmer/baby's resuscitation trolley is fully equipped.
That's simply lame. Lame. Lame. Pathetic. Appalling.
Might as well keep the manicure set above in the warmer.
Maybe it is just that 1 person.
Maybe. Just maybe. Should have send her away on the bus below.
3 comments:
frustration is the mother of all f##k ups.. so be calm...
:) Again, I have to say the system is to be blamed.
In the first world country that i have worked in. Any emergency CSec/instrumental delivery is attended by a paeds MO/Reg. There is also a midwife/neonatal nurse attending just for the baby's need.
The resuscitation trolley is checked by a neonatal nurse once every shift. Restock after every use. And the paeds MO/Reg check the equipment before any delivery that we are called to.
Obviously, this cannot be done in a under resource system. Unfortunately, under resource means under perform. Under perform may means little to the hosp management, but can be life and death for the little baby...
the resource abundant here probably is apathy.
system is a problem.
but human determined the system.
i attended a perinatal mortality meeting before, and the paed consultant which spoke that day kept ringing in my mind whenever sh*ts happens.
"we're holding meetings after meetings, the pattern of mistakes are always more of less the same, but it kept recurring over and over again."
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