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All in a Day’s Work

9th August.

Rhythm: Sinus tachycardia

Cause: My first-ever resus shift at the Emergency Department (ED)

The morning had barely begun when a frail old lady with a history of abdominal aortic aneurysm was uptriaged for hypotension. Her CT scan showed a large 7-cm aneurysm. While drawing blood samples from her, she suddenly complained of severe abdominal pain and collapsed. My senior and I started CPR immediately.

Rhythm: Pulseless electrical activity

Cause: Hypovolaemic shock from aneurysmal rupture

The vascular surgeon-on-call called for an urgent laparotomy and we quickly initiated the massive transfusion protocol. Much like a scene in a medical drama, I crouched on the trolley and performed CPR until the surgical team took over in the OT. What a start to a first resus shift for an ED rookie!

Just as I returned from the OT, an elderly Chinese gentleman arrived in resus. He had collapsed at home. The LUCAS device was strapped over his chest and actively delivering CPR.

Rhythm: Asystole

Downtime: 40 minutes

Cause: Unknown

Despite several rounds of adrenaline, it was still a flat line. Eventually, my senior decided to call off the resuscitation.

It was my first time breaking the news of a death in the ED. It felt so much harder to broach the topic this time as compared to the deaths I had signed up in the wards. Perhaps it is because we forewarn the families of dangerously ill patients. As it turns out, my apprehension was unwarranted as my senior took the lead and invited the family to the discussion room.

“What happened this morning?”

“My father returned from his usual jog this morning. We called him for breakfast 20 minutes later but he didn’t respond. We found him in his room, unconscious. We did everything we could! My brother started CPR and I called the ambulance. Did you manage to save him?”

“I’m sorry. We did our best. He was already unresponsive for at least 40 minutes when he arrived. He did not respond to our resuscitation and has passed away.”

The room went silent. Then, emotions started flowing. The family, who were initially paralysed by shock, started to deny that this had actually happened. “How could this be? He was still fine after exercising this morning.” We did not insist we understood what they were going through. Cure sometimes, treat often, comfort always; said Hippocrates. We sat in silence and offered our deepest condolences before we were called away for our next standby.
After a long day spent managing the rest of the shift in various states of arrhythmia, with cases of acute pulmonary oedema and road traffic accidents, amongst others, I managed to reach home before the National Day Parade ended. The 8-minute long fireworks display was magnificent. Watching it on TV, I was reminded of how my country was born out of sheer grit, which makes our achievements as a nation more victorious. Similarly, I also marked 9th August as a Singaporean who experienced both triumph and sorrow, albeit in one average day in the ED.

Happy National Day, everyone.