Narration

A 5-year-old female was admitted due to 5 days history of abdominal pain, fever and vomiting. Her WBC count was 25x 10⁹ /L.

                Her abdomen was very tense.

                Our impression was a ruptured appendicitis with generalized peritonitis.

                 I referred her case to our service consultant who mandated for an immediate operation as soon as possible.

                We  gave antibiotics and hydrated the patient. Afterwards we promptly brought the patient to the OR.

                I made a rockey davis incision. Upon entering the peritoneum there was sudden gush of purulent discharge.

                The appendix was somewhat hiding behind the cecum which I managed to ligate and remove. Afterwards, I proceeded to wash the entire abdomen.

When I was about to close my incision the anesthesiologist halt me.

 “ Nagdedesat tayo.” He said.

I saw the monitor it was only 70% O2 saturation. I  gave time to the anesthesiologist to fix the oxygen desaturation.

Before I was able to ask him what went wrong another drop of the O2 sat flash on the monitor.

The anesthesiologist and so do I went on panic.

We checked everything, auscultate, change the ET then auscultate again.

But the O2 sat continued to go down. It went down to  30%. That was the time when somebody paged a code blue.

Then there came the residents from the department of pediatrics. They resuscitated the patient while I made a call to my consultant to inform him what happening.

After the operation, My chief resident asked me what happened. “Honestly sir I don’t know.” I said. I guess it was just a sequelae of an on going sepsis which succumbed the patient to near death.

He asked me if I  monitored the fluids that we gave to the patient. I said “yes”. I gave 300 cc of D5 0.3 nacl when she was at the ER. I auscultated the patient’s chest prior to OR. There were no crackles.

My chief was not convinced with my theory. He wanted a formal audit to discuss  the matter. He was just worried that things may happen again to other patient that is why he wanted me to present the case as a morbidity audit.

 “Prove to me that it was due to sepsis.”

 He told me.

Patient was admitted to pedia ICU, where everything was strictly monitored.

The patient is now completing the 14 days antibiotics regimen given by her pediatrician and now on her way to full recovery.

INSIGHT

n  Physical, Ethical, Psycho-social

n  Discovery, Stimulus, Re-inforcement

                I was able to convince my chief resident. The patient suffered from ARDS.

                 Acute Respiratory Distress Syndrome. It is a sequelae of septicemia.

                This is a government hospital. Where patients from every corner of manila take refuge.

                Here, we practice  the “first come, first serve basis.”

                 We always say..

                “Wala po kami magagawa. Mahaba po ang pila”.

                .. And its true.

                Sometimes we would even talk to the patients.

“maari po pumutok and appendix nyo habang naghihintay.” Again its true.

  We really are doing our best to treat them all. But sometimes things limit us to do it.      

                But I guess not for a pediatric patient.

                We have to really prioritize pediatric patients.

                Our pediatric surgery consultant have always reiterated to us. “Do not fool around with the very young. They surrender very easily.”

                Well I guess this one proved him right.

END