A Sad Day for Me..part of it..

Hari ni saya post call..oncall hari ahad memang memenatkan..kes tak banyak pun tapi ward work yang banyak..ambik darah, set IV line, review patient, assist tu dan ini..

Jadi, bila pagi, mata memang agak mengantuk la..dapat tidur pun tapi yang tak berkualiti..sejuk menggigil..air cond kuat sangat..

lagi pun kes yang terakhir masuk dalam kul 4.00 pagi..clerking..then terus ambik darah untuk pagi tu plak..

Apa yang menyedihkan, my patient yang Treacher Collin Syndrome dah takder pagi ni..

# contoh baby Treacher Collin Syndrome..
(THIS ONE IS NOT THE EXACT BABY I WILL STORY)
Sedih sangat..

This baby already 65 days of life today..

Diagnosed to have Treacher Collin Syndrome with Resolved Aspiration Pneumonia and 3x Acute Life Threatening Event which is Asystole..2 times need Adrenaline..latest episodes was about one month ago..

Last night during my oncall..after night review..i feel like i wanna go and play and joke with him..as usual..

i call his name, i touches his head..his cheek, his chin and also his back..

he looks at me and his eyes follow me..extraocular muscle intact..

i can se that he's smiling to me..

what a wonderful feeling to have such bond with him..

so do the staff nurse who always feed him, give good nursing care to him..

at that time, the oxygen saturation is 100%..good..

until my MO called me to help her..so, i said to the boy "till we meet again"..

until 5am..he was feed via Ryles tube..

Staff nurse informed me around 5.45 that the baby had desaturated as low as 40% post feeding..the baby can't tolerate feeding and regurged a large amount of milk..milkcurd..

the milk came out from his nose n mouth..

they do suction n revealed milk curd...from the previous feeding around 2am..

MO attended the patient and was put under headbox oxygen 5L/min with the baby in left lateral position..

i attend him around 6.30am..he looks cyanosed..letahrgy looking..not like as normally he looks..

i know the baby won't survive..and also wooried if the ATLE will recur..

at that time the saturation around 80-95%..

around 7am..at this tme, i was sleeping for 10 mins..my colleagues told me that this baby desaturated again..he was given Positive Pressure Ventilation for about 20 minutes..

he's apneic..

luckily he can maintained the saturation at 70%..still bad..

during morning round with the specialist, i informed him what already happen that morning..so, this specialist proceeds with the examination..turn him into supine position..

and then put him bank in prone position..i put him back on Headbox..

STILL..NOT THE EXACT BABY..JUST A SAMPLE PIC

then, all of us noted that the baby became apnei..the chest not moved..the baby cyanosed, his limbs were hypotonia..
then, we start with the chest compression and ambu bagging..
around 20 minutes too..

however, around 11.30am..again..he became asystole and apneic..my frenzs do the chest compression..up to 7 doses of adrenaline adminitered..nothing..until around 1pm..he's gone.

during this time, i had exam for neonatal resuscitation porgrammed..until i finished my exam around 1.30pm, then i know this boy already RIP..

i can't hold my tears..went to pantry, meet the staff nurse..told her what already happen.
she's shocked with the news..
almost all the staff nurse will miss him so much..

Previously, this baby always crying during feeding time..and his cries will be the loudest among all the baby..
and we used to call his name everytime to calm him down..
Nurse in prone position to prevent the tongue pushed backwards and obstructed the airway.


This baby also got cleft palate, which makes the feeding..bottle or breasfed difficult..with the risk of aspiration very high..
His chest always got sternal recession..like AP diameter is very small everytime he breathe in..
The face..yes..typical Treacher Collin Syndrome..
he got down slanting lateral part of the eye, coloboma, no eyelashes at the lower lids, hypoplasia of mandibular..and blind pits between the tragus and mandible (this one i noticed last week)..also, the ears is malformed, other features..hmmm..dunno how to describe..
Mainly, this baby got problems with the respiratory tract..

Now, he's gone..and hope Allah's blessed with him..

Al-Fatihah..

SORRY FOR THE SPELLING ERROR AS I TYPED THIS BLOG IN THE DARK..my Roomate already fall asleep.for not disturbing her nice sleep, i just decide not to switch on the light..