My worst Oncall during Paeds Posting

On 10th January 2010..what a nice date for this year..

my 1st oncall at general paeds ward during weekend...previously, i only got my calls during weekedays..and weekend during my nursery rotation..

Quite nervous actually since that morning..Being nervous is not a good sign for me..

As i will always think of whether that day will got many admission and severe cases will come..

Yes..that's right..

just two hours oncall..around 9am, already got 2 new cases..

hahaha...

until 5pm, already got 6 cases..

until 10pm, total 10 cases..and final case at 3am..

fuuuhhh...the most unstable patient was a case of SEVERE Acute Exacerbation of Bronchial Asthma..

SEVERE AEBA secondary to URTI

This child, 4 years old, was diagnosed to have Bronchial Asthma in July 2009..came in with history of fever and cough for 2 days and noted to have rapid breathing 4 hours prior to admission..from my assessment, the asthma control is very poor..u know why??she used inappropriate aerochamber..device that help to delivered the inhaled medication.

that's why her father claimed almost every night she will get cough..

On examination, she appeared lethargic, tachypneic with respiratory rate of 50/min..with subcostal recession

the chest got very tight air entry..scary enough..

i give her 2x nebulized Salbutamol and Atrovent..with Face Mask oxygen 5l/min..and also Iv Hydrocort stat..

improved..but recur around midnight time..at that time, i did informed my MO as he told me not to aggressive...cam u imagine how can i sleep well that night..

fuuuuhhhh..actually now i know how to manage bronchial asthma patient..

in the morning, i reviewed the chect X-ray..got perihilar haziness of bilateral lung..i wish to take the picture of the X-ray later on..

just to share..

however, since evening, i already said to my mind and already imagine that no admission plz after 12..just one..and i just requested to staff nurse to inform my buddy (who already went to sleep at 12MN) while i'm setting up IV line for another special child.

apa yang penting, kerjasama...

I'm Not JONA k.. maybe the combination is not good...hahaha..that's whay my colleagues said..

no lah..at least i learn a lot during my oncall..and refresh back the management..as previously i was in Nursery..

Thanks a lot