Real case. Eventually..

Jaga malam kemaren dapet 3 pasien. Dua diantaranya emergency yang butuh penanganan dan berpikir cepet. Mungkin karena udah terbiasa dapet pasien gak penting kaya salah satu pasien tadi malem yang dateng karena keluhan insomnia (intinya sih dia minta obat tidur), jadi otakku bener2 lambat untuk berpikir cepet nanganin pasien emergency.

Pasien pertama laki2, 8 th, diagnosa flame burn grade 2b derajat 34%. First thought crossed my mind was fluid resuscitation. Since pasien luka bakar sangat besar kemungkinan nya dehidrasi kan, aku minta perawat masukin RL aja dulu sambil mikir what's next? Berapa banyak cairan yang harus dikasih? How to deal with the injury in addition i'd got a pediatric patient here. Surprisingly the patient didn't cry. He just absentmindedly looking at what he had done. All i could think about to decrease the pain and keep thinking what's next. Somehow, everything I'd studied in school and coass obviously gone by the wind without a trace behind back.

The situation urged me to open book and admitted me as a total failure of doctor :| i was worried about the amount of fluid resuscitation, the complication and so on. There i found the initial fluid therapy to be given is 4 ml/kgBW multiple to the degree of the burn. For the first 8 hours, you should've been giving a half of total fluid that had calculated before. For the injury I was about recommending burnazide or mebo zalf to decrease the pain and relieving reason. Yet, since the drugstore of the hospital has nothing of them, I just could give him a wet lint along as hoping it'd be enough for him till tomorrow, until the family enabled to bought at the outside drugstore.

Alat, obat, dan otak yang terbatas bener2 buat nasib si adik ini jadi sial maksimal. Jadi pasien ku ini awalnya mau ngidupin lampu minyak. Somehow, minyaknya tumpah dan bakar semua kaki, bokong dan tangan kiri nya. As his doctor, i felt so useless and disappointed. Luckily the hospital has a 24 hour-pediatrician. So she took over handling the patient in ward.

Pasien selanjutnya wanita primigravida yang sedang inpartu dan sudah pecah ketuban sejak seminggu yang lalu. Karena tinggal di pelosok yang jauh dari peradaban, pasien baru bisa nyampe rumah sakit sekarang. My first action? Sent her to delivery room. There i tried to identified if the fetus still alive by doppler. DJJ (denyut jantung janin) terdengar sekitar 150an. Stupid me of not having a watch so i couldn't count the DJJ. Another misfortune patient of having me as her doctor :(

Then went another disaster, pasien gak bisa bahasa Indonesia dan bahasa Batak. Taunya cuma bahasa Nias which no one here known but his husband. Jadi untuk nanya2 pasien harus nyuruh suaminya yang translate. Pfft. Setelah ditensi pasien ternyata hipertensi emergensi 200/130 mmHg. Aku masukin nifedipine digerus sublingual. Then, blank...

Huaaahhhh... What a super pathetic doctor I am!!! I cursed myself to the most stupid and lazy and useless doctor ever. The most right thing I did last night was calling the 24 hour-obstetrician ASAP :|

Sp.OG nya langsung nyuruh aku pasang kateter untuk cek proteinuria karena krisis hipertensi nya. Damn stupid me, how could PEB (Preeklampsia Berat) didn't crossed my mind?! Trus dia suruh aku cor RL karena pasien mulai ngantuk dan ditakutkan syok. Haaahhh... Menilai kesadaran pun aku gak kepikiran :/

Infus udah di cor, urine udah aku ambil trus aku bakar. Dan bener aja proteinuria +4, Kejang (-). Sp.OG nya langsung nyuruh aku persiapan operasi SC cito untuk terminasi kehamilan dan pemberian MgSO4 bolus 15 cc. Trus 30 cc Mg SO4 dimasukkan ke 500 cc RL di drips 14 tetes per menit. Believe me, waktu koass aku sangat hapal semua prosedur di atas. Sampe kalo aku lagi tidur trus tiba2 dibangunin ditanya penatalaksanaan PEB, aku bisa jawab di luar kepala tanpa harus mikir. Dan sekarang? Semuanya hilang like I just heard them for the damn first time.

I'm so grateful by having an emergency case just not as usual. Every patient who admitted to ER is a learning for me and reminder to study more as well. And another moral of the story: where on earth you can find doctor who's not have a watch?! So, nenok!!! Get your stupid watch back and change the battery AND quit being a lazy!!!