There is always a myth in our medical fraternity that when you see a complicated or interesting case, 2 similar cases will come knocking on your ER/clinic door soon after. I do not buy it. But I saw 3 cardiac cases of different severity just last week. Good cases come in three - Myth or truth?
It all started off with a school going girl coming in for some dyspnoea and chest pain. My ER colleague thought she looked pale and suggested to order an ECG to look for anaemia-induced strained pattern of the ECG like adults. Coincidentally I was reading the ECG chapter for my exams. So why not.
Though not commonly diagnosed with ECG, but I had the gut feeling that the ECG shows pericardial effusion with variable voltages. They called it electrical alternans where the R waves shows different heights within the same leads recording. True enough CXR showed a huge globular heart and pericardial effusion was confirmed with our ECHO.
Symptomatic pericardial effusion, there is not much choice in Kapit. Send out of Kapit or tap in Kapit. With permission from our paediatrics cardiologist, patient was wheeled into OT on the same day for a diagnostic pericardiocentesis under GA.
Being a first timer for this procedure, I held my breath from the insertion of the needle to the placement of the catheter with Saldinger method . It was a success. Patient was so much better the day after. But we still do not know what causes the pericardial effusion. Glad to have such opportunity to tap a heart before I leave Kapit.
While seeing the girl with pericardial effusion, out second case came the same afternoon from Poly Clinic, with an incidental finding of a likely heart block for paediatrics input. A school going girl planned for dental extraction noted to have irregular pulses but otherwise stable. Fortunately our cardiologist was due coming for visiting cardiac clinic 3 days later, so we gave an appointment to see again during cardiac clinic.
With all the rights of freedom of speech, my paediatrician declared, "So there will be a third case coming soon, probably during my absence when Nickson is alone"
This is another myth that we believe - DO NOT jinx yourself by inviting completed cases because they will actually come. I don't buy that either. But the 3rd cardio-pulmonary case came 2 days after my paediatrician left for a meeting. T_T
It was the most complicated case that I have ever managed. It was a newborn with birth asphyxia complicated with persistent pulmonary hypertension of newborn. Unfortunately we lost the baby at day 3-4 of life. Wasn't a good experience but I learned a lot throughout the whole process. Thank God for Angel who understood and supported me all along. Told her I had never felt that stressful in my life before which was true.
Thank God everything is over. Had a nice weekend spending time with Angel and Ethan in KL. Nothing comforts me more than home after a long and stressful week.
So cases come in three?
It all started off with a school going girl coming in for some dyspnoea and chest pain. My ER colleague thought she looked pale and suggested to order an ECG to look for anaemia-induced strained pattern of the ECG like adults. Coincidentally I was reading the ECG chapter for my exams. So why not.
Though not commonly diagnosed with ECG, but I had the gut feeling that the ECG shows pericardial effusion with variable voltages. They called it electrical alternans where the R waves shows different heights within the same leads recording. True enough CXR showed a huge globular heart and pericardial effusion was confirmed with our ECHO.
Symptomatic pericardial effusion, there is not much choice in Kapit. Send out of Kapit or tap in Kapit. With permission from our paediatrics cardiologist, patient was wheeled into OT on the same day for a diagnostic pericardiocentesis under GA.
Being a first timer for this procedure, I held my breath from the insertion of the needle to the placement of the catheter with Saldinger method . It was a success. Patient was so much better the day after. But we still do not know what causes the pericardial effusion. Glad to have such opportunity to tap a heart before I leave Kapit.
While seeing the girl with pericardial effusion, out second case came the same afternoon from Poly Clinic, with an incidental finding of a likely heart block for paediatrics input. A school going girl planned for dental extraction noted to have irregular pulses but otherwise stable. Fortunately our cardiologist was due coming for visiting cardiac clinic 3 days later, so we gave an appointment to see again during cardiac clinic.
With all the rights of freedom of speech, my paediatrician declared, "So there will be a third case coming soon, probably during my absence when Nickson is alone"
This is another myth that we believe - DO NOT jinx yourself by inviting completed cases because they will actually come. I don't buy that either. But the 3rd cardio-pulmonary case came 2 days after my paediatrician left for a meeting. T_T
It was the most complicated case that I have ever managed. It was a newborn with birth asphyxia complicated with persistent pulmonary hypertension of newborn. Unfortunately we lost the baby at day 3-4 of life. Wasn't a good experience but I learned a lot throughout the whole process. Thank God for Angel who understood and supported me all along. Told her I had never felt that stressful in my life before which was true.
Thank God everything is over. Had a nice weekend spending time with Angel and Ethan in KL. Nothing comforts me more than home after a long and stressful week.
So cases come in three?
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