Friday, July 07, 2006

Triage Tales 19

Disclaimer: The following story is a work of fiction. All similarities to people, places, things and events are coincidental by nature.

A 33 year old male, badly burnt on his torso and upper and lower extremities, is found by concerned citizens near an electric post. He is brought to the nearest hospital and social workers are able to locate his relatives. The hospital begs off from treating the patient. Using the excuse "we are unable to treat this patient," the hospital sends off the patient in an ambulance WITHOUT calling the receiving hospital.

(Which is very typical of smaller hospitals in Metro Manila and its surrounding provinces - especially if the patient is indigent.)

Patient arrives at the Triage and is hypotensive and gasping. No one seems to know what happened, and the patient can only respond to yes-no questions. Naturally, the ER accepts the patient inspite of the fact that it was an uncoordinated referral.

The secondary survey reveals 30% TBSA (torso, both upper arms, L inner thigh) full thickness burns, no clear electrical entrance or exit; 0/5 on all extremities.

XRays are normal (no trauma), CT is equivocal, and the last resort is an MRI of the cervical spine which will take at least two weeks on emergency basis.

Patient's quality of life = ???

And to top it all off, patient will not be admitted immediately at the Burn Unit. Why? Because, as with most charity and special/critical units of this hospital, the unit is full.

What is frustrating in this case is the inability of fellow doctors to at least coordinate their transfers. Just because your patient is indigent does not mean they do not deserve to be referred doctor-to-doctor.

There is another case of a 43 year old male, vehicular crash victim. Came in coded, with signs of lividity and fixed dilated pupils. Resuscitation done and was ultimately futile.

Referral note said that patient was GCS 3, with BP of 70/40 and hematemesis. No medical personnel accompanied the patient. That doctor must have big balls to send out a very unstable patient.

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