Thursday, September 17, 2009

Life Is A Gamble

G.T., a 24 year old male was referred to me because of fever, rashes and decreased platelet count. His initial platelet was 76. In the management of decreased platelet like in dengue, transfusion of platelet is warranted if the platelet count is 50 or less or if there is a sign of bleeding... epistaxis, gum bleeding, tarry stools... The reason for the delay is that a rising platelet count is the gauge if the patient is already recovering from the disease.

When the patient’s platelet was already 58, the attending physician requested 3 units of platelet concentrate as standby. However the blood was not immediately available. Platelet went down to 50 and I ordered the transfusion at once. But they haven’t secured even a unit.

When we were informed that 3 units are available in another hospital, the latest platelet was already 62. I was faced with a decision whether or not to go on with the transfusion. The next platelet was 63, so I proceeded. A unit of platelet concentrate will increase the count by 10. With 3 units, I expect his platelet to rise by 30 or to 93 starting with 63. But later platelet counts after the transfusion were 67, 74, 78 and 84. This means probably that his count further decreased even after transfusion.

I compare this decision like playing black jack. When your card total is around 18 to 20, you can hit for another card. But there is a chance that you can go over 21. If I had not proceeded with the transfusion, I could have compromised the life of my patient.

Saturday, September 5, 2009

Going Home

I have given the order to discharge patient P.R. (see Stubborn Mother). He has less phlegm and breathing without oxygen. He was very happy to go home. I attended a meeting. After about 3 hours, the resident physician called because P.R. arrested. His heart rate is zero, blood pressure is zero and no breathing. CPR was futile. I considered that he aspirated.

He is now going home. Not to their earthly home but in the home of our Father. Home... where he will be always happy... no physical deformities... no mental deficiencies. He will be forever with our Fathers arms.

Wednesday, September 2, 2009

Stubborn Mother

I admitted P.R. last Sunday, August 30, a 24 year old male with cerebral palsy. He looks like a 7 year old boy with severe malformed body. I diagnosed him to have pneumonia.

They want to stay for 24 hours only.

Aside from the challenge that I have to compute for the medicines to give, his mother refused the antibiotic, antipyretic and ferrous sulphate because he has history of allergy. For a patient who has pneumonia, I’m only giving inhaled bronchodilators.

The mother did not sign the Home Against Medical Advice form. No other medication was given until today, September 2, when his father arrived. Now I am giving the proper management.

Almost 3 days were wasted. If I was able to treat him properly at the start, he could be home by now or tomorrow.