My today Diary - Such a quality 24 Shift in this maternity hospital !

[DrAmir0078]

Hi SDN Anesthesiologists,
Brining to you my last 24 hrs unique cases (never happened before and that is why writing it - I was thinking of full moon myth, but apparently it is waxing crescent lol) in this district semi urban maternity hospital south east of Iraq, and I am still in the OR, just finished my last C-Section.

Yesterday morning at 0730 AM, we started with
2 cases (1 and 2) with one Primi failure to progress and the other previous 2 scars. Both were GA for C-Section and one had male baby at 0815 am and other female at 0835 am (these were post call cases - of Tuesday)

Then started new day :
Case #3- Ectopic pregnancy case - ovarian ectopic, 2 miss periods.
GA done... OK and no blood transfusion needed

Cases #4 and #5 (stich sinus removal and wart removal - mute patient)

Case #6- C-section done for Previous 3 scars under spinal anesthesia for her C-Section - moderate bronchitis. (male baby at 1220 pm)

Well... went for rest around 0130 pm

Got a nice sleep to start my night shift that I always run it with one anesthesia tech assistant !!!

At 0830 pm got a call for case #7 - from the labor ward with episiotomy uncontrolled bleeding.
GA given, 1 unit blood and 2 FFP - almost 2 hours operation time!

Had some rest like an hour, then got a call for a previous 2 scars with contraction - case #8, but the patient with 3 days rash eruption of chickenpox all over the body including her back, that I was concerned to give spinal anesthesia, but dared to give GA under cautions for the C-Section (male baby at 1220 am), and the most unfortunate that she had ruptured uterus, required blood transfusion and a general surgeon call, everything then OK and we were almost happy for the end; I was so upset about chickenpox and the way we deal with infection control !

I went to rest at 0230 am and got a call for another 2 patients

Case #8 with obstructed labor and required immediate delivery for deceleration and fetal bradycardia - the boy needed some resuscitation (caput presentation) after the C-Section under general anesthesia (male baby at 0400 am), even mother had cervical internal tear required repair too.

Case #9, an emergency patient with G6PD deficiency, her Hb was 6.7 and required blood transfusion of 1 unit on the table while finishing case #8, and C-Section then done under GA (male baby - 0445 am) , I got some delay recovery and advised for another unit of blood transfusion.

I then went to sleep at 0600 am and the same OB Attending called me about obstructed labor case - #10 and done under GA (male baby 0835 am).

Then we are now Thursday (full staff), and I gave 5 different cases out of 8 (called my colleague to relieve me, because I have an exam for special course CME credits for salary bonuses enhancement).

5 cases = 2 C-Sections - one Spinal (Hypertensive), and the other GA - (one female baby 0910 am and other male baby at 1200 pm); 1 D&C, 2 cerclage.

Not to mention 8 cases on Tuesday itself (8 C-Section and one of them Intrauterine death unfortunately) - 6 males and 2 female babies.

Still have the whole Thursday, now is 0115 pm.


27 cases till now...


I am tired...

Cheers and Peace from where I am !

Amir

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[Sriddymopboi]

Why so much GA? Where are the epidurals?

 

[DrAmir0078]

Why so much GA? Where are the epidurals?

It is what it is over here in this city, most of the women are preoccupied with bad thoughts against spinals unless she is very sick with respiratory tract infection and allergies, then she would be convinced, otherwise no and they refuse it with crying, and I am overwhelmed with all my tries to convince them.
No epidural kits unfortunately and I am almost forgot how to do it. In the residency, I had done like 7 to 10 times I believe.

 

[coffeebythelake]

What specialized airway tools do you have? Video laeyngoscopes?

 

[gunnershow]

It is what it is over here in this city, most of the women are preoccupied with bad thoughts against spinals unless she is very sick with respiratory tract infection and allergies, then she would be convinced, otherwise no and they refuse it with crying, and I am overwhelmed with all my tries to convince them.
No epidural kits unfortunately and I am almost forgot how to do it. In the residency, I had done like 7 to 10 times I believe.

Even if you tell them it's safer for mom and baby? And that GA, while safe, turns a controlled situation into an uncontrolled, time-sensitive event?

I'm no academic anesthesiologist who thinks GA section means the end of the world, but it's still something I try to avoid.

 

[MirrorTodd]

Lol and people in the US are freaked out by doing GETA sections.

 

[Greenbayslacker]

It's posts like these that make me so grateful to be practicing in the USA. Even with all our problems, it's really not that bad. Even if we lost half our tools and meds we would still be better off than a lot of the world.

@DrAmir0078 thank you for your hard work in this clearly limited resource setting, and for putting up with criticisms.

 

[coffeebythelake]

Lol and people in the US are freaked out by doing GETA sections.

With airway tools such as video laryngoscopy, the risk is only slightly higher with GA. But I think most women want to be awake for the birth of their child. I don't know if there are cultural differ3nces with that in Iraq. Or maybe they are so preoccupied with irrational fears of spinal and epidurals

 

[DrAmir0078]

What specialized airway tools do you have? Video laeyngoscopes?

You got me in this, lol
Last Tuesday, I got a videolaryngoscope (it wasn't hospital supply, but it was a gift by the company who supplied us with GE ventilator, it was in the warehouse for a year and the latter department asked us to get it, otherwise will be transfered to another facility).
I was trying to film it for you guys (I used it in my last 3 days shifts - cool gadget) as an achievement we got; and between us, it is a secret, two weeks ago we got Sonosite Edge 2 Ultrasound. So, Do you think me myself (asking myself) are we still limited resources ? Of course Yes and we will continue!

 

[DrAmir0078]

Even if you tell them it's safer for mom and baby? And that GA, while safe, turns a controlled situation into an uncontrolled, time-sensitive event?

I'm no academic anesthesiologist who thinks GA section means the end of the world, but it's still something I try to avoid.

Trying my best convincing methods, but some work some ended up losing my temper.
My other friend, he immediately turns them without asking them and do it. I myself can't!

 

[DrAmir0078]

Lol and people in the US are freaked out by doing GETA sections.

Well, some provinces here, even in the south of Iraq - more semi rural side; doctors got united about spinals and one friend told me he forgot GA!
This area I am in, the women are totally from another galaxy! lol

 

[DrAmir0078]

With airway tools such as video laryngoscopy, the risk is only slightly higher with GA. But I think most women want to be awake for the birth of their child. I don't know if there are cultural differ3nces with that in Iraq. Or maybe they are so preoccupied with irrational fears of spinal and epidurals

I have learned from here if you remember before I started in this hospital - I had a post thread about what are the tips about OBs,,, Etc - you opened the horizon of that airway troubles are not as bad as others... Etc


Certainly they got fears here about spinals and epidural - they simply all mention about bad for back and will make them crippled paralyzed, and I ask them if you know someone got paralysis, they said NO. You know women like to gossip and talk.

 

[DrAmir0078]

It's posts like these that make me so grateful to be practicing in the USA. Even with all our problems, it's really not that bad. Even if we lost half our tools and meds we would still be better off than a lot of the world.

@DrAmir0078 thank you for your hard work in this clearly limited resource setting, and for putting up with criticisms.

I am very thankful over here, and thank you all for allowing me to share with you my world.

 

[DrAmir0078]

@Greenbayslacker - I am sharing with you my 6 months Stats in this hospital and you can see Spinals vs GA and the total numbers - I only work 3/(24hr) days a week - my apologies if I had shared it before!!

I assure you the next months the rate of spinals are lowered down, it is not because of the patient factor, but seriously I am tired and exhausted of talking to them, I had spoken about it in details here. I had difficulty convincing young age women 15 - 24 years old !