April 9, 2019

"COD is no longer 'cash on delivery' when I become a houseman...
May Allah bless and grant you Jannah, ameen."
- Hanis, 5th April 2019

Basically, death is not uncommon in Surgical department as well. 

Most of them are patients with advanced cancer that already metastasis to vital organs especially lungs. Not to forget, victims of MVA (motor vehicle accident) with ICB (intracranial bleeding) - bleeding in brain. I witnessed a lot of cases in which we ended up issuing Death-In-Line (DIL) and Do-No-Resuscitate (DNR) after discussing with the family members regarding poor prognosis or deterioration of patients.

To those who are clueless what is actually COD in medical line - it is a short form of cause of death. It is not easy to come out with diagnosis for a living patient and to be honest, it is even difficult to come out with cause of death as well. Superiors always remind us, be careful with what we are dealing with, document everything we have done and do everything that we have documented. 

There are few criteria before we can pronounce the death of patient.
  • check the vital signs - usually heart rate, blood pressure, SpO2 will be unrecordable - means cannot be detected anymore
  • check the glucometer (level of glucose in blood) - if too low, can be the cause of death as well
  • check the pupils - usually fixed, dilated
  • check lungs and heart sound - none... a bit tricky with patient supported with ventilator and we can still see lung expanding with transmitted sound on stethoscope 
  • check cardiac monitor - usually it will show a straight line (asystole) - print it out.

Usually if CPR is commenced to save patients life, it is only be done for up to 30 minutes. After prolonged shortage of oxygen, most of organs will slowly shutting down, especially brain. It is uncommon to go beyond that, taking note of resuscitators conditions as well. Commencing CPR is very tiring, pregnant lady should never do that. 15minutes of CPR = at least 165kcal of energy.

Slowly getting numb to this.
Ya Allah, guide me to Your light, ameen!

SM, Perak, Malaysia

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