For HO, we have a logbook that contains quite a list of procedures which we have to observe or perform before completing each posting. For paediatrics, one of them is ET (exchange transfusion). Sadly, I had never done it!
Last Sunday, I thought it was my lucky day because one of my patient had very jaundice. He was on his day 6 of life and presented with jaundice, according to his mother, he is feeding well and doesn't show any signs of sepsis. So we started him on triple photo and took another level of serum bilirubin... it was as high as 399.5 umol/L! So we ran bolus over 1 hour and took another serum bilirubin level after 2 hours... it went higher, 412 umol/L!!! So I got the consent from the mother and explained to her about the needs of doing an ET. She agreed and signed the consent form. Prior to that, we already took some blood for crossmatching so that when we plan to proceed with ET, the blood will be ready. Anyway, my MO inserted the UVC (umbilical vein catheter) as the exhange of blood will be done via the UVC. I couldn't do it because his umbilicus were already dried up, he was 6 days old already. So, after the UVC was inserted, we checked his latest serum bilirubin, and it went down to 325 umol/L! My MO called the specialist on call and he said that we don't need to proceed with the ET. How sad for me... because I was already excited about it. I even had a plan in mind of what time it will finish and when I will go to pray Subuh.. hihi.
So the next day, I spoke to my specialist about me not being able to do ET yet and I am almost done with paeds, and she said that it's ok because what's most important is that the baby is getting well... and I thought to myself, yes, that should be the main aim when treating a patient, which is to make sure that the patient is ok and if possible, avoid any risky procedures. It's actually my third time when I planned for ET but the bilirubin decreased, so it wasn't done... someone actually told me, it's because I bring good luck that's why my patient didn't have to do ET... I'd like to believe that! :D
2 comments:
aik, dah nak habis posting paeds dah ? waaah cepatnya masa berlalu..
kak niah, kiranya ET tu procedure yg risky la ye ? hurm...
hi rem. it's not a dangerous procedure, but there are risks when you exchange blood, risk of immediate reaction, infection etc. yeap, i have 3 more weeks in paeds, sedih dah rasa.
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