This has been the most frequent word that comes into my mind recently.Been in medical "chronic" ward but all problems are so acute.
One incident,a patient in his 40's came in with 1 months history of shortness of breath and severe lost of weight.History of operation done under ENT(oncology) ,?NPC(scar at posterior auricular area)...No significant history of TB noted.
Patient was very breathless,:''doctor,tolong aku..."
The Blood pressure lowish(90/50),the radial pulse was barely palpable,hmm,i thought,run fluid!Oxygen high flow....
Chest bilateral decreased air entry with crepitation and dullness."Ok,really bad case of TB???"Heart sounds were soft.
Chest radiograph:bilateral lung effusion and a very huge heart.
"hmm....acute pulmonary oedema also???"
Me on the phone:"Hi doctor,it's lee from male ward,we just had a admission ,patient was very breathless,lowish BP,not very stable.""OK,i'll come and see later."
After 15 minutes....no sign of MO.
Mr Pharmacy(who can be a better houseman):"better be careful of this patient,looks like going to collapse anytime"
Me:panic again.
Then the Heroes of the day were sighted(respiratory team)
Dr A and R:"any respi cases?"
"dr,can you help us with this case"
Seen everything,hear every history,The chest X Ray:"GLOBULAR heart".
"Have you felt the apex beat?"
Me:err...nope,but heart sound really soft and pulses barely palpable"
"Let's scan the heart"
What do you think is the diagnosis??? I swear to myself i will never missed this again!!!
