Emergency Medicine

POINT OF CARE LAB

• 24x7 available facility in 201 green zone headed by the senior most biochemist and 4 lab technicians.
• Available tests:
  • CBC
  • RFT WITH ELETROLTYES
  • ABG
  • VIRAL MARKERS
• These tests are being done for polytrauma patients and patients taken to E-OT. This lab also caters to various ICUs and EOT. On an average 200-250 samples are run every day. Funds for running the POC Lab is generated from NK 48 Insurance. There is also a pneumatic shoot facility wherein other vital blood investigations can be sent to the main central laboratory.

TRAUMA REGISTRY

• In 2021, with the support of World Bank, TNHSP and NHM, online entry of patients was started as “Trauma Registry” which included Pre-arrival Intimation as well wherein a patient can be tracked from point of pickup to discharge from any hospital in Tamil Nadu.

CODE BLUE CRASH CARTS

• Multipara monitors and Defibrillator 30 no’s was sponsored through global grant rotary international.

POINT OF CARE USG MACHINE

• A point of care USG is also available in ED which is being used for various procedures like central line catheterization, arterial line insertion, POCUS, EFAST, on arrival Nerve blocks , Abscess drainage and thoracocentesis.

BEDSIDE XRAY

• We also have mobile Xray facilities for sick patients

SKILL LAB

• Our skill lab was inaugurated in January 2018 as there was an need for continuing medical education to relearn life saving skills like BLS, ACLS, PALS, endotracheal intubation, surgical cricothyroidotomy, pericardiocentesis, central venous line catheterization, IV access, and POCUS. Various training sessions are being conducted to postgraduates and staff nurses.

DECEASED DONOR MAINTENANCE UNIT

• A two bedded unit exclusively for maintaining brainstem dysfunction patients is present within the green zone of ED. Patients diagnosed with BSD are shifted here and after 2 apnoea tests, relatives are counselled about the option of organ donation. Patients and their relatives are given their due dignity and respectful space to grieve.
• ED, MMC along with Dept. of Anaesthesia has successfully completed 50 organ retrievals till date. The youngest donor being 18 months and the oldest being 80 years. The donor is always handed over to the relatives after honour walk and after paying their final tributes by the Head of the institute.

• Diagnosis: ACS- CAD/ AWMI/ Moderate LVSD/ T2DM/ Primary PCI to LAD
• 28/2/2023
  38yrs male patient, came with complaints of Left sided chest pain on 28/2/2023 morning 8:30 am and one episode of syncope. Pt was taken to saidapet GH, referred to RGGGH.
  
  Pt was received in gasping state. At 202, pt airway was secured with ETT and ECG showed ST elevation in V2 to V6. Pt went for asystole. Resuscitated as per ACLS guidelines. DC shock of 200J given thrice i/v/o recurrent ventricular fibrillation. ABG showed respiratory acidosis. Inj. Amiodarone 300 mg iv stat given. ROSC OBTAINED at 9.40 am. Bp 70/? PR 180/min. Inotropes infusion started.
  
  Pt shifted to CCU ward at 10 am. PR 129/min BP 70/? SPO2 100%.
  
  Shifted to Cathlab immediately. Primary PCI to LAD done on 28/2/2023.
  
  Intraop, pt had multiple episodes of VT and DC shock given. Amiodarone loading and maintenance doses were given. Post procedure, pt went for ventricular fibrillation and cardiac arrest. CPR started. Ionotropes continued. ROSC obtained. Cardiac pacing initiated with TPI. Reverted back to sinus rhythm.
  
  ECHO- Hypokinsia of AS/AL WALL OF LV LVEF 35%.
  
  Patient was under strict monitoring in Cardiac ICU and was extubated on DAY2 of admission and safely discharged after a week.

• Diagnosis: RTA with penetrating chest injury s/p right sided thoracotomy
• 05/03/23
  27/M
  Alleged H/o RTA while driving lorry hit against a tiled house and sustained injury to Right chest wall with struck wooden log around 2:30am on 05/03/23 in Avadi. Referred from Avadi GH to Kilpauk MCH and then to RGGGH after inserting a ICD.
  
  Diagnosis:
  *RTA PENETRATING CHEST INJURY RIGHTSIDE BY A WOODEN LOG*
  Right ICD insitu
  
  On arrival at ED :
  5.55am
  PR 78 bpm
  BP 120/90 mmHg
  Spo2 98% in room air
  Hemodynamically stable at present
  GCS 15/15
  
  Informed CTVS once we received a Pre-arrival intimation.
  
  1 pint PRBC on flow. Further 2 more PRBCs were reserved. Normal saline was rushed. Meanwhile blood samples were sent.
  
  *EFAST*: *NEGATIVE*
  IVC diameter 2cm
  
  Patient shifted to OT by 6:20am.
  
  Case was operated by the CTS team and the wooden log was removed safely. The whole procedure and post-OP period was uneventful.

• Diagnosis: P3L3/ TERM- 37wks 3days/ Labor Natural/ boy/ AGA/ 2.5 kg
• 19/10/2023
  22yrs Female,
  History of leaking per vagina followed by a sudden gush of fluid from the vagina around 9.35am for which she was taken to ED from the cardiology OPD.
  
  LMP: Not known
  EDD: 06-11-2023
  B Positive
  G3 P2 L2
  37 weeks 3 days
  Underweight
  Anemia (corrected)
  
  AN mother:
  1st child - 7yr old, Male child, Home delivery, Alive and Healthy.
  2nd child - 3yr old, Male child, Home delivery, Alive and Healthy.
  3rd – Present Pregnancy
  
  On arrival to ED:
  She came with labour pain, well contracting uterus with fetal head at +2 station. Mother delivered an alive Term male baby cried immediately after birth without episiotomy at 9:45am. Cord was around the neck twice. Cord clamped and cut. Injection syntocin 10 units IM given immediately after delivery. Injection syntocin 10U in 500ml Normal saline at 12◦ per minute started. Placenta completely delivered by 09:55 am.
  
  Intrapartum and Postpartum periods were uneventful. Bleeding PV within normal limits.
  
  Baby was resuscitated by the pediatrician and Pt was shifted with the baby to IOG for further management.