since 2004 and am doing electroconvulsive therapy to patients without use of anaesthesia, and i did not see any complication from that apart from the fear of some patients who do it for the first time, or some cognitive impairment for one day or 2 after the course....
but before few days something bad happened, a patient can not go out of bed after i did electroconvulsive therapy for him, and he felt some pain in his left thigh, but not so severe pain, yet he can not walk at all, i did an exam for him and concluded that there is a muscle spasm..and prescribed some pain killers, but the next day he was the same, i ordered an x-ray, and the report of it says that there is some evidence of an old fracture in the left neck of femor, i ordered another x-ray, another view, and it says: NEW FRACTURE OF LEFT NECK OF FEMOR.....
oh god...i knew i did nothing wrong, i did the same thing that i did 100 times before, maybe 1000s, but this man, i think he had an already abnormal bone, or what happened, whatever happened the patient and his familly was looking at me in a way that tells me that am guilty and i felt really guilty....
in the electroconvulsive therapy room i usually ask for 2 other substaf to help me, usually one a nurse and the other is a cleaner, yes, a cleaner, the nurse holds the patients lower jaw (to prevent dislocation of the lower jaw), and cleaner put his body above the lower limbs and hold with his hands the upper limbs to prevent there dislocation....
i put the instrument and click the bottom, and then concentrate on the patiewnts face and breathing and heartbeating, using suction and oxygen when needed...
i think i need to change the menaover, i think i will ask for one nurse and 2 cleaners, if i cannot ask for 2 nurse and one cleaner..
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7 comments:
Wow, Dr. Sami,
it is hard to believe "they" don't let you use anesthesia...but I guess things are different all over, right? It is certianly not your fault that things went so wrong, it is those in charge, that make you do this thing without proper (in my mind!) equipment and help. Please try hard not to feel guilty, as you have nothing to feel bad about...I know, that is easy for me to say...
take care of yourself, tracy
dear 3eeraqimedic please send me your first thought i want you to help me thinking about that....if you have a thought that you think will increase my feelings of guilt, be sure not sending your first thought may increase it more, if you find it not nice, i will find it nice to hear it be sure...and regarding your question about ECT , i will write a blog for that, for you and me and for everyone...
dear Tracy, thank you for your support, they really neglect the psychiatry ward, we wrote to the people in charge about what happened ( about the fracture) and told them that we still want them to send us an anaesthetic even if he comes for one day a week, still they don't respond, they are running short of anaethetists...
thank you 3eeraqimnedics for your response.....you have the right to say all that...
These things happen when performing ECT without muscle relaxant. No doubt you have good reasons not to use anesthesia.
Why can't you use anesthesia, etomidate and succinylcholine are not that expensive. He you tried to liaison with other hospitals e.g. in Europe?
How often do you use ECT and for what indications?
Regards
Dr Shock
The problem we don't use anaesthesia is that there is no anaesthetic free one hour per week for us cause they are leaving country, and those who stay are very busy in the surgical ward....I think they can find some time to come for us...but there is no pressure on them to come to the psychiatry ward...the medical staff hear is antipsychiatry....
we do ECT often for refractory depression, severe depression with suicidal ideation, and different type of acute attacks of psychosis when we want (the patient's familly want) fast improvement...
Regarding attachment or liason, i don't know how to do that, i hope i do something like that..
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