Friday, July 22, 2011

i must be more careful with patients with large noses

who'd thought that a large nose would be a point of contention?

this patient, Mr E, was to undergo a major back operation, which means he has to be positioned face downwards during the surgery.





as standard operating procedure, a soft gel support was placed below his face as cushion. the surgery was successfully completed in over 6 hours. however, 2 days later, Mr E mentioned that his nose was dark red & i explained to him that was because he had been lying face down for over 6 hours, so that was a result of pressure on his nose. it was then that i noticed he had an exceptionally large nose. still, i reassured him that it will get better with time. unfortunately, it became infected after a few more days & antibiotic injection & cream had to be administered. he had gone home since & i hope all will resolve when he comes back for review.

what Mr E has is a typical case of a pressure sore on his nose, the same type bedridden people get on their backs when they lie too long in one particular position. sometimes, even after we've taken the necessary precautions, unexpected events like this still occur.

which is a real damper, especially so since the major back surgery had gone on well.

20 comments:

Michelle Mak said...

its ok larr doc... u didnt know abt it...
next time just be more careful lurr:)

reanaclaire said...

Lying on the stomach with face turned sideways can "stiffen" my neck.. so when i go for facial, the bed has this hole whereby one's face just fit into it without turning sideways.. do the operation tables have this type of hole for the face to face down without suffocating and affecting the nose as mentioned? Just curious.. :)

wenn said...

everyone goes through a lesson to be learnt.

ilene said...

Thanks for the tip! I must remember to tell this to my doc when he operates on my spine (if and when I pluck up my courage)! :)

doc said...

Mich,

yes, must be more careful!

doc said...

Claire,

thanks for the tip. i must check if the hospital will order a massage table!

doc said...

Wenn,

this reminds me of the biography Tuesdays with Morrie. the blunt statement made was that when you stop learning, you die, or something to that effect.

doc said...

Ilene,

not to worry if you don't have a large nose!

Yvonne Foong said...

Never had any sores. Thank goodness. If his face was turned sideways, how was pressued applied to his nose?

Unicorn Girl said...

This is the disadvantage of having a large nose . By the way , is this patient of yours a caucasian ?

Medie007 said...

wow. that's new. lol. i thought the cushion would hve an indentation in the middle? hmmm... can't imagine how painful it would be on the nose... and the gosh, suffocation! had it not for the intubation. lol.

Birthmark said...

I should tell that to the doctors in the future. You guess it right, doc. I have one.

doc said...

Yvonne,

in the actual situation, Mr E's face was placed straight down. there was a little trough on the gel support for the nose but obviously, the pressure sore still couldn't be avoided.

doc said...

UG,

no, he's an asian.

doc said...

Medie,

he had a general anesthesia & was intubated. there is a trough on the gel support for the nose but unfortunately, the pressure sore still happened.

doc said...

Birthmark,

glad to be of help.

Yvonne Foong said...

The House Clinic gives us a list of possible side effects and complication from surgery that we might experience the moment our surgery is scheduled. So maybe your hospital should include sore nose as one of the possible side effects so that patients will not sue you when their noses turn sore after surgery.

doc said...

Yvonne,

even after listing out the possible complications, there is nothing to stop the patient from taking action if they want to.

Adino said...

Yeah a massage table would probably help, and maybe would help with the breathing as well, cos I can't imagine how he could breathe properly lying face down?

doc said...

Adino,

he had a general anaesthetic with a tube inserted into his windpipe to assist breathing.