Wednesday, March 26, 2008

The wards

So over Easter weekend the wards were relatively quiet but then we got a backlash of many admissions as the new week was starting. We saw some interesting cases including a once in a lifetime tricuspid stenosis. We also diagnosed an 8 year old girl with endomyocardial fibrosis. Then there was the patient who arrived without a brachial pulse, no blood pressure, and a heart rate of 180. We gave her lots of fluids, started broad spectrum antibiotics, stress dose steroids, and put in a foley. Her EKG showed SVT which turned into sinus tach after a few liters were in. I thought we had saved her but she developed flaccid paralysis and died 3 days later. That was the second death on the female ward in 2 days. At the beginning of the month the male side had more sick patients. We still have our share though. But most of our post-Easter admissions were lacerations and traumas after drunken fights or accidents.

One patient we had was stabbed in the chest with a machete. Through physical exam we diagnosed a hemothorax and then confirmed it on chest xray. Luckily he was stable enough and it was not large enough to require a chest tube. I have had to improvise in a few situations. First a man came in who was punched in the face and his mouth was bleeding. They sutured his bottom lip but his mouth continued to bleed overnight. By the time I arrived the next morning his clothes were drenched in blood and he was still bleeding from the mouth. When I explored his mouth I noticed he was bleeding from a crack in his upper gum. I held pressure for 15 min and he held pressure for another 30 min but it still would not stop. So I went to the pharmacy and asked for some adrenaline. I diluted the adrenaline and injected it around his gum which turned white and stopped bleeding. We observed him for another day and he had no more bleeding. And the gum also went back to normal color.

Another case was a boy who was beaten and had a dislocated shoulder. It had been out of the joint for 24 hours. I had never reduced a shoulder dislocation and didn’t really know how to do it. But I didn’t want the boy to have to wait for the orthopedic officer to come in the next day because it is very painful and the longer it is displaced the harder it is to reduce. I was looking for a book to tell me how to pop it back in which I had at home but not at the hospital. Then one of the med students said they might have a book in their backpack that said how to do it. It had less than half a page about this topic just one paragraph. But I read that paragraph and felt the boy’s anatomy. We gave him some diclofenac, codeine, and valium then I said here goes nothing and tried to reduce the dislocation. It worked! I fixed his shoulder! Everyday is an adventure here with its ups and downs.

Rafi

Here is a link to pictures of Kisoro hospital: http://picasaweb.google.com/rafiki/UgandaKisoroHospital

1 comment:

Benjamin said...

You don't know how to pop in a dislocated shoulder? Didn't you learn anything from Lethal Weapon? (other than "they fuck you at the drive-thru", obviously)