Thursday, January 3, 2019

The Last 36 Hours

The last 36 hours have been quite busy at the hospital (a little more than usual). It was probably a combination of people waiting until after the New Year to come into the hospital and being short staffed (only 2 long-term general doctors-including myself, one general surgeon, one temporary doctor, and 2-3 students). Patients are lying on the floor (due to overflow) in Male, Female, and Maternity Wards.

I was on-call for the hospital starting yesterday morning. In the subsequent 36 hours, I have performed the following (to all the non-medical folk, sorry for the medical jargon!):
- 7 Cesarean sections (placental abruption with Hct of 14% with IUFD at ~30wks- she had a Couvelaire uterus, woman with two previous C-sections in labor, fetal distress, failed induction for woman with severe preeclampsia, and arrest of dilation for the others)
- 1 Manual rotation of a baby from occiput posterior to occiput anterior with successful delivery of healthy baby soon afterwards
- 1 Incision and drainage for large forearm abscess
- 1 D&C for retained placenta fragments after delivery of a non-viable 15 week baby
- 1 Debridement for Fourniere's gangrene (necrotizing fasciitis of the private area)
- 1 Splinting of a lateral humeral epicondyle fracture
- 1 Suturing of knife stab wound to the upper arm

Other cases seen on the ward in the last 36 hours:
- DKA in young boy with Type 1 diabetes
- Status epilepticus in woman with presumed meningitis
- Extremely low birth weight (~0.6kg) neonate born to mother with HIV
- Two cases of necrotizing fasciitis of a leg (from knee to foot)
- Two cases of Ludwig's angina (bad jaw infection from abscessed tooth)- one in a pregnant woman who began having preterm contractions- now stopped
- One case of tib/fib fracture who did local treatment for two weeks before coming to hospital for wound care. Now in long leg cast with windows in the cast for wound care.
- Polycythemia in a neonate born at ~37 wks via normal delivery a copy days ago to a mother who delivered monochorionic monoamniotic twins - both babies now doing well despite their umbilical cords being twisted in a knot before delivery (mother was referred in to our facility because of labor and loss of fluid)
- Bowel obstruction in older gentleman
- Enlarged right atrium and right ventricle in adolescent boy with hypoxia and elbow abscess

Hope you enjoyed the snapshot of a not-so atypical day here at BMC.
God is good :)

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