Good bye CWM

Check it out!!! New state of the art US that the ED just got. It is actually better than the one at my hospital. It has all 4 probes and the images are great. There is a transvaginal probe but no probe covers yet.

This is me teaching one of our interns Anorag how to do an US guided aspiration of a suprapatellar bursitis. The images are so clear here.

Other cases for the last few days:

29 y/o F with arterial bleed to the R wrist after "accidentally" falling into a glass door while fighting with her mother. The incisions don't coincide with the story, but this was her statement. She bled EVERYWHERE! VSS. I sutured off her radial artery that she ligated (only after getting sprayed with blood everywhere - way to work my last shift and go out with a bang). She had bled approximately 1500 ml, On exam, pt has a dusky hand with intact ulnar pulse. Capillary refill intact. Pt does have an ulnar nerve palsy (ulnar claw hand - pt is unable to extend her 4th/5th digit). Radial artery is ligated. Pt also had obvious ligation of her flexor tendon.

Arterial bleed, "ulnar claw hand"

She was taken to the theatre for surgical exploration repair. 

Breast cancer. This woman let this grow for >1 year before seeking medical attention. She was scared to go to the hospital. 

Recurrent TB (there are no N95 mask here just the thin basic ones, that do NOT prevent the spread of tuberculosis) 

Hepatitis

Dr. Amit pointing to a patient that is actually being ventilated with a ventilator in the ED

More sepsis from diabetic feet...

Other interesting cases (not mine but good learning case):

Case: 51 y/o F with chest pain earlier in the day (that resolved) now presenting to the hospital with generalized weakness and lightheadedness. ECG with .... 3rd degree heart block.

Her pulse was in the 30s and she was hypotensive. She was mildly obtunded. She was being treated with atropine, with very little response. There is no isoproterenol (their standard medication that they use to tx bradycardia) so they were giving her salbuterol (similar to albuterol - which is an asthma medication, that as a side effect causes elevated heart rate) to actually promote tachycardia. Huh? Interesting. It actually worked transiently. She did have an increase in mental status.  After some discussion with other consultants the patient was started on a dopamine infusion. She actually got even more alert with this. Blood pressure improved.

Like I stated in a previous post, normally transcutaneous vs transvenous pacing would be placed in the ED or the CCU until a definitive pacemaker could be placed. This could be lifesaving. However, they do not place TCP or TVP here and it takes months for a patient to get a pacemaker (if at all) so medical therapy is all they have at the moment. For third degree as well as second degree (Mobitz type 2) heart block definitive treatment is with a pacemaker.

3rd degree heart block. Sorry my phone died that day so I had to take a picture on my actual camera. 

Amit's face when I ask for something they don't have and then he subsequently states a very rehearsed/methodical, "We are a under-resourced country and we etc etc."

Suva homes

Typical Suva flats

Port at a distance on my walk home

Suva mall/shops

Last night in Suva

 Leaving Nadi/Fiji just in time. Flash flood in Nadi town and the town is being evacuated. It has rained nonstop for the last 2 days. Yikes! I wonder what happens in the villages?