Tuesday, August 30, 2011

Trauma made easy/crappy

In an effort not to be Debbie Downer, I don’t share all of the tough cases that come along, so I’ve been sitting on this one for awhile. It happened the other night but since I’m trying to balance my “good outcomes” with my “not so good outcomes”….read ahead. It turns out ok.

I was working an evening shift. Since one of my co-workers was sick, I’d worked a double shift that day and was just dead tired. I was counting the minutes until 10pm so I could go crawl into bed. Fortunately it was raining pretty hard that day which is awesome for a couple reasons. First, I love rain. Always have. Second, people here do NOT love rain, so if it’s raining, they tend to stay in their houses…..and not come to the hospital. It had been really slow that day and evening.

At about 8pm I was in the peds ward checking on my kiddos when they told me there was a patient to be seen. When I walked down to our “ER” (the bench in front of the nurses station) I saw a kid about 4 or 5 years old that did NOT look good. When I asked what happened, they told me it had been a motorbike accident. Shoot. I’ve seen how these motorbike drivers drive! They. Are. Crazy. So right away I knew that most likely they had been traveling pretty fast and of course...... no helmet.

Right away I noticed a relatively big head laceration on his forehead. Rats. That means he probably hit his head when he fell off. The second indication that all was not right with this kid is that when I bent down to look at him, he reached for me. Kids almost NEVER reach for me here. He was hurt, and I’m a scary white person, so he should have been trying to hide from me. The fact that he reached for me was a big red flag. He was also mumbling incoherently (I couldn’t understand a word of it anyway, but clarified with his father that no, he was not making any sense).

So I was pretty sure he had a head trauma of some kind. Mild concussion or big brain bleed….who’s to know. As I started looking closer, I noticed that he was bleeding from his nose as well. He started coughing and coughed up some bright red blood. His lungs sounded horrible….probably full of blood after seeing what he coughed up. His abdomen was distended but was it distended because everyone here as worms and distended bellies or because he’d perforated some abdominal organ and was bleeding internally.

We have an OR team here. Some of them have been here forever. They’ve been trained by lots of different people so do a lot of different surgeries, skin grafts, etc. They’re very talented. If it wasn’t for the fact that if I had surgery here I would a) have to lay naked as a jay bird in front of all the people I work with. B) have my arms tied down like I’m being hung on a cross to keep from putting my hands where they shouldn’t go c) have to settle for Tylenol for any post-op pain and d) have a HUGE scar because laproscopes haven’t made it here yet…..I would totally let them operate on me.

Anyway, I digress. Since I am confident in our OR team, I called the CHO (community health officer) who works here to see what they would be able to do. The conversation went like this.

Me: Hey buddy. I have this kid here who flew off a motorbike, most likely has head trauma, is coughing up blood and may or may not have a lacerated spleen and/or liver. I’m wondering if it would be possible for the OR team to open up this kid, take a look at his liver and spleen, see if it’s bleeding at all, and put in a chest tube if necessary. I’m not sure if he needs all of that….I’m just wondering if they can do any of that.

Him: No. They don’t do any of that.

End of conversation. Ok. At home, this kid would have kept me running for a few hours…x-ray, CT, meds, consults. Here? I sutured up his head lac and admitted him for observation. I did call the lab man in to check his hemoglobin. At least we could give him blood if he needed it.

Honestly? My pediatric trauma assessment skills aren’t finely tuned, but I didn’t have a lot of confidence this kid would make it. I was most concerned that he had a big head bleed that was just going to continue to get worse. His mother came to see him and the wailing started. As I left to go home, I expected to be awakened by more wailing as he passed away.


It’s been 3 days now and the kiddo is doing great!! MUCH better than I hoped for! He’s started eating a little and today was walking all around. Not quite up to smiling yet but patiently stood still while I took a picture. :)

Note: I put 7 stitches in this kid’s head. It took me a painfully long time. Two guys were there to “help” me and I think by the end of it they were uber frustrated and just glad it was over. Apparently I need to keep practicing. :)

Thanking God for a great outcome in what seemed to be a hopeless situation!!

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