Sunday, November 7, 2010

Checking in on the medical front from Kijabe

Last week was heavy with RTA’s (road traffic accident’s). One of the unfortunate results of improving roads in Africa is that cars can go much faster and the resulting accidents are more severe. On the weekend a small bus collided with a lorrie it was overtaking and about 13 people came into Kijabe. Three people died and others were admitted with serious injuries. Two days later a similar event brought people into casualty, say around 14, but thankfully no one died. One young man was paralyzed from the waist down and others suffered multiple open fractures. Treating CHI’s (closed head injuries) is a challenge here. We don’t have a CT scanner so you must rely on clinical evaluation, which is a bit like crossing your fingers. I learned an interesting neurosurgery trick the other day: you can screw through the skull, insert a catheter into the ventricle, inject air and take an x-ray. Then you can tell if there is midline shift and be guided in where to drill a burr hole. I had to put a number of joints back into place with all the accidents and had the pleasure of putting my first traumatic posterior hip dislocation back into joint. I have put back innumerable prosthetic hip dislocations at Northwest and thankfully the techniques are no different for traumatic hip dislocations. I have a small pocket pulse ox/heart rate monitor and it works perfectly for cases requiring moderate sedation. I pop it on the finger, inject a little valium/fentanyl and voile, pop goes the joint…after a bit of pulling of course. I have oxygen and suction, as well as airway stuff, so we’re good on that front. I’ve had to learn to live without etomidate or propofyl here, but have come to a new appreciation for the old fashioned standbys.

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