3 Feb, 09 | by BMJ Group
This evening I am pretty tired again. January and December tend to be the busiest months for the Emergency Unit and there have been a higher percentage than normal of really sick HDU/ITU type cases lately.
The days are pretty unpredictable, like A&E at home. The numbers may not seem that high on paper, but often I am swamped, trying to figure out how to fit four adults and a mother and baby onto two beds and a stretcher whilst writing notes, giving drugs, asking the nurse for various things and my poor translator trying to translate my 500 questions at once.
It may not seem like a huge number but when simultaneously you have an asthmatic on a stool in the corner having a nebuliser, two sick people on the beds, another with no recordable blood pressure on a trolley, an unconscious poisoning patient on another trolley squeezed into the middle and a child having some sort of seizure on a trolley half stuck out the door (as I did the other week), you see it gets quite tricky.
Anyway, the last two nights I have worked till 1am (could be worse) and the days have also been really busy. Wednesday night, one patient who had been bitten on his finger by a cobra kept me occupied. Although they are supposed to give primarily neurological symptoms, patients often have prolonged clotting time also. We recheck their blood test repeatedly and if it is abnormal or they have active bleeding or neurological symptoms we give antivenom. It’s a nightmare to give because the patients invariably become more unwell, vomit, sweat and their blood pressure plummets.
Last night I was called in overnight for two patients, one of them having an MI. We are lucky that we have many of drugs that I would normally use on cardiac patients, give or take a few. Occasionally I have to improvise but we manage (for example, sticking a patient’s head in a bucket of ice water for SVT; I was very pleased that worked, but the patient did not look quite so happy).
This MI patient had stopped taking medication and now was on his third. So many patients default their clinic follow up and medication here. I normally try to ask why they didn’t go but often they can’t give me much reason.
The patients usually present quite late to the hospital. Sometimes I don’t think they realise the significance of their symptoms.
Overnight we have curfew so patients leave it as late as possible before coming to hospital, if they can get here at all. They often go to “local doctors” before they come to me. This I find very difficult because, while they are trained in ayuverdic medicine and I have no issue with that, these practitioners are also giving western medicine about which they have no training. Often the drugs or doses are inappropriate. They also give powders which are crushed tablets of unknown mixture.
Anyway, my patient with the MI is doing fine today. Not so the patient who came in with life threatening severe asthma, rapidly deteriorated and I had to intubate and transfer, which means enduring 45 minutes of fighting the urge to vomit whist bagging my patient and being bumped around the back of the ambulance.
While waiting for the ambulance to take us back, a patient arrived in cardiac arrest. We try and keep good relations with the teaching hospital staff and I don’t like to interfere but I really felt I had to offer to help so I ventilated and gave drugs (my emergency drug box was luckily sitting on the shelf next to me) whilst the MO did chest compressions.
It actually made me feel pleased about how I see things are starting to improve at our hospital, particularly with cardiac arrests. MSF is responsible for a weekly teaching program that I organise and take the many of the sessions. Everyone is welcome; doctors, nurses, nurse aids and anyone else free (pharmacists, for example) often come too. I have tried to cover the basics in my last few months. The previous EU docs did this too. There are no other senior doctors in the hospital apart from the MSF team so they appreciate all the support and teaching we can give them. I have got everybody practicing log rolls, cervical collars, chest compressions (I even dragged the security guards into EU to do CPR on a mannequin) and we have moved onto advanced life support amongst other subjects
Anyway, now I have to go back to work. There’s a very wheezy child I have to see, a poisoning patient to review and a couple of patients I need to follow up on the ward. Never a dull moment.
The author is working as an emergency doctor for MSF.