Final surgery ward runs.

Hints and stuff and stuff

Wednesday nove 12 surgery ward runs day 2

We started in th female ward, all the windows are open, but the screens aren't being used so there are flys everywhere. Sort of scary when the are open wounds and burns a plenty.

Patient 1
Patient sitting up, has abdominal pain, constipation, recently operated on hemmeroids, a intestinal block not sure if complete or partial, complete generally means no passing of stool or gas, fecal impaction, vitals were done.
Bp 80/40 blood glucose 7.6 mmol/L temp 37.8

IV inserted for fluid saline, after 2 attempts on left arm finally succeeded on right arm, all done with same needle. Patient to be monitored, block may need surgery.

Patient 2
Dental problems, switching wards

Patient 3
Femur fracture, 6 kg traction splint, will stay in ward up to 8 weeks.

Patient 4
Femur fracture, chest pain, displaced clavicle, HIV, at least one opportunistic infection, on a 2*4kg traction splint. To be in ward 6-10 weeks.

Patient 5
Young child, mid shaft femur fracture 2 kg traction for 6 weeks.

Patient 6
Patient was talked about in there morning briefing. Motor accident leading to open tib fracture above the ankle, between transportation on scene to a health clinic, and then transportation from the clinic to th hospital patients wound was not cleaned, no bandaged, and no fluids given. Patient arrived in hypo-volumetric shock with a dirt and gravel filled bleeding wound. Emergency operation scheduled but delayed, was the surgery discussed on my their surgery post.

Patient 7
Complaining of pain, has deformed foot and leg fracture, continued monitoring.

Patient 8
Girl whose arm fracture I helped set and cast on Tuesday theatre surgery, doing well and being discharge.

Patient 9
Femurs fracture 6 kg traction, 1 month in ward, 1 month to go. Some complications because of bedsores. Needs more consistent position changes, there do exist bless that don't get bed sores as explained by th doctor, but of course not affordable or convenient.

Patient 10
Young child, with X-Ray no fracture found, to be discharged.

Patient 11
Palpating suggests patient leg is not fractured, X-ray shows small foot dislocations/fractures, some small wounds from motor accident, dr hoping to be able to discharge by end of day.

Patient 12
Young child, motor accident
Eyes swollen shut, leg abrasions, no fractures found, waiting for swelling to come down so can be certain no problems are hidden. If nothing found will discharge.

Patient 13
Young child, facial and head burns dangerously close to eyes but thankfully not quite. Much improved since Monday, no longer constant vomiting nor dehydrated, looks much better, standing, eager to play, look around.

Patient 14
Young child with bone pain, hyper calcification, bone growth, leading to excess red blood cell production from the bone mass. I think was to be transferred to internal medicine ward, not certain.

Patient 15
Woman with extensive 2-3rd degree burns across back of legs and thighs. Looks somewhat improved since Monday, continue monitoring and staying in ward.

Patient 16
Smelly, lots of flys, patient has swollen labia and vulva gland from a bacterial infection. Has at least 1 STD, doctor notes poor hygiene, will require surgery.

Patient 17
Large neck abscess, has had it 20+ years, was drained last week according to older gap students. In ward for continued monitoring, cleaning, draining, changing dressings. Dr would use scissor clamps to insert a whole pad of gauss into the drain hole in the abscess and then would scrub around, get new gauss, repeat. after about a half dozen passes we moved on and a nurse changed the dressing.

Patient 18
Child with burns on legs hands and feet. Much improved since Monday, that or it just seemed better since I wasn't there when they were removing some gauss. Continued monitoring.

Patient 19
Child with burns on back of thighs, also looking improved since Monday.

Patient 20
Gangrenous surgery patient from Tuesday, continue monitoring and dressing changes.

Patient 21
Child with small swollen open sore under armpit. Minor surgery for Thursday then likely quick discharge.

Patient 22
Large breast lump, dr does examination, believes it to be non cancerous after feeling it.

Comments on ward runs day 2
I felt a lot better after day 2 relative to day 1. It seemed like patients were improving, I knew what to expect, I was more adjusted to the timeline, climate, sleep hours, what to expect in the ward, the smells... Maybe I had already grown a tolerance and steeled myself a bit, but I didn't feel like that, I felt more optimistic almost eager.

On Thursday theatre surgery I forgot to mention one surgery, mostly because we only viewed it briefly before moving back to another surgery room. S a patient from a motor accident, skull fracture, patient aggressive and confused, required sedatives.

Friday ward runs surgery

Today we went through the male ward for the first time, a bit quieter, more visitors, more people doings things rather that just laying around. Less burns, more fractures, people,on phones, reading papers...

Patient 1
Child with foreign body in ear for last 4 days before coming to hospital, to be sent for minor surgery today.

Patient 2
Sleeping, confused, refuses to let go of blankets, twisting and turning, yes never open long. Patient has head injury needs a ct scan of the left parietal. Slow steady recovery expected naturally. Considered mild severity, though not responding well with our check doctor explained that if he pursues the checks he will get verbal and physical responses as desired. Later during the day I saw sitting up and being fed by his friend/brother, even small amounts of talking.

Patient 3
Is a prisoner, has history of falling down and recently reported frothing at th mouth. Antiepilectics given.

Patient 4
Old man, constant shaking and mumbling. Can't pass urine thorough his urethra, his a catheter in through his supra pubis area for passing urine. doctor performs a rectal exam though extremely painful. Patient bridging on shoulders and feet screaming out and minor convulsions. Doctor reports his prostate extremely enlarged, hard, and rough. Malignant tumour of the prostate gland, patient had testies removed 2 years prior to reduce the tumor. Doctor notes the catheter is not working anymore and tries to insert a urethral catheter again to the extreme pain of the patient. However hr fails, says the urethra is completely blocked/shut. Surgery scheduled to removed and replace catheter.

Patient 5
Bike accident, chest injury, hypertensive, discharged with some anti-hypertensive drugs.

Patient 6
Bullet wound in hand, surgery from Thursday, I guess he's sticking around for awhile.

Patient 7
Needs nutritional support, has been in hospital for many months, had 4+surgeries just to remove infection and close stitching from original abdominal surgery months ago. Doctors and nurses don't like him draining resources, claiming he's,doing nothing to help himself, lays around all day doing nothing.

Patient 8
Anal fistula, opening between tissues, surgery hoped to be done yesterday but delayed due to time constraints.

Patient 9
A screw and wire in knee as seen from X-ray, not sure how it's proceeding, doctor with us stopped being so talkative or explaining anything after the old man...

Patient 10
Wound on top of head and back, dressings and monitoring.

Patient 11
Burns covering face and head, dressings and monitoring.

Patients 12-20
Femur fractures, traction splints, long ward stays.

Patient 21
2 feet in water bath, swollen, peeling, open sores, diabetes related complications. Lots of flys, horrible smell.

Patient 22
Long deep cut in leg above knee. Nurse cleaning it out with large syringe of aware and saline, dozens of repetitions, wrapped with antiseptic covered gauss.

Doctor sort of disappeared leaving us hanging. Later we got a long lesson on intestinal blockages from our mentor doctor.

Friday was a little different but there was little time for reflection as we were soon leaving for our safari.