Friday, November 28, 2008

Lightning and Cyanide

You just never know what they are going to call you about when you are on call. They often call with patients who have dehydration, malaria, pneumonia, or a chopchop, and I feel pretty comfortable with all of these. However, when I got called the other night and they said a girl got struck by lightning, I didn't feel so comfortable. I knew nothing about lightning strikes nor what I needed to be worried about, look for, how to treat, etc. I told the nurse I would be down, but first took 5 minutes to open Harrison's and read about lightning.
Thankfully, the girl did well. Her and a friend were outside when the storm came. Her friend died instantly, but she survived. The trauma in that, seeing her friend die, is something I am sure is much worse than the pain she had from the lightning strike itself. She ended up with a lot of muscle pain of her arms, and some red eyes, but otherwise was okay and went home a few days later.
In doing further reading, I have learned more about lightning strikes. There is about a 10% fatality rate of those who are struck. The majority don't get burns, but lots of other complications can occur. They can get neurological problems like neurocognitive changes, seizures, HA, and more. The biggest concern is cardiac arrest due to asystol (heart stopping), as a result of the lightning, this at times results in death, but God made our body so often we can restart our hearts again. Eye and ear complications as well as chronic pain syndromes often occur as well.
Another on call patient was a kid who had eaten a cassava root raw and now was having some SOB and abdominal complaints. I didn't field this call, but saw the kid on the ward just an hour after admission. We were concerned about cyanide poisoning in this patient. Let me tell you how much I knew about cyanide poisoning, that's right, nothing. So after seeing the kid, I went to Bill to find out what I should really be looking for in this kid.
It turns out that cyanide poisoning has occurred here before when a family ate a whole bunch of beans and most of them died as a result. Therefore, we now have a cyanide poisoning antidote kit with the important meds we can use to treat the poisoning - amyl nitrite, sodium nitrite and sodium thiosulfate. He was given amyl nitrite and sodium nitrite and apparently was doing much better on the ward than in the ER. We continued to follow him and he did just fine. One recommendation I read was to transfer cyanide poisoning pts to the ICU or to a local toxicity center - apparently our pediatric ward serves as both, with me being the doctor in charge.
So all that to say, you just never know what kind of calls you may get when you are on call here at Kudjip. You gotta be ready for anything.