Thursday, December 10, 2009

If you build it, they will come

As the famous Field of Dreams quote says, "If you build it, he will come." In our case, we built the new hospital and now patients are coming. Today I walked onto the medical ward to ask Bill a question and found these people on the floor. This is the first time I have seen pts on the floor in medical ward since we moved into the new hospital, but doubt it will be the last. We have 6 extra beds on medical ward, but today we needed more. On another note from the day. A guy came into the clinic with a history of cutting himself on his forearm 2 wks prior with a bush knife. He had gone to a health care center and they had stitched it up, but he was having swelling over the site, so he came to us. I examined him and felt a fluctuant mass on his forearm and thought he had an infection that needed drained (everything here gets infected). So the medical student and I took him to the ER to perform our incision and drainage of the abscess. The student cut the mass, but no pus came, so I decided to squeeze harder. Instead of pus, I expelled a huge blood clot that squirted across the room to the wall with bright arterial blood soon following. Blood was pumping out of his forearm all over my shirt, so I quickly applied pressure. I am not sure if the student understood what had happened, but I knew this wasn't an abscess. He either had an arteriovenous fistula which we cut into (connection between the artery and vein) or he had severed his radial artery with the chop and the blood had clotted forming the hematoma and as soon as I dislodged the clot, the blood came. I attempted to blindly put a stitch in to stop the bleeding, but when blood started pumping from 2 places, I quickly stopped and asked for Dr. Jim to come. We got a tourniquet on him and I held pressure as we waited for Jim to come and prepare him for surgery to tie off the vessels. Thankfully, the surgery went well and his ulnar artery was still intact which will provide the blood supply to his hand from now on. Note to self - not everything that is swollen and fluctuant is an abscess.