Getting Acquainted

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Wow the nights are hot but the days are hotter. Surprisingly I’m getting acclimated quickly. The VET is no longer working with Medishare (she just stopped by to help last night) so I am training/showing the ropes to a new nurse tonight. She’s really nice- a big organizer so her mission is to keep our supplies in some kind of order (and to help her stay awake, she doesn’t normally work nights).

We still have the amputation/tetanus pt, the other tetanus case was flown to the US today. We now have a potential brain dead pt (from a car accident) who underwent a crani and has a make shift EVD (created from another pts shunt tubing). (EVD is an external ventricular drain (sits in a ventricle in the brain)  that drains cerebral spinal fluid (CSF) from your brain to divert the flow of CSF and prevent increasing ICP, or pressure of the brain causing more damage). His buritral is not to monitor or at a specific level- open to draining bloody CSF. His head is bandaged with kerlix and with all the typical signs and symptoms of head trauma. This is is 18. He survived the earthquake, and may end up dying from a MVC.

I used the young boy volunteer haitian translator  to communicate with his father. I explained how serious this is and what may happen. The father just looks at me with swollen, reddened eyes, smiles and opens his arms up and says “I leave it up to god, he will know what to do” and he smiles again and thanks me unconditionally.

If there is one thing I have learned already it is that the Haitian people look toward a higher power to get them through. They accept what they can not change, easily. They don’t argue with the nurses when given bad news, they accept the news and pray. They have a lot of faith in us as well and its a lot of responsibility- but we all want a better outcome and we work hard to help produce that.

Its difficult to care for these patients especially in this case because we don’t have a CT scanner, we can’t go for MRI as we do back home. We can’t check his ICP (intracranial pressure), and we can’t do  as much as I wish we could. But what we can do is assess him, treat symptoms, keep him cardiac monitored and prevent secondary complications. Sadly he has lost corneal reflexes and unresponsive to painful stimulation. We are using all the equipment we can to help this boy.

As I said before we are using cots to place the patients on and you can’t raise the head of bed to 30 degrees to prevent aspiration, or to decrease ICP, you have to make do with what we have and create a way to raise their heads. Luckily we have one VERY old hospital bed that this patient is in, and we were able to take a needle box closed and lift the rubber mattress up to elevate the head of bed.

Another pt arrives- MVC (motor vehicle accident) rolled over him, tossed him out of the vehicle. He was driving a transportation vehicle. In the ER he has. GCS of 15, a number system comprised of the pts ability to open eyes, follow commands, speak. He has bilateral pleural effusions and major trauma to his face arms and legs. By the time he reached ICU he was losing his airway, not opening eyes and no longer following commands.
There was also blood build up behind his left eye causing it to protrude out. The blood was evacuated by performing a sub-retinal hemorrhage evacuation.

We intubated him immediately. And began to irrigate his wounds. With the lack of supplies we used a burn dressing to protect and cover the wounds. He received bilateral chest tubes- only one set up to a Pleur-Evac and the other a old milk jug, I know, creative!
It’s been a busy day. We ended the day with 4 critical patients. Another large problem we are having are the flies. We have Fly bags hung to catch them but no such luck. I am going to look for cheese net or mosquito nets to cover the pt.’w with because we have flies all over the oral airways, on and in the wounds, its horrible. We won’t eat a hot dog or a hamburger if a fly lands on it, so how it is okay for flies to infect and land on wounds?