Disaster response B #6
Today started out slow, and ended with a 4 hour operation. Ended meaning I haven’t been called again yet.
I did rounds with the local surgeons on my patients. We also rounded on the ortho patients who had wounds.
We brought back the first wound change patient to the OR. The first was the leg wound on a woman that weighs two of me, and is 4ft 9in. Her leg wounds are slowly improving. I talked to her about her experience during the past few weeks of the hurricane. She said she lives on Abaco- the island that was nearly flattened, but had moved here for work. She is a chef and couldn’t find work there. She was at her rental apartment when the storm started. The water started coming in under the door. The landlord ran around telling people to leave to get to higher ground. She went out and started walking down the street. She said the water was flowing deeper and deeper. People were walking everywhere. She said the water flowed down the street, may take a left or right around a house and keep going. She said the water was up to her waist and brown with sewer. A truck was going by and she hailed it down, and climbed on. She said she would go where ever it was going. It went to the Seventh-Day Adventist church. She stayed there for two days. She said that in the storm part of the roof of the building was torn off and they got rained on, and some debris fell down, but no one was hurt. She doesn’t yet know what happened to her house in Abaco.
After that there was a person with a buttock abscess with a WBC count of 1.8 and HIV. That abscess was much cleaner than yesterday when I opened it.
I then helped out in the ER to see patients with abdominal pain, foot ulcers with osteomyelitis (bone infection) and small lacerations.
I was in the ER when the triage people rushed in a lady who was holding her head and bleeding all over from her head. She had two large wounds open on each arm. We rushed to take care of her. She was placed on a bed and I started to evaluate her. Nurses put in IV lines in her legs. The story she told was that she told her son to mow the yard today, and she went out of the house. She came home and he hadn’t done it. She asked him why not and he got angry. She said that he uses marijuana laced with other things. He grabbed a machete and attacked her, slicing into one arm, then the other, then her head. She was able to get away and to the hospital. The cut on her head was about 3 inches long. On the left arm there was a large flap of skin with a laceration (cut) about 8 inches, on the right arm a laceration about 6 inches. Another doctor and I took her to the operating room.
After putting her to sleep about 2:30 PM we got to work on the right arm. We washed it out and explored it. She had 4 extensor tendons cut in her right arm and some muscles too. I took off the dead tissue and slowly repaired each of the tendons. I closed up the outer sheath of the muscles and then skin, and placed her in a arm splint to relieve the tension on the repairs. That took about 1 hour. The other side had 7 cut tendons and the ulna bone had been sliced in half as well. I debreeded the dead tissue and started to repair the tendons. The orthopedic surgeon decided to put a plate on the bone so I undid the tendon repair, and the three of us doctors plated the ulna. First clean off the bone, next put the titanium plate in place. Then with the row of holes, drill a hole through the bone, then measure the thickness. Tap the hole, then choose a screw that is the right length for that hole and screw it in. Next do that repeatedly till it has about 2-3 screws on each side. We fit the bone fragments back in the hole behind it and then started the tendon repairs. Each tendon was a bit tedious to repair as they were about 1-2mm in size and I had a larger suture than I wanted- so added to the challenge. Eventually we were successful and closed up the other layers and put that arm in a splint. Next I cleaned off the head laceration and closed it with staples.
She was extubated (breathing tube taken out) and we went to the recovery bed. I explained to her family her injuries and what repairs I had done and the likely recovery course. It was 7:30PM. It was an interesting surgery. I went to get my rice and vegetable supper. They got a fridge today with cold drinks and some candy bars. That’s where I got dessert! Now off to bed after checking on her one more time.