Disaster Response B #10
Again we meet a variety of people here. Today I sewed up a guy who is from New Orleans who was working with a wrench and the nut let go and he hit himself with the wrench. As I sewed up his chin, he told me how they are trying to raise 2 barges that were sunk by the storm. He does underwater welding. He also mentioned that they can cut 4 inches of steel underwater when oxygen is used. He said to weld underwater you have to coat welding electrode with bees wax to make it waterproof so that it can be done.
I have two kids that were admitted with head injuries. One 11 year old boy was found having a seizure in the bathroom. We were able to get a CT of his head and he had an epidural bleed that was small. He did well overnight and a repeat CT was the same. When I checked in on him in the evening he was playing on his phone, and when I checked on him this morning- he was playing on it again. So today he went home.
The other was in his late teens. He had been riding a motorcycle and went into a telephone pole. He was unconscious for a few minutes then was thrashing about by the time he came to the ER. It took us about 4 hours to get a head CT on him from across the street. He had a small bleed in his head, a broken rib with a bruised lung, and a small broken bone off the edge of his pelvis. He required a lot of sedation to keep calm, but he is improving today and responding more appropriately. His repeat head CT doesn’t show any progression of his bleeding and remains small too.
I was asked to see another person who had had a stroke. They had no gag reflex. This means that if we attempt to feed them they are very likely to aspirate it. (breath it in). They can’t move the left arm or leg. So because the esophagus is paralyzed, a feeding tube is needed to keep them alive. So I was asked to place a gastrostomy tube. I waited till the family came in around noon and discussed it with them. At home I would place a PEG tube which is placed using a gastroscope , and puts the tube from the inside out. Here no gastroscope is available, so I discussed the small incision method of putting one in. After they agreed we took them to the operating room.
In the operating room they were put to sleep and a small incision was made in the upper abdomen. I realize that the liver was bigger than anticipated and comes down to the area of my incision. I pull it out of the way and find the stomach and choose a site for the tube. I make a separate hole for the tube and make a hole in the stomach and put the tube in. I put a purse string suture around it and start attaching the stomach to the abdominal wall. I then realize that the liver is going to be putting constant pressure on the tube site. That would not be good as it may disrupt the connection between the stomach and the abdominal wall. So it take it all back out and choose a lower skin tube site. Then I redo the same process. The lower site puts it in a good position for the liver and I close the abdomen. Later his family, his pastor and many friends come in. They gather around his bed and hold hands and pray for healing for him and also sing songs of praise to God. I am happy to see this outpouring of love for him.
Another patient works as a police officer. He has a ulcer on the bottom of his big toe that is infected. After walking around in the water of the storm it got much worse. So we take him to the OR to clean it out. We find that the dead tissue goes all the way to the bone and that the bone is soft and infected. He will need the big toe removed, once he is mentally prepared for it.
I know the ER is getting slammed tonight. Every few minutes I hear an ambulance come in. Guess I will see if I get called in tonight or not.