Today started out slow, but a little after 3pm Casualty got hectic.
We had 2 patients with incredible pneumothoraces (collapsed lungs). I've never seen chest x-rays that looked like these, even in text books. The collapsed lung on both patients was about the size of a golf ball. I took pictures of the films. The most common cause of a pneumothorax in this area of course is TB, which seems to be the most common cause of a lot of medical aliments here. So I spent part of my day restraining patients' flailing limbs while the doctor put in chest tubes.
One woman came in completely delirious, alternating back and forth between wailing in pain and singing. She had fallen off her roof while she was hanging clothes out to dry, and the hematoma on her forehead made it pretty clear she had hit her head. The hospital doesn't have a CT scanner, so we had to send her to the nearest town for a CT of her head, then she'll return here for treatment. She has been seen at the hospital before: 6 months ago, when she gave birth to her son.
Another man with either pneumonia or TB (not sure yet) came in with a O2 sat of 68% on room air. Ideally, you'd like your O2 sat to be at 100%, or at least 93%. He was in bad shape. We admitted him to the ICU.
And one woman had nothing physically wrong at all that we could find. She was complaining of generalized abdominal pain, and every time we asked exactly where the pain was she pointed to a different spot. She also said her chest kind of hurt, her arms and legs kind of hurt... I suspected it at first, but after all her tests and labs came back normal, I was pretty convinced this was entirely psychosomatic. It's incredibly common here, even more so than in the States. This is a culture in which neither men or women are expected to show emotions; they are a very stoic people. All that suppression is bound to catch up with you eventually, and it usually manifests itself as very vague physical symptoms. A pain here, an ache there, a loss of appetite. This occurs in both genders, but seems to be harder on the women. Nothing to do but reassure her that she's OK. Let this be a lesson to us all: let it out, your body will thank you.
We had 2 patients with incredible pneumothoraces (collapsed lungs). I've never seen chest x-rays that looked like these, even in text books. The collapsed lung on both patients was about the size of a golf ball. I took pictures of the films. The most common cause of a pneumothorax in this area of course is TB, which seems to be the most common cause of a lot of medical aliments here. So I spent part of my day restraining patients' flailing limbs while the doctor put in chest tubes.
One woman came in completely delirious, alternating back and forth between wailing in pain and singing. She had fallen off her roof while she was hanging clothes out to dry, and the hematoma on her forehead made it pretty clear she had hit her head. The hospital doesn't have a CT scanner, so we had to send her to the nearest town for a CT of her head, then she'll return here for treatment. She has been seen at the hospital before: 6 months ago, when she gave birth to her son.
Another man with either pneumonia or TB (not sure yet) came in with a O2 sat of 68% on room air. Ideally, you'd like your O2 sat to be at 100%, or at least 93%. He was in bad shape. We admitted him to the ICU.
And one woman had nothing physically wrong at all that we could find. She was complaining of generalized abdominal pain, and every time we asked exactly where the pain was she pointed to a different spot. She also said her chest kind of hurt, her arms and legs kind of hurt... I suspected it at first, but after all her tests and labs came back normal, I was pretty convinced this was entirely psychosomatic. It's incredibly common here, even more so than in the States. This is a culture in which neither men or women are expected to show emotions; they are a very stoic people. All that suppression is bound to catch up with you eventually, and it usually manifests itself as very vague physical symptoms. A pain here, an ache there, a loss of appetite. This occurs in both genders, but seems to be harder on the women. Nothing to do but reassure her that she's OK. Let this be a lesson to us all: let it out, your body will thank you.
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