A lady was brought into the out-patient dittery on the feet supported on either side by her sons with a history of severe headache.I have learnt not to take things at face value so I dug for history further.The lady sounded confused but the bystanders insisted that the headache and loss of appetite were her main complaints for the past four days.On prodding further ,the son added that it had started with fever a few days back but had been treated by the local doctor for malaria(read quack).I still did not buy what they were saying so I took her to the casualty and started working on her regular parameters.Her BP,Pulse rate ,temperature and the GRBS was fine.Her saturation however was just 82 %.On clinical examination she had crepts in the right base.
Putting two and two together ,an hour or two later and she would have presented with hypoxic seizure and we would have been running around in circles for the diagnosis.This is a delimna of clinical presentation in this part of India.People rarely present with fever if the quacks have got hold of the patients.The regular fever treatment has steroids in the pack.
She had a beautiful florid right lobar pneumonia.I find myself having to demonstrate the clinical findings showiing them what a normal saturation should be and why the patient needs oxygen by putting the probe on the bystanders very often.Once they understand they are very cooperative.
The other day a man presented to the OPD with severe chest pain,cardiac sounding with a son who was very upset.ECG showed STEMI (ASMI) and so after confirming that they would not be able to afford TPI we decided to thrombolyse the patient with streptokinase.With prayers and a graver understanding that we do not have a defibrillator I started the streptokinase and parked my self next to the patient by the monitor for the next hour,keeping a close watch on his heart on the monitor.He responded well.His STEMI reverted and he was completely pain free and stable after a couple of hours.I had put him on enoxaparin ,by the following day when I went for rounds, he was sitting up in bed and he gave me a wide grin and asked me ,'Am I supposed to just lie down like this or what?'In other words ,he was completely well and did not think he needed to be in the hospital anymore.I understood his logic and so I found myself explaining to him that he had had a major cardiac event.I discharged him by the third day as soon as he finished his three days of enoxaparin .
The other day a tall ,well built man from the village just walked into my OPD with a bystander and when I asked him what his problem was ,he said I don't have any pulse or BP ,just examine me.I was taken aback and then gathered that he had been to the local doctor who had benn confused by his lack of pulse and had asked him to move to a higher centre.He had no other complaints.I rushed him to the casualty,'He walked'.I lay him flat on the bed and got around to getting an ECG on him.He had a PSVT .We had no defibrillator,he had no pulse or BP,but inspite of his wacky hemodynamics he had no complaints of dizziness ??? we could see his precordium dancing away but he insisted he had no palpitaion.
On our insistance he agreed to lie flat the entire time.We put him on Oxygen ,started him on IV fluids and digitalised him with 500 micrograms to start with and 250 mics eight hours later.When I came to see him at ten o'clock at night he was still the same ,his heart rate persisted to be high and the BP was unrecordable.By eleven he was due for the second dose of digitalis which he duly got.By midnight ,when I called up,he had reverted to normal sinus rythem and had a blood pressure of 130/80.
In the meantime we got hold of some oral verapamil and put hom on it once the blood pressure and the rythemn was controlled.When we saw him in the morning he gave me a wide smile and told me ,'I am feeling fine now'.It seemed ironic that he never once told us he was poorly the entire time he was in shock.
We are grateful to God for these small medical victories .
Putting two and two together ,an hour or two later and she would have presented with hypoxic seizure and we would have been running around in circles for the diagnosis.This is a delimna of clinical presentation in this part of India.People rarely present with fever if the quacks have got hold of the patients.The regular fever treatment has steroids in the pack.
She had a beautiful florid right lobar pneumonia.I find myself having to demonstrate the clinical findings showiing them what a normal saturation should be and why the patient needs oxygen by putting the probe on the bystanders very often.Once they understand they are very cooperative.
The other day a man presented to the OPD with severe chest pain,cardiac sounding with a son who was very upset.ECG showed STEMI (ASMI) and so after confirming that they would not be able to afford TPI we decided to thrombolyse the patient with streptokinase.With prayers and a graver understanding that we do not have a defibrillator I started the streptokinase and parked my self next to the patient by the monitor for the next hour,keeping a close watch on his heart on the monitor.He responded well.His STEMI reverted and he was completely pain free and stable after a couple of hours.I had put him on enoxaparin ,by the following day when I went for rounds, he was sitting up in bed and he gave me a wide grin and asked me ,'Am I supposed to just lie down like this or what?'In other words ,he was completely well and did not think he needed to be in the hospital anymore.I understood his logic and so I found myself explaining to him that he had had a major cardiac event.I discharged him by the third day as soon as he finished his three days of enoxaparin .
The other day a tall ,well built man from the village just walked into my OPD with a bystander and when I asked him what his problem was ,he said I don't have any pulse or BP ,just examine me.I was taken aback and then gathered that he had been to the local doctor who had benn confused by his lack of pulse and had asked him to move to a higher centre.He had no other complaints.I rushed him to the casualty,'He walked'.I lay him flat on the bed and got around to getting an ECG on him.He had a PSVT .We had no defibrillator,he had no pulse or BP,but inspite of his wacky hemodynamics he had no complaints of dizziness ??? we could see his precordium dancing away but he insisted he had no palpitaion.
On our insistance he agreed to lie flat the entire time.We put him on Oxygen ,started him on IV fluids and digitalised him with 500 micrograms to start with and 250 mics eight hours later.When I came to see him at ten o'clock at night he was still the same ,his heart rate persisted to be high and the BP was unrecordable.By eleven he was due for the second dose of digitalis which he duly got.By midnight ,when I called up,he had reverted to normal sinus rythem and had a blood pressure of 130/80.
In the meantime we got hold of some oral verapamil and put hom on it once the blood pressure and the rythemn was controlled.When we saw him in the morning he gave me a wide smile and told me ,'I am feeling fine now'.It seemed ironic that he never once told us he was poorly the entire time he was in shock.
We are grateful to God for these small medical victories .
Comments