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Showing posts from August, 2014

Where less is more…

In my three months of tenure in Lakhnadon I have but lost one patient truly .There were two young kids with aluminium phosphide poisoning and one lady who was brought in decerebrtating ,a case of hanging which I would not count because they were expected to die anyways,we do get extremely sick patients reffered to higher units by our colleagues from the government hospital and local nursing homes. I have been severely restricted in my patient management due to lack of equipments. In my earlier tenures I have seen aweful iatrogenic faux-pas in well-equiped places which have given me restless nights. Having talked to a physician colleague who works in a critical care unit in a research institute and her observation that patients actually do better in a peripheral set up because we are less invasive ,I wonder if she is right.She was talking about how elective intubations expose patients to nosocomial infections and the pneumonia resulting greatly increases the cost for the patient beca

Uncomfortably comfortable.

Today,I stand in a strange place. I do my rounds of the hospital ward and I wonder where I am . I have two ladies who have undergone total abdominal hysterectomies,one gentleman who has undergone resection anastomosis who has just started liquid diet,one gentleman who had his obstructed herniae released and underwent a herniorhaphy with a mesh insertion,two ladies who delivered by caeserian section,one lady with a breast abscess who underwent incision and drainage,one patient post-snake-bite who underwent skin grafting,one patient who has come for exploration of the sole of his feet for probable foreign body.One gentleman who has presented with a bad wound infection post-electrocution for wound debridement. I also happen to have a lady with unstable angina,a young kid on ambu ventilation for snake-bite ,a few patients with fevers and acute gastr-enterites. By the grace of God they all are doing well. These past few weeks I have seen a lady with a haemoglobin of 1.


Malti was brought in with snakebite. A tribal from a village in Seoni ,was not talking,drowsy and had labored breathing. We pumped in ten vials of anti-snake venom ,gave her neostigmine and atropine, intubated her and taught the relatives to ventilate her with an ambu-bag. She needed ten vials more but financial constraints on the part of the hospital and the relatives did not make it possible. At ten in the morning the nurse anaesthetic after consulting me decided to extubate her.However, on extubation, her breathing stopped.I was busy attending to another patient ,so the nurse anaesthetist intubated her and she was back on ambu bag.The whole village it seems were keeping a vigil in the vicinity of the hospital so there were no dearth of hands to bag her. We had given them some tips about watching the saturation et,al. At around ten–thirty at night I received a phone call from the nurse asking me to attend to the patient immediately as she was bloating everywhere.I rus