So I pretty much took a break from writing in the blog during my last week in Santa. Now I'm in Puno for the festival de la Candelaria and while I'm resting to adjust to the altitude thought I'd catch up on this blog.
So my last week in Santa was jam packed with a busy call, a trip out to a distant community to pick up a patient, lots of interesting discussions, dancing, and the sad loss of a patient. So where to start....
My last call was filled with three semi-emergencies, but thankfully they all happened before 11pm. The first was a 3 year old girl that took a 3 meter (just over 9 feet!) fall right onto her head and per her mom had lost consciousness for a few minutes. Luckily they brought her right in and she was awake and screaming...and it was a good sign that every time I came near her she tried to push me away with both her arms and legs. There wasn't a whole lot to do, except observe. I checked her complete blood count....mostly to have a baseline in case later she showed signs of internal bleeding. After a few hours and some ibuprofen she was much calmer and was able to go home the next day.
The next patient that rolled in for me was, Cristian, a 14 year old boy who had a generalized seizure while working out in the country with some family and friends. One of the medical assistants who works at the center had been out there with him and she witnessed the seizure. She told us that it lasted almost 20 minutes and she was really afraid he was going to die. He'd never had a seizure before, so it was particularly scary for his family. When he arrived at the center he was post-ictal (the sleepiness that comes after a seizure), but he was able to answer my questions and move all his extremities. My main goal for him was to prevent him having any more seizures. Finding the cause for the seizures would be much more difficult. Thankfully the clinic has dilantin, but there are no automatic IV pumps, so with the help of one of the Peruvian docs we figured out how to dilute the loading doses and how fast to run them. I definitely want to get better at figuring out dilutions of medicines, preparing IV fluids, etc. It's crucial here. Anyway, I made my nice list of possible causes for his seizure and that was pretty much the extent of his work up. We ruled out meningeal malaria, he didn't have any signs/symptoms of infection, and his CBC looked good. There is no CT scanner or EEG and no one could say that he would definitely get either of these if he went to Iquitos. He also had a heart murmur which may or may not fit into the whole picture. Anyway, he didn't seize anymore and we sent him home the next day on oral dilantin. His family was going to see about going to Iquitos to see a neurologist.
The last emergency patient I had come in was a man in his 60's who was brought in lethargic and semi-responsive. His family had brought him by canoe to Santa from a village 4 hours away. I hated the thought of that man being on a canoe in that condition. When he arrived he was too weak to move himself from the stretcher to the bed and he was semi-responsive to my questions. We found out that he had had pretty bad diarrhea for about 5 days and then as it was settling down he decided to take a "natural purging solution" to cleanse out his system. Not a good idea! So then he started to vomit everything and couldn't stop. Thankfully his family brought him in, b/c 5 days of steady fluid loss is bad. Anyway, all we did for him was hydrate him and give him some anti-nausea medicine and it worked. And told him to never take another purging solution ever!! He was able to go home the next day as well.
So that's it my last call!
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