Disaster response B #5
It sounded so nice. A patient is in the hospital and almost always has family around them. This evening many were gathered around and singing hymns to the patient. They sang beautifully and loud. Other patients families joined and as well as some of the staff. This evening was a loud evening. Claps of thunder, music blaring from a loudspeaker somewhere with hymns on it, and the singing in the hospital. Earlier in the evening I rounded with the surgeon that came over to round with me.
The day also started with rounds with one of the local surgeons. Then I went to the OR to see one of the orthopedist dressing changes. He has very different method of wound management than I’ve never seen before. So I wanted to see how his dressings worked and his methods. This patient had had an infection in their foot after the hurricane. The infection was in a number of compartments of the foot. He had taken the patient to the operating room and opened about 5 different compartments in the foot and ankle area. Then he placed a plaster cast with a lot of padding. He told the patient to walk on it. He says the cast causes a hydraulic force in the foot to squeeze fluid out and push it up the leg. The padding and cast absorb the fluid, then he leaves it in place for 4-5 days. The dressing was saturated but the skin and wound looked well, and healing granulation was starting.
Next was a guy with an anal fissure. He had tried a variety of topical treatments and no change for about 4-6 months. He wanted it fixed as there was burning sensation with it. We took him to the OR. In the OR I found the area of the fissure and went laterally on the anus and made a small incision. Finding the 2 muscles that in-circle the anus, I cut the inner one. The inner one spasms, and keeps the fissure from healing. The outer muscle is the one that maintains continence. I injected a bunch of local anesthetic and then finished the operation,
Another patient had a small hole in her leg. She described being with her family in their villa when the storm hit. They were up on a hill, so they didn’t get flooding, but did get wind and rain. The windows broke and the roof started to leak. They huddled in the bathroom in the center of the house. Pieces of roof were crashing all around them and they were running to get out of the house when something hit her let. She didn’t think much of it when they were running for their lives. Later when she took off her pants she realized there was blood running down her leg. It seems to be hurting more so she came in to be seen. I looked at the wound and it appeared like a small ulcer. After numbing her up, I took off the dead stuff and found a hole that went nearly down to the bone in her leg, about an inch deep. I cleaned it out and packed it.
I go by the ER frequently to see if there is something I can help with as our Er docs are getting 2-3 hours of sleep a night and are going the entire rest of the day. They said I could see a boy for them. There was a 14 year old boy who came in. He was chasing a friend and stepped in a puddle of water and slid and fell and split open his chin. He told me he was afraid of needles and had passed out before. He asked if he could be put to sleep so that it could be closed. I said no, but if he passed out, he would be asleep for it anyway! I sprayed lidocaine in the wound and waited while I prepared everything. After that I was in the process of injecting lidocaine, when the ER doc brought up a light on a stand to help me see. He lifted it up and aimed it down at the boys chin. Just then the light slowly slumped and went down. I looked at the doc and joked that it needed Viagra. Both the boy and his mom just busted up laughing. The boy did great with the injection and I was able to close it up without problems.