Dept Of Anesthesiology & Critical Care, University Of Pennsylvania School Of Medicine

PENN MEDICINE In Haiti -- Dispatch 14

January 30, 2010 10:42

Subject: Education and teamwork

 

Yes, Tom Floyd is a real man. Today we are doing a case that requires good muscle relaxation, which is not commonly used here. While they have ventilators on the anesthesia machine, it uses too much oxygen, which is supplied by tank and is in short supply. Therefore, when used, assisted ventillation is by hand.

 

The local team does not use neuromuscular monitoring, a skill we are introducing to them. In this photo, Tom Floyd is demonstrating what a normal response is on himself. He then compared normal to the patient after vecuronium.

 

I am waiting to hear the yelp when they try this on themselves...

 

The local staff are exhausted. In spite of this, and even after working late last night, their team returned early thus morning to do a full day's worth of cases on a day off. The physicians joined us for rounds at 6:30, and are helping with anesthesia and scrubbed in learning from our physicians.

 

This includes all the support staff, including folks to clean and sterilize equipment between cases.

 

A very impressive group of dedicated health care providers.

 

Michael

 

PENN MEDICINE In Haiti -- Dispatch 13

January 30, 2010 10:30

Subject: Empty beds

Today for the first time we found empty beds and open floor space while rounding. The inflow of earthquake trauma patients is slowing down.  We are starting to see an influx of patients with a wide variety of advanced disease presenting for care.

One such patient is a young boy who appears to have advanced osteosarcoma. He has a very large lesion on his lower leg with a large solid node in his groin. We will do a biopsy tomorrow, but the outcome is poor in any country if he has the advanced disease we fear he has.

While empty beds are hopefully a good sign, thus is not always the case. This was the bed for the boy who fell off the horse. He died last night at 9 PM with his mother and our nurses nearby.

Michael

PENN MEDICINE In Haiti -- Dispatch 12

January 30, 2010 08:53

Good morning.

We operated relatively late last night, finishing our cases around 9 PM. The good news is that the day went very well, and we did some good.

This photo is our improvised efforts at telemedicine. We are taking a photo of Xrays or wounds, then sending them via e-mail to colleagues home for suggestions.  This is working out rather well.

Today we have a full OR schedule plus several dressing changes under anesthesia that we do on the floor (literally).

The team is healthy and in good spirits. None of us slept well, because the dogs and bats were out in full force. We blame the full moon.

  Tom got up in the middle of the night to tell them to shut up in English. Fortunately, the dogs appear to speak English, and moved away to continue their howling.

Until next time,

Michael

 

 

PENN MEDICINE In Haiti -- Dispatch 11

January 29, 2010 17:56

Subject: Day 4 update

 

We are having a rather busy day today. Our OR schedule was disrupted when this young man arrived in the morning. He fell from a gourde and became unresponsive. It appears that he has an epidural hematoma, although we do not have access to anything other than plan film X-Ray.

 

We took him to the OR to do an emergent Burr hole, but the procedure was not done when we were unable to find a neurosurgeon who was available to care for him. As a result, he us receiving medical management only.

 

He has only his mother at his side. He lost his father in the earthquake. Mom spent all she had to bury her husband and has nothing left. We will look into how much she needs to bury her son and do what we can to help.

 

We will now need to operate into the evening to allow us to keep up with need. Our OR schedule is full through Monday, and we are now booking into Tuesday. We are starting to schedule all procedures we expect any individual patient will need, so that definitive care is completed on as many patients as possible.

 

This afternoon "wound rounds" took almost 3 hours. We use a fair amount of ketamine for the children, as many have open wounds. We are learning how to do anesthesia on the floor, literally. Today we had to move from the cast room to the floor by a plug because the extension cord died in the middle of removing a cast in a child. Once the old cast was off we moved back to the cast room.

 

Until next time,

 

Michael

PENN MEDICINE In Haiti -- Dispatch 10

January 29, 2010 13:39

Subject: Her momma is dead

We are now well into our third day of surgery.  We have 12 big cases and several small cases scheduled. We are trying not to do too many cases, but the local hospital is now asking us to take care of more and more people.

That hospital has stayed at 200% normal patient count, and they are admitting 10-15 patients a day as more people leave Port au Prince.  Many are trauma patients who require surgical care.

We cared for a 12-year-old girl with a femur fracture. As she was waking up from her procedure she was calling for her momma, a term recognizable in most any language.

The response, which we have heard before, was "Her momma is dead."

We returned this young lady to a living grandmother.

Michael

 

DSS: I made some minor edits for phrasing and abreviations

PENN MEDICINE In Haiti -- Dispatch 9

January 28, 2010 11:05

SUBJECT: Cases underway

Today we have scheduled 12 cases, but the cases we do change as the day progresses due to new patients as well as changes in priority.

 

We are caring for several people who have undergone amputations who then became infected before they could undergo final wound closure. As a result we are revising lots of these wounds.  We will then bring them back for washouts until clean enough to close.

 

The first case was a young girl with open wounds on her legs and arms.  We are hopeful she will not loose a limb, but she will need skin grafts when the wounds are ready.

 

The CRNA I am working with is intermittantly tearful, and has been all morning. Caring for the girl was hard for her. I don't know what family members she lost, and language barriers and work environment prevent me from talking about this. However, her courage in coming to work to continue to care for these folks is amazing.

 

Today we gave the anesthesia team some more if the supplies we brought. They are very grateful for the gifts provided by Penn. Thank you for allowing us to provide these supplies.

 

We are integrating our supplies with the existing supply chain with rare exception. This is appropriate, especially given that we are the only team here operating.

 

Patient flow is much improved now that we know each other. It has been fun working towards integrating our team into this hospital. I would like to think that while the beer helps, ultimately it is the skill of our surgeons that did the trick. That, plus their obvious compassion and efforts to treat everyone with respect.

 

Regards

 

Michael

 

DSS: I made minor edits for spelling, and a minor change in some of the wording.

PENN MEDICINE In Haiti -- Dispatch 8

January 28, 2010 07:37

Subject: Start of day 4

Good morning from the steps of the Friendship House. While waking up thus morning we were met by beautiful Africian music coming from the church.  Not a bad way to start the day.

We finished up yesterday a little before midnight. However, Derick and Bab had to return to tend to a patient with some post- op bleeding.

We did 13 cases yesterday, including several children. Two were ASA 4, and several more were 3's. One was on a dopamine infusion (no pump) in the ward for pressure support.

Today we are working on our pacing skills, and have established a schedule we hope to follow for the remaining of our stay. Patient rounds at 0630, resupply at 0730, breakfast at 0800, team meeting at 0820, operations start at 0930, lunch- dinner at 1430, more operating in the afternoon, finish OR cases by 1900. We will work in a couple of hours of wound rounds in the afternoon.

Wish us luck!

 

Michael

PENN MEDICINE In Haiti -- Dispatch 7

January 27 14:05

Subject: Improvise

No view boxes in the OR, so Xrays hang from the ceiling. The ortho docs are making do with no fluro, of course, and by all measures are doing a great job. The case they are doing now may allow the young woman to keep her leg.

Michael

 

PENN MEDICINE In Haiti -- Dispatch 6

January 27, 2010 14:03

Subject: Surgery has started

 

All patients we are operating on who are not in the building the ORs are located in are transported to the building, leading to patients everywhere.

 

We are running 2 rooms. The 2 ortho docs are doing their thing in one room, while we have a rather full general surgery schedule in the other. The patient below is our third case. She is a very ill young woman undergoing a cholycystectomy. Tom, 1 of our 2 Anesthesiologists, was recruited to assist. As a result, I am doing anesthesia in both rooms with the wonderful help of the local team.

 

Michael

PENN MEDICINE In Haiti -- Dispatch 5

Wednesday, January 27, 2010 13:56

We had an occasion to go to the emergency room this morning when the local team asked for our help. The ER consists of an entrance way and 1 room. It is amazing what they can do with what they have.

 

The lines quickly form for triage. In addition, this is where families wait as well.  Two of the 4 areas that hold trauma and surgical paitents are located in adjacent building.

 

Michael