This patient had been in a prior accident and was being treated for an ankle wound. I was chart checking the medics and saw he had fevers for 6 days despite being on antibiotics (Cloxacillin is their gram positive med and they had him on IV Metronidazole too). He would be a Sepsis Alert in a bigger hospital. Yesterday was my second clinical day this week and he had been admitted last Friday after I left. I saw all medical patients 2 days ago and then saw all the trauma patients yesterday, along with the sicker medical patients again. So I went to examine him for the first time, already intending to tweak his antibiotics with some I bought from India. His ankle was warm and tender but not swollen or oozy. He said it felt a lot better but his ipsilateral thigh was hurting a lot. I noted a warm, swollen, and tender thigh. He had a healed surgical scar there. I grabbed the ultrasound and discovered a big fluid collection all along the top 2/3 of his femur. One portion was encapsulated. SO, he got started on Vancomycin. It was the nursing staff’s first time to administer Vanc, and all went well other than patient itching which resolved with Benadryl. I asked the surgical procedure staff to see him first in the morning. Today, I happened to be looking for procedure supplies and walked in on them I&D-ing this patient. Ultrasound didn’t lie. Check out this luxurious, silky pus streaming out of that thigh 😁 300cc’s today. Patient feeling better today. I was soooo happy the surgical team told me “Good job, Teacher!” Because it can take a long time to win over staff in this type of environment. They call me “Rah-moon,” which literally means Teacher in Karen/Kayin language but is what they call the doctor.
Big Head Baby: "Snow Falling Down"
Back in August, before I arrived here, a Burmese mother arrived at the hospital in labor. She had not wanted another pregnancy, so she took some medicines to try to abort the baby. The medicines didn't take, though, and she remained pregnant. She did not have any prenatal care, so did not know to take vitamins or alter her nutrition. It is also possible she just wasn't able to obtain any of those things. When she was in the prenatal area, a cursory ultrasound showed that the fetus had an abnormally large head, so the mother was transferred to the bigger hospital for a c-section. The baby girl was born with severe congenital defects, including cleft lip and palate, microphthalmia of her right eye, one shortened arm that never developed a forearm and had a vestigial non-bony finger at the end, abnormal fingers of her other hand and toes of both feet, and of course hydrocephaly. I have not been able to procure the early imaging of the baby's head, but another volunteer here ...
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