Before I start I should warn all you non-medical people this is a highly medical post, I'm sorry if it is boring or confusing for you.
When you do anything for a while it becomes your normal. There are occasional variations in the normal but you have the expected variations that you are prepared for. Working at Tenwek there is a type of patient that I have gotten to know very well – the “poisoning patient” these are individuals who have attempted suicide by ingesting chemicals, often pesticides that they have on hand.
We have 1-2 of these patients a week and the treatment is usually along the lines of gastric lavage, intubation and ventilation if unconscious, atropine for low HR, watching electrolytes and if all goes well in a few days extubate them. They get them some counseling and they go home. Depending on the poison taken some patients end up dying due to electrolyte or other abnormalities but this is still in my thought process of “this is normal for a poisoning patient”.
So when I got called to help set up a ventilator for a poisoning patient I did not think much of it. The patient came, I placed him on a ventilator – no problems. A few hours later I got a call from the physician. The patient now had subcutaneous emphysema and it was getting worse. My immediate thought was my ventilator did something funny – so I asked the staff to bag the patient and went up the hill to see what was up. The ventilator was working fine – well not fine, it's old, but it was not doing anything that would cause a pneumothorax. However, an x-ray was done and it showed a large left pneumothorax the surgeons came placed the chest tube and things went back to normal. Not sure how he got the pneumo as his ventilating pressures were normal – did he have a pre-existing bleb that popped? After a few more days on the ventilator,a chest tube removal, reinsertion and removal again. The patient was eventually transferred to the ward and I pray that with the help of counseling from our chaplains that he will make a full physical, spiritual, and emotional recovery.
This patient was not my only abnormal poisoning that week. This time it was a 2am page – we have a poisoning patient and we cannot get him oxygenating well on the vent can you come help? So up the hill I went. When I arrived I saw the patient settled on the ventilator with Spo2 -80’s. I took a listen and didn't hear any air entry on the left side. So I took a look at his x-ray and saw that his left side was completely whited out. OK,not normal. I didn't think this was in relation to the fact that this man had taken poison. So after fiddling with the vent – high PEEP, low PEEP, high rate, lower rate etc. I finally got to some vent settings that the patient managed to oxygenate with. The next day he went for bronchoscopy and he had a huge mucus plug blocking of his left mainstem bronchus – not normal. The next morning I also try to put together more of the history, he had seized in casualty – secondary to hypoxia? Had this man even taken poison? This patient had questions continually running through my brain. Sadly I never found out the answer, I left to Nairobi for a few days and when I came back I learned he coded and died. I pray that he knew The Lord.
Sorry to have this post end on a sad note. My next post will be much less medical and be a little more fun.