Some Thoughts And A Case

March 31st, 2015 by Brittni McLam


Here’s the view looking out over the river valley from the hospital compound


One of the joys of taking care of patients here is the variety. Common things are still common, but there are uncommon things also, and one never quite knows what to expect. We do a fair amount of prenatal care, and that at least is becoming a bit easier. Otherwise I feel quite over my head most of the time. Especially with children. Who are all scared of me, and I haven’t yet figured out how to win them over. My attending carries balloons to give out, but I didn’t think to bring any of those.


This has been the first time in a while that I have been abroad in a country where I cannot communicate at all in a second language. Its a rather disconcerting feeling! That and it is not culturally rude to stare, so one often feels like a parade animal or something. Or the piper with many children following through the market! They are beautiful though, and friendly, there are bright colors everywhere, and many sounds and lots of smells. Such a rich mixture for the senses!


Anyway, here’s a bit of something think about, with apologies to the non-medical readers…


A G1P1 mother and her newborn (3 hrs old) arrive at the clinic with a chief complaint of “poor sucking.” The night medic decides to admit them to your service. The mother is found to have abdominal pain, a fever, elevated white count, and UA suspicious for a UTI.


The newborn [your patient] is admitted also: Chief Complaint: “poor sucking”, estimated gestational age 38 weeks, born at home 3 hours ago. No prenatal care was available. Vital Signs: temp 97, heart rate 144, respirations 28, pulse ox 97%, weight 2.1 kg. No abnormalities are reported on exam. Plan is to encourage breastfeeding and monitor.


The next morning, there is report of a seizure at 0430. Staff started O2 and gave diazepam. On rounds, vitals are similar to above except RR is now 76, sats 95%. O2 is running at 1/2L with the prongs in the baby’s mouth. Blood glucose was 61, bili 11.9, a CBC showed WBC 20, Hb 18.9, Hct 59.5, platelets 217. Ca 9.13


What would you like to do? Feel free to email, or just ponder and I will post an update in a couple days 🙂