{"id":17,"date":"2013-05-13T19:19:28","date_gmt":"2013-05-13T19:19:28","guid":{"rendered":"https:\/\/inmedblogs.us\/jeffreywalden\/?p=17"},"modified":"2015-06-08T19:23:10","modified_gmt":"2015-06-08T19:23:10","slug":"male-ward-and-snakebites","status":"publish","type":"post","link":"https:\/\/inmedblogs.us\/jeffreywalden\/2013\/05\/13\/male-ward-and-snakebites\/","title":{"rendered":"Male Ward And Snakebites?"},"content":{"rendered":"

\"kiwoko-female-ward\"<\/a><\/p>\n

 <\/p>\n

This past weekend was Murchison Falls.\u00a0 It deserves its own separate post and also deserves pictures.\u00a0 Unfortunately I cannot upload over this internet connection.\u00a0 Suffice to say that we saw plenty of antelope, hippos, crocs, herds of giraffe, monkeys, troops of baboons, a lion, had our way blocked by a herd of elephants, and also had a cape buffalo threaten to charge our van.\u00a0 It was also a bit of a challenge arriving at the National Park as our clutch gave out several times and we were stranded at one point for over an hour, surrounded by Tsetse flies (whom our guide assured us \u201ccarried no diseases\u201d \u2014 yet we had admitted a patient with African trypanosomiasis just the week before).\u00a0 But pictures and more later\u2026.<\/p>\n

 <\/p>\n

Today was my first day on Male Ward.\u00a0 I am working with Dr. Natasha.\u00a0 We\u2019ve had several interesting patients, including a 10 year old who was admitted for snakebite.\u00a0 He stated that he had been swimming the day before (Sunday) and had felt a \u201cbite\u201d under water.\u00a0 His father had watched him for most of the day but then brought him to the hospital on that evening.\u00a0 He presented with a decreased level of consciousness (GCS score of 10 \u2014 which basically meant he was moaning and withdrawing from pain, but not much else) and continued to drift in and out of consciousness.\u00a0 He also had labored breathing.\u00a0 Due to this, and the history of snakebite, he was given anti-venom late last night.<\/p>\n

 <\/p>\n

Today, when the admitting physician came to see him, he was sitting up and talking in bed, no longer confused.\u00a0 He\u2019d had no bleeding, and his main symptoms had been decreased respiratory rate, hypotension, confusion, and pain\/swelling in his left leg (the bitten leg).\u00a0 He\u2019d had no bleeding and had also been started on antibiotics (cloxacillin here staph\/strep infections as they don\u2019t have MRSA yet) the night before as well.<\/p>\n

 <\/p>\n

It didn\u2019t really sound like a snakebite to me.\u00a0 For one thing, puff adders are the main snakes here, and they are in the pit viper family, similar to rattlesnakes and copperheads, which produce an anti-coagulant and not neuropathic venom.\u00a0 Cobras and black mambas are the other poisonous snakes here, but these produce neuropathic venom similar to coral snakes at home as they are all from the elapid family.\u00a0 In the US at least, the two antivenoms are very different, and in the British Formulary (used here) they are not to be mixed.\u00a0 No one here knows if the antivenoms are combined or separate.<\/p>\n

 <\/p>\n

However, for this patient, he\u2019d had no bleeding.\u00a0 He had had neurological symptoms, but not the ones typical of snake bite, which is almost an like Guillan-Barre in that it is ascending paralysis (if bitten on a lower limb).\u00a0Later today, when we rounded on him, he had a clearly red and unilaterally swollen limb and still had fevers.\u00a0 He had no fang marks, indeed no skin breakage of any kind on his foot, which is where he swelling was the most pronounced and where he thought he\u2019d been \u201cbitten.\u201d\u00a0 There was definitely no signs of skin necrosis, which would be expected if he\u2019d had enough venom injected to cause systemic symptoms.\u00a0 It looked much more like he had a case of bad cellulitis.<\/p>\n

 <\/p>\n

Interestingly, as we were discussing him his blood smear came back positive for malaria. This explained the fluctuating fevers and altered level of consciousness.\u00a0 We started him on anti-malarials as well as increasing the dose of his cloxacillin.\u00a0 Dr. Natasha is not convinced that it\u2019s not snakebite, but she did hold off on any further antivenom (he became confused and disoriented a few minutes after we rounded on him, but improved greatly this afternoon after being started on his meds).\u00a0 More to follow on him tomorrow.<\/p>\n

 <\/p>\n

We also had a patient with blood pressures of >200\/>100.\u00a0 He has diabetes, hypertension, and chronic renal disease.\u00a0 It\u2019s just like being back home!\u00a0 Otherwise, many patients had gastroenteritis, HIV including cryptococcal meningitis and two with toxoplasmosis, malaria, typhoid fever, TB, and a couple of patients that we\u2019re still trying to figure out.\u00a0 One of the patients positive for toxo titers also has what seems to be hemi-neglect (meaning he totally ignores\/doesn\u2019t see the left side of his visual field) as well as total left-sided weakness and persistent myoclonic jerks (meaning his left arm and left leg constantly jerk) that doesn\u2019t respond to diazepam or phenobarb.\u00a0 I<\/p>\n

 <\/p>\n

Also of note, regarding blood transfusions \u2014 they don\u2019t transfuse blood unless the hemoglobin (called Hb here) unless its lower than 5.\u00a0 In the States, the transfusion threshold is 7.\u00a0 We routinely see Hgb\u2019s of 2 and 3, sometimes in kids who were running around and playing earlier that day.\u00a0Otherwise, all\u2019s well, back to Male Ward tomorrow.<\/p>\n","protected":false},"excerpt":{"rendered":"

  This past weekend was Murchison Falls.\u00a0 It deserves its own separate post and also deserves pictures.\u00a0 Unfortunately I cannot […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-17","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/17","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/comments?post=17"}],"version-history":[{"count":0,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/posts\/17\/revisions"}],"wp:attachment":[{"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/media?parent=17"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/categories?post=17"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/inmedblogs.us\/jeffreywalden\/wp-json\/wp\/v2\/tags?post=17"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}