This post was originally written on Thursday, September 30, the day that these events happened.
There is a lot of medical mumbo-jumbo in here, so I will include a little glossary at the end.
I was awakened today with a "999" page to the nursery. "999" here means come immediately, do not call first. I had slept in scrubs since I was on call, so I jumped up, threw on socks and shoes and hurried to the nursery. I found one of our patients, a child born with encephalocele, had stopped breathing and the nurses were giving bag/mask ventilation. The child had ventilated easily with the bag and mask, and sats and HR were good with bagging. The problem was that when you stopped bagging, there was NO respiratory effort at all. Not a gasp, nothing. Because the encephalocele implies that there is a good chance of a brain abnormality, it is debatable here whether you would intubate this child or not, because the child might never make an attempt to breathe again. I checked quickly to see if ICU had a bed and a ventilator available, and they did. Next I had to talk with one of the main docs here and also the pediatric neurosurgeon. The opinion was that this child should be given the opportunity to be ventilated, at least for a few hours, to see if he would begin to breathe on his own again.
I returned to the nursery, and with the help of the intern and the nurses, we intubated the baby and transported him to ICU for ventilation. I received a crash course in the little ventilators we have here shortly after arrival, and have previously had to change ventilators once since I have been here, so I was able to grab the ventilator and get it ready to go for this child (no respiratory therapists here to set eveything up). We settled him into ICU and ordered a chest x-ray for tube placement. Side note: the parents later asked if the child could breastfeed while on the ventilator. This was not the first time I have heard the question asked since I have been here.
I then returned to nursery to grab the things I had left there. I walked in to find a 3 day old who was just being admitted after driving all night in an ambulance from Somalia. This child had bilious vomiting and an incredibly distended abdomen. The child had not stooled once since birth. Examination turned up a good reason for no poop: no anus. We ordered some preliminary labs and films and called the pediatric surgeons to come see him. They came and agreed to operate on him today. Fortunately, the rectum was very close to the skin surface, so they were able to just open up an exit for him.
No Anus = No Poop and a Really Distended Tummy
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After that baby was admitted, I went back up the hill to the apartment and finally showered, changed, and ate breakfast. I returned to the hospital and went about the usual daily activities, which led to me seeing a 7 year-old boy with significant direct hyperbilirubinemia (total 19, direct 11), fever, and proteinuria. I was also called to the clinic to see a child with a positive Gower's sign, which suggests Duchenne Muscular Dystrophy. I am hoping that maybe he has a spinal cord lesion instead, but we found out that there was a family history of DMD, so DMD is the likely diagnosis.
And, earlier this week, we had a girl with carpopedal spasm and a positive Chvostek's sign, which I have never seen before. She ended up passing away, so please feel free to pray for her family, as they are undoubtedly mourning her loss.
Glossary:
Encephalocele - a "neural tube defect" in which there is an external sac at the base of the skull which may contain membranes and fluid only or may contain brain tissue. Related to spina bifida.
Gower's sign - when a child uses his arms to help straighten/strengthen the legs as he stands up.
Carpopedal spasm - spasm of the hands and feet associated with low calcium
Chvostek's sign - twitching of the mouth when the facial nerve is tapped or percussed. Also associated with low calcium.
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