Just another day

Nothing remarkable happened today, I just took a handful of pictures and thought it was worth sharing with you all!

 Jen sharing his butterfly ultrasound probe with all of this morning during rounds. Truly an amazing tool to have in any setting, especially when resources are limited. I have found myself using the portable ultrasound machine (sonosite) that we have available to us far more than I did at home just because CT is so expensive (although we do have one here!).



The visiting surgical team from Singapore rounding on one of their post-op patients this morning in one of our private rooms. This patient had an open cholecystectomy and was doing well this morning. (That's Badura on the far right, our trusty and amazingly brilliant translator!)

 This was one of our ICU level patients this morning. I initially admitted her a few days ago when she presented with profuse diarrhea for several days. She was hypokalemic to <2.0 and hypotensive. That improved somewhat by 48 hours, but that's when she started to go into alcohol withdrawal after not drinking for 4-5 days. I unfortunately failed to get that bit of history from her. She never seized, but went into DTs, subsequently having an aspiration event, leading to persistent hypoxia through yesterday. This is Jen showing me how to use the CPAP machine, which you have to hold to the face manually, unless you make a strap out of tape. While her oxygenation did improve with supplemental O2, she remained markedly altered, hardly waking to voice. This morning her platelets dropped to 22K, prompting us to transfer her to the nearest government hospital for more appropriate ICU level of care.


If she were Burmese and without a medical insurance card, she would not have access to the Thai medical system and we would have to do our best by broadening her antibiotics and crossing our fingers. Fortunately, her Thai medical card will get her healthcare at any of the government hospitals for 30 Baht ($1).



I don't know much about this baby other than her mother had a C section at the hospital at some point during the day while I was seeing patients in the outpatient clinic. From what the nursing notes say she was born at 37 weeks, but was hypoxic on delivery thus the oxygen box around her head..



This was one of my last patients of the day, a ~10 year old girl who had fallen onto an outstretched left hand about 10 days ago and had some snuff box tenderness on initial evaluation. Her exam was largely very benign, and she had a negative xray, but given the tenderness I put her in a plaster thumb spica and had her follow up today (10 days later) for repeat xrays and reeval. Well this is how she showed up in the clinic with her "thumb spica". Her mother said the thumb part fell off about 5 days ago. The good news was she had no pain, no swelling, and no suspicion for a true scaphoid fracture. And also, this just made me laugh :)


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