Day 11 - Code Black

The morning started off slow, then we had a mass casualty. One patient walked in with a head injury from a road traffic accident (RTA) and we started to evaluate him.  Auna was asking questions and getting the ultrasound for a FAST exam and when I turned around, suddenly there were two more young men on stretchers behind us.  They were from the same RTA, a lorry carrying oxen collided with a car.  One of the men was drowsy, very difficult to wake up, and wouldn't answer questions.  The second was alert and talking with abrasions to his arms and legs.  I started to evaluate the drowsy patient, when another young man from the RTA was rolled in on a stretcher in worse condition than the drowsy guy. This one was very difficult to wake up as well and was initially talking, but then stopped. Then, two more men walked in and sat in chairs, both from the RTA but in better condition than the 4 we had on beds. We saw each patient, did a FAST exam, wrote radiology and lab orders on each, and laid the paper slips on their beds.  We had no names, no charts.  We started each note and left those on the stretchers too.  We thankfully had extra nursing hands and one GP from the room next door to help carry some of the load. The two sickest patients, with altered mental status, each needed a CT scan but the friends with them only had money for one of the two patients.  The most altered went to CT scan and had a severe fracture of his C1 vertebra. It is a miracle he is not paralyzed.  He had to be transferred to the capital as we do not have a neurosurgeon here.  We don't know what kind of injury the other altered patient has (maybe a concussion, maybe a head bleed) but we could not get imaging. Maybe he will be observed in the hospital, maybe he will go home with his family if they can't afford the hospital stay. 

As soon as things started to calm down after the mass casualty, another patient was wheeled in on a stretcher salivating, vomiting, and lethargic.  He smelled of pesticides and his friends said he "drank poison."  Our first organophosphate poisoning!  The nurses immediately put an NG tube in the patient and started gastric lavage with normal saline (we don't intubate for airway protection here) and we gave him 2 mg atropine IV (we also don't have 2-PAM here).  His secretions cleared up almost immediately and he stopped vomiting.  We admitted him to the ICU for close observation and more atropine as needed. 

Our lunch break was much needed after a ridiculously busy morning!  The afternoon was much quieter at least in the ER, but a crowd of people gathered outside on the hospital grounds to watch a helicopter land and stood staring until long after the passengers left.  We ended our work day with an airway lecture and intubation practice with the GPs and some nurse anesthetists at the hospital, with an encore lecture/lab planned for Friday.  Then, we celebrated our first of two Thanksgivings with the family with whom we share our house.  Our second celebration will be on Saturday, and the word is we will have a Butterball turkey thanks to a staff member at the American embassy!

Happy Thanksgiving friends and family!