Case of the Week: 14th May

May 15, 2018

It’s 9am in the morning at Kivunge Hospital. A 45-year-old female was carried in to the nursing station by a relative. She was unable to speak as she was working so hard to breathe, looking exhausted, having to use her neck, shoulder and back muscles to breathe. Her oxygen levels were 87% (these should have been well above 94%). These are all indications of a life-threatening asthma attack.

 

The local doctor assessed her and prescribed a Salbutamol inhaler for her family to purchase from the local pharmacy. This would have been completely ineffective and she was unable to take large enough breaths to get the Salbutamol delivered to her lungs, where it is needed to work.

 

Unfortunately, this doctor then began to attend to other patients, despite this lady being, by far, the most unwell patient in the hospital at that time, so the HIPZ team stepped in...

 

We gave her repeated doses of Salbutamol via a nebuliser (a means of converting the liquid to a gas so it can be breathed in and work in the lungs much easier), oxygen and intra-venous steroids, but she remained critically unwell. The next step was to give her Magnesium and then Aminophylline, both of which are common practice in the UK, but would only be given in a resuscitation / high dependency care area and with full monitoring. So we had no choice but to sit with the patient for nearly an hour and give these medications into her drip 1ml every minute (as there are no means of timing the rate of an infusion) and to feel her pulse (as the only observation monitor available was being used on the ward round).

 

After nearly 2 hours, she started to show signs of improvement, and thankfully, was well enough to be discharged from the ward 2 days later. For the HIPZ team, this highlighted how unsupported the local medical team are. The local doctor was only 1-year post graduation and would never in the UK been able to manage such an unstable patient themselves. HIPZ will take this opportunity to run some teaching sessions, so next time, she will feel more confident, as hopefully, will the rest of the team. 

 

 

Update on last week's case: 

Unfortunately, our female patient from last week with her first presentation of diabetes is already back on the ward with uncontrolled sugar levels. We continue to advise on her insulin regime and monitor her sugar levels. 

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