Sat in the Green House restaurant in Sen Monorom after the first day at the URC retreat (a complete misnomer) I heard a sound you never want to hear - screeching brakes, a sickening thump and then the wailing of a mother.
My plate just cleared and second can of beer nearly completed my eyes met Janice's - apparently my face was a picture of resignation. "Esther - go!" she urged so I was quick off the starting blocks but already there was a large crowd of rubber-neckers - a favourite pass time in Cambodia. The URC maternal & neonatal health team were sitting at the table next to me so as I followed the mother, who had scooped up her child and was running up the main street to a near-by private clinic, I called for someone to help me translate.
The SUV with its drunk driver left the scene quicker than the rubberneckers did.
At the private clinic I found the girl already laid on a bed with the clinic doctor shoving a large glucose tablet in her mouth. I have heard of 'DEFG - don't ever forget glucose' in APLS circles, I just wasn't aware that is preceded ABC, or perhaps stuffing a large foreign body into a traumatized child's mouth is a method of obstructing their airway hence giving the healthcare professional something to do about 'A'.
I'm always sensitive to stepping on other doctors toes (I'm sure BTB would disagree!) so I asked one of the URC team to explain to the clinic doctor that I was an emergency physician from the UK & if he didn't mind could I help. He said he didn't mind as he threw the girl about like a rag doll - obviously not too concerned about a possible c-spine fracture.
Exit stage left clinic doctor.
My paediatric emergency medicine kicked in as I disengaged the hysterical mother from her hysterical friends and phone, asking her instead to talk with her daughter. In my "unclear Khmer" (I quote my teacher) I asked the terrified little girl how old she was, was this her mummy and where did it hurt. It was either me or the glucose tablet but she calmed down quite quickly whilst I assessed ABC first (call me old fashioned!).
Having established that she had cleared her airway of the glucose tablet, had a normal respiratory & cardiovascular examination and with a quick check of her abdomen I was surprised to find she had no obvious serious injuries. I was about to start a full secondary survey when two things happened;
1) Janice (who all this time had been hiding behind the door frame) called out to me "Esther does this girl need a drip?" Now you could argue that in Cambodia everyone 'needs' a drip (it is a panacea) but on this occasion (as with most others) I did not feel it was necessary. The reason Janice was asking was that a disheveled woman had come into the 'resus' room holding a drip. On close inspection it became clear that she was in fact not a nurse but another clinic patient with an IV running who was just rubber necking.
2) Due to my brief distraction with the drip patient when I turned around to perform the rest of the secondary survey I discovered I had been pushed out by the mass of hysterical Cambodian women, two URC obstetricians and a VSO health management advisor who was at the head of the bed, asking the girl (in khmer) to wiggle her toes. I had a momentary lapse when I thought that perhaps an emergency medicine specialist with sub-speciality paediatric emergency medicine training may not be the most appropriate person to see a 7 year old girl who had just been hit by a SUV. (X-ref 'A*' blog)
The little girl by now was regaining her composure, sitting up she was pretty insistent that the only thing that really hurt was her left arm. All the joints were pointing in the right direction, there was no crepitus, she could move her arm well and all things neuro & vascular appeared in tact.
Mum was smiling and thanking me.
The little girl agilely leapt off the bed.
Clinic doctor entered stage left, "She's fine" he announced - on this occasion I was able to agree with a Cambodian doctors diagnosis.
I told her what a lucky girl she was. Walking back to the Green House it hit me I was feeling pretty lucky also. If she had have been seriously injured we were 7 hours from Phnom Penh and the nearest half decent trauma health facility. I began to miss the metropolis of BTB.
Sitting back down I ordered another beer but my sobering thoughts counteracted any anaesthetic effects I had desired from it.
My plate just cleared and second can of beer nearly completed my eyes met Janice's - apparently my face was a picture of resignation. "Esther - go!" she urged so I was quick off the starting blocks but already there was a large crowd of rubber-neckers - a favourite pass time in Cambodia. The URC maternal & neonatal health team were sitting at the table next to me so as I followed the mother, who had scooped up her child and was running up the main street to a near-by private clinic, I called for someone to help me translate.
The SUV with its drunk driver left the scene quicker than the rubberneckers did.
At the private clinic I found the girl already laid on a bed with the clinic doctor shoving a large glucose tablet in her mouth. I have heard of 'DEFG - don't ever forget glucose' in APLS circles, I just wasn't aware that is preceded ABC, or perhaps stuffing a large foreign body into a traumatized child's mouth is a method of obstructing their airway hence giving the healthcare professional something to do about 'A'.
I'm always sensitive to stepping on other doctors toes (I'm sure BTB would disagree!) so I asked one of the URC team to explain to the clinic doctor that I was an emergency physician from the UK & if he didn't mind could I help. He said he didn't mind as he threw the girl about like a rag doll - obviously not too concerned about a possible c-spine fracture.
Exit stage left clinic doctor.
My paediatric emergency medicine kicked in as I disengaged the hysterical mother from her hysterical friends and phone, asking her instead to talk with her daughter. In my "unclear Khmer" (I quote my teacher) I asked the terrified little girl how old she was, was this her mummy and where did it hurt. It was either me or the glucose tablet but she calmed down quite quickly whilst I assessed ABC first (call me old fashioned!).
Having established that she had cleared her airway of the glucose tablet, had a normal respiratory & cardiovascular examination and with a quick check of her abdomen I was surprised to find she had no obvious serious injuries. I was about to start a full secondary survey when two things happened;
1) Janice (who all this time had been hiding behind the door frame) called out to me "Esther does this girl need a drip?" Now you could argue that in Cambodia everyone 'needs' a drip (it is a panacea) but on this occasion (as with most others) I did not feel it was necessary. The reason Janice was asking was that a disheveled woman had come into the 'resus' room holding a drip. On close inspection it became clear that she was in fact not a nurse but another clinic patient with an IV running who was just rubber necking.
2) Due to my brief distraction with the drip patient when I turned around to perform the rest of the secondary survey I discovered I had been pushed out by the mass of hysterical Cambodian women, two URC obstetricians and a VSO health management advisor who was at the head of the bed, asking the girl (in khmer) to wiggle her toes. I had a momentary lapse when I thought that perhaps an emergency medicine specialist with sub-speciality paediatric emergency medicine training may not be the most appropriate person to see a 7 year old girl who had just been hit by a SUV. (X-ref 'A*' blog)
The little girl by now was regaining her composure, sitting up she was pretty insistent that the only thing that really hurt was her left arm. All the joints were pointing in the right direction, there was no crepitus, she could move her arm well and all things neuro & vascular appeared in tact.
Mum was smiling and thanking me.
The little girl agilely leapt off the bed.
Clinic doctor entered stage left, "She's fine" he announced - on this occasion I was able to agree with a Cambodian doctors diagnosis.
I told her what a lucky girl she was. Walking back to the Green House it hit me I was feeling pretty lucky also. If she had have been seriously injured we were 7 hours from Phnom Penh and the nearest half decent trauma health facility. I began to miss the metropolis of BTB.
Sitting back down I ordered another beer but my sobering thoughts counteracted any anaesthetic effects I had desired from it.
Amazing story, well told. Sounds like everyone around was fortunate that you were on scene. I just returned from a brief trip to Cambodia and am trying to learn more about the medical systems there. Just stumbled across your blog, thanks so much for writing!
ReplyDelete-Colleen from the USA