February 05, 2013

Surviving Sepsis Campaign 2012: New Guidelines and a Fun Algorithm!

I'm out of practice when it comes to routine ICU care.

 But I am a fan of making sure that people don't die on my watch when they are septic.

So when I heard that the new Guidelines were published... I wanted to be first in line to read them!

  2012 Sepsis Guidelines Published
A revised and updated edition of "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012​" were officially released at the Society of Critical Care Medicine's 42nd Congress in San Juan on January 20. Thirty international professional organizations supported the content of the new guidelines.

 I took the opportunity tonight to put together a Prezi presentation on the subject, much to the delight of our med students and Haitian resident. I'm not sure how applicable it was to the case at hand, in retrospect, but it is useful information nonetheless (since fluids and antibiotics are abound even here in Haiti!)



February 04, 2013

Tet Fe Mal

(The case provided is inspired by a true story. I've changed the details to blan HIPAA standards. Random google image of a tap-tap provided for visual effect.)

Only the rushing traffic of tap-tap trucks and motos loaded to the brim with passengers stirred the stale and acrid air of the bustling city of Cap Haitien. Clouds of smoke rose from the cluttered gutters, spewing out a miasma of burnt plastic -- the country's sole way of waste disposal -- as toxic fumes.

Small currents of wind trailed behind the vehicles that swerved precariously around each other, weaving braids of smoky eddies in their wake. Paul-Jean, a small boy of 9 years, stared out the back of one such tap-tap named "Love Jesus." His eyes were transfixed by the smoky patterns and the noisy chaos of the street side merchants. It had only gotten busier in the weeks leading up to the coming of the festive Kanaval. It was a big celebration throughout Haiti as their special version of Mardi Gras.

"Love Jesus" pulled over at the corner of a busy intersection after two brisk thumping strikes were authoritatively delivered against the side of the vehicle as a signal to stop. PJ got out and waited at the side of the road while his manman paid the driver, and then climbed out over the half-dozen passengers also stuffed in the seats.



He heard the thubbing of the moto barreling down the road before he saw it -- the vehicle weaving and dodging the stodgy slower tap-taps and narrowly missing their side mirrors and passenger limbs sticking out the windows.

But the moto didn't miss him.

The world whirled around in a roaring redness... then black.


A week later, he still flinched whenever a moto zoomed by -- and his protective manman folded him close into her bosom on this leg of their journey. This tap-tap (named "Bon Fet") weaved drunkenly back and forth on the path. The road was dusty and riddled with the pock-marked memory of monsoons past. On some of the deeper unavoidable potholes, PJ had to hold on to the railing and clutch at his floppy fishing cap to avoid losing his seat. His mother had saved up and given him the cute hat as a present since the accident.

He still hoped that he would get to see some of the parades of Kanaval, but manman insisted that that this trip was just as important.

"Eske ki pwoblem ou genyen jodiya?"
"Tet fe mal."

The doctor asked why he was there in the hospital and his mother had blithely replied that he had a headache. He concentrated on drawing "Bon Fet," complete with a birthday cake on the top to complete the tap-tap. The adults chatted more and his mother swept off the floppy fishing cap without any dramatic flair, but by the inaudible gasp and silence that followed, she might as well have shouted and pointed.

PJ's head had been partially de-scalped and on the corner of his forehead, above his right eyebrow, a motorcycle handlebar's length off the ground, was a shiny patch of skull like an offset unblinking third eye.

Interlude: Acid-Base Algorithm

I learned about a great book recently entitled Symptom to Diagnosis (Thanks Nathan!) which I started reading a few weeks ago. That, in combination with my proclivity to rewatch some old TV shows on iTunes in the evening has led me to compose less blog posts than I anticipated on this trip. However, there are more to come -- with a different POV.