Day 1... TAKE 2

The 6am start was not in anyway pleasant. And it was FREEZING. Once again turned up to find out that the consultant wasn't there, but they found the one from emergency med who sorted me out!
Apart from the usual cycle of bloods, fluids, cannulas and dressings what did I do?
Well, I did most of the skin layer closure of a prisoners face that had been slashed open narrowly missing his eye. It needed four layers and 38 stitches to keep it shut. But before any of that could be started there was an arterial bleed that had to be isolated and tied off. WITHOUT ANALGESIA I have no idea how the poor man managed to stay still!!
a wound like this in UK would most certainly have merited plastics, but here apparently they don't leave their ward for hell or high water. So a senior reg and I were left to do it.

I watched the regs try to cannulate a very dehydrated baby with septic burns on her forearm. Apparently she'd been seen at a clinic a week ago and the mother had been told to change the bandages every three days - which clearly hadn't happened.
It took 11 tries to cannulate this poor kid, who didn't cry or try to move away. It's the first case of kwashiorkor that I've ever seen, and it was stereotypical, the regs talked about how in the UK if anyone saw a kid like this it'd be a case of neglect. The kid was taken off by paeds surgery for debridement under GA. But they're not sure how the skin will do as a large majority of it looks necrotic.

A bit later a woman ran in as she had a burnt man in the back of her car. It's unclear how it happened, but with both legs that alone was 36% partial and full thickness burns. The skin had peeled back off his hands which was AWFUL. But for the protection afforded by his massive boots and a thick cotton shirt he was pretty much burnt all over. He was intubated to protect his airway but that was difficult as he kept going into rigors.
Again, something like this in the UK would have warranted specialists, but here in the resus room there wasn't even a consultant! 3hours later a plastics surgeon came down to see him.
I was told that anything over 50% full thickness they don't even try to save here, they just make them comfortable.
It's been a long day, and the team here are all really nice.

I do really need to find some shops though, my supply of salad and cream cheese whipped with blue cheese (odd I know - it sounds like it belongs with lidls' cheese with mould. But it is very tasty!) has run out. So all I have in my cupboard is tea and coffee!
Maybe I'll try and order takeaway!
Toodles! Xoxo

P.S. That's sunset over soweto. I probably need to suck it up and buy a camera.