Sudden Unconsciousness - No Head Scans Available
You know when a medical emergency has arrived when the noise of several heavy, clumsy feet grow louder and louder towards you.
So it was, as I sat in my consulting room three days ago, when this young man was rushed in semi-conscious. The accompanying elder sister calmly narrated how they had both eaten lunch at home before setting out on their journey to a popular open market quite close to the hospital where I work - when he began complaining of feeling ill; later leaning over on a stall just before passing-out on the ground.
He was "drowsy" but rousable when I called out his name. I pondered what the diagnosis could be as the nurse gave the steroid (Hydrocortisone 200mg) shot through the i.v. line secured - no recent fever or complaints of ill-health whatsoever nor was there any history of Seizure Disorders. Then the fact came forward that he fell backward and hit his head while shooting basket ball hoops at home - but that was four days ago and he then didn't appear hurt one bit.
I commenced anti-Malarial injections when later he started running a fever - he had slowly begun regaining consciousness all along and had vomitted cupiously, also.
With Head Injury (Intra-cranial Bleeding) a strong possibility, I watched over a couple of days as he got better - good thing too, because the readiness to do CT scans to the head was as usual not there: low assessibility to a machine in this environment, and affordability on the part of many patients in terms of the usual high costs in the few centres that do CT scans.
I've been a bit disorganised of late and keep posting events backwards! Oh well, I'll try to keep up. Promise.
So it was, as I sat in my consulting room three days ago, when this young man was rushed in semi-conscious. The accompanying elder sister calmly narrated how they had both eaten lunch at home before setting out on their journey to a popular open market quite close to the hospital where I work - when he began complaining of feeling ill; later leaning over on a stall just before passing-out on the ground.
He was "drowsy" but rousable when I called out his name. I pondered what the diagnosis could be as the nurse gave the steroid (Hydrocortisone 200mg) shot through the i.v. line secured - no recent fever or complaints of ill-health whatsoever nor was there any history of Seizure Disorders. Then the fact came forward that he fell backward and hit his head while shooting basket ball hoops at home - but that was four days ago and he then didn't appear hurt one bit.
I commenced anti-Malarial injections when later he started running a fever - he had slowly begun regaining consciousness all along and had vomitted cupiously, also.
With Head Injury (Intra-cranial Bleeding) a strong possibility, I watched over a couple of days as he got better - good thing too, because the readiness to do CT scans to the head was as usual not there: low assessibility to a machine in this environment, and affordability on the part of many patients in terms of the usual high costs in the few centres that do CT scans.
I've been a bit disorganised of late and keep posting events backwards! Oh well, I'll try to keep up. Promise.
Just wondering why you would prescribe anti-malarial injections without confirmation of a test. It not like the patient is suffering from febrile neutropenia - which can then be classified as a medical emergency?
ReplyDeleteAs the patient is vomiting, lost conciousness and seems generally confused, with confirmation of a head trauma, then a TBI is the most likely conclusion, which a CT scan would easily confirm. As this was not available, an examination of the patient for any contutions and admit him for observations, arrange a CT scan as soon as possible would have been more appropriate.
Incidentally, fevers do present as symptoms for a TBI. He may have fractured his skull and could be suffereing from a serious heamatoma based on banging his head with a concrete floor.
In times like this doctors themselves seems confused and incapacitated proving that Jesus is the greatest of all Physicians. With God nothing shall be impossible. I sound religious,right! but that's true.
ReplyDeleteHmm...
ReplyDelete