I received the following from Anil on Sunday, January 24, 2010 at 23:38 ET. This is the second half of the email. The first is posted here. I've also made minor spelling and grammar corrections and have tried my best to fill in missing words. I've added hyperlinks where I thought they might help.From: Anil S. Menon
Sent at 23:38 ET/Haiti Time
The end of each day delivers a blow, and today was no different.
Four days ago a woman was shot. She was 32.
She survived the earthquake, but during an aftershock everyone scrambled from the house, and a shot misfired, hit her in the back, the right lung, left her paraplegic, and she went to another hospital. She must have had a
pneumothorax, got a chest tube, and was sent here to get on the USNS Comfort.
She looked okay, didn't seem to be in distress, even had her chest tube pulled by someone, but of course put back in a day later, but never made it on the ship. As a paraplegic, she might not regain her ability to move her legs, and she could wait for a little while before her bed sores got bad and infected.
We could not have known she would develop a pneumonia today but she did. She began breathing 50 times a minute with an
oxygen [saturation] down to 68% and only 90% [even when we put her?] on oxygen [support?], and her only chance was likely a transfer to another facility. To be sure, we checked her lung and heart and abdomen with an ultrasound, gave her more antibiotics and fluid and began to transfer.
It was tough to find a small bottle so we moved the large oxygen bottle onto the truck, moved
her onto the truck, and she began to really
decompensate. She was frothing at the lips, moaning, and breathing heavily. I jumped behind her to prop her up and elevate her chest. Bob sat beside her and lifted her chin, and we scrambled to get this old pick up truck running.
As we moved out of the compound, I thought she would slip out of the back of this pickup, but Bob said "don't worry I got her head in my hands" as he lifted her jaw for better ventilation. I just focused on bagging her as we drove through the crowded streets, and was glad to have a national expert in airways at my side.
There was actually another patient sandwiched in the back of this open pickup truck, another septic young woman, and Bob kept reassuring her: "Don't worry, I won't let you slip. I got you". He didn't, and we made it to the
DMAT tent.
We told them to get an airway together immediately, but they seemed a little too calm. There is a fine line between composure and delay. Luckily, the Army escort helped us rush her to the treatment tent while we asked for an airway. A
cardiothoracic surgeon told us he would intubate, and Bob was reluctant but in someone [else's] turf.
He of course forgot his
stylet, couldn't see anything, and put it in [the patient's] esophagus. The fluid coming from the tube was enough to suspect this but, the air bubbles in her stomach confirmed it. Bob snatched the tube and quickly put it in. Unfortunately, her heart had stopped. CPR wasn't enough, and she didn't make it.
There were so many turns that could have changed events from transferring her earlier, not initially disconnecting the oxygen, recognizing her earlier, and better communication, more assertiveness with the various care teams. I tell myself that it would have been tough being a paraplegic, but it was tough to lose her. I really thought she was fine this morning. I couldn't find he family since they got lost in the chaos.
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Anil Menon, MD is a clinical instructor at Stanford School of Medicine focused on surgery and emergency medicine. His research interests are Aerospace Medicine, Emergency Medicine, and Wilderness Medicine. He graduated from Stanford Med in 2006, received a degree in mechanical engineering in 2003 and became a full ER doctor in 2009. He has practiced medicin in combat in Afghanistan and will be practicing aerospace medicine next year at NASA. Menon is a flight surgeon assigned to the 173rd Fighter Wing (F-15s) of the Oregon Air National Guard, and he's part of a team sent to Haiti by Stanford.
This entire series is chronicled under the HaitiDrDispatch tag
