Rounds took a while today. We have quite a few patients. Several had big dressings to change. Two of the wound vacs needed changing also. Our diabetic patient's amputation stump incision looks good but unfortunately his blood sugar is very high. We had to get the doctor working in the ER to evaluate him and make recommendations.
Nathan and ZJ were out in the storage area working on cutting some wood to make shelves so I helped them for a couple of hours.
Later in the afternoon, we took the man with the pelvic injury to the OR. I gave him some sedation and put in a distal femoral traction pin with local anesthesia. I used the C-arm to see if his displaced hemipelvis would reduce. It did come down to the right level but the S-I joint was still widened. It definitely needs a screw or two to get it together. I will need good anesthesia for that so will probably need to wait a week. After I finished and was starting to move the patient to the gurney, his oxygen saturation dropped significantly. We put him on oxygen which didn't seem to help. We finally decided to put him on heparin. He improved a lot in less than an hour. I wish I had consultants available to help with these complicating problems. Fortunately, he stabilized and seems pretty normal. ZJ, Lynne and Mark helped monitor him through the night.
The clinic today wasn't nearly as big as the clinics last week. I saw several more patients for John Henrzenberg today including a 20 y/o with severe spastic club foot and knee flexion spasticity. I think he can be improved a lot with surgery. Dr Stutz of the Lovejoy team did a major procedure on his spastic upper extremity. I put him in a preliminary stretching cast. Our 12 y/o girl with the comminuted femur fracture suddenly had a lot of pain in the therapy department. Her external fixator had come loose so we admitted her. We will only have anesthesia for a few hours tomorrow. I hope we can get all of the casts changed and pins removed on the clubfoot patients and still have time to get her ex-fix back on. I still have the man with the hip fracture that needs a hemiarthroplasty. Maybe I can do him on Thursday if we have anesthesia long enough.
The anesthesiologist came today between 8:30 and 9 am and told us she had to leave by 11. We hustled and used all three rooms and were able to get 5 cases done including replacing the ex-fix and reducing the fractured femur on the 12 y/o. The anesthesiologist really did a good job. She had some of the OR nurses monitoring the patients as we changed casts, removed pins and did manipulations. We then had 3 cases using local anesthesia. It turned out to be a very productive day. We only had to cancel the patient for clubfoot correction. We finished all of the cases in time for JJ and I to throw the football for a while. We had fun. He is a very good natural athlete. Tomorrow is Flag Day here in Haiti and the clinic might be smaller. If so, I'll try to get all of the translators to get their Packers tee shirts and we'll try to have a little scrimmage.