Nepal emergency department - day 1 & 2

After only two days of working within the hospital emergency department, I have seen a number of conditions that I have never seen before within the UK, only read about. When arriving the department and the hospital in general was a bit of a shock. With only one doctor in charge of a 30 bed unit backed up by a couple of paramedics and a few nurses. The lack of concern for hygiene and dignity of patients and how the department was organised hit me in the face. Despite the lack of resources almost every investigation and treatment was available as in the UK. They had just adapted techniques in order to preserve equipment that we dispose of easily and after each patient within the UK. For example, ECG stickers do not exist over here, instead they use suction applicators so that there is no waste from patient to patient.

The biggest shock came in the fact that the medicine side of the job is so similar as within the UK. Treatment and investigations used don’t differ and the conditions are largely the same as within the UK.

The one thing that I have seen a lot of over here compared to the UK is snake bites. These are relatively common with multiple presentations a day. There are 4 snakes other here that can cause haematotoxicity. The other serious complication that can result from certain snake bites is neurotoxicity however this is a lot less common over here. INR, prothrombin and partial prothrombin times are all tested in patients that present with a snake bite due to the higher likelihood of a haematotoxic reaction due to the species present in Nepal. Pressure immobilisation bandages are used in a first aid setting to try and stop the venom returning to the central circulation system, or at least delay it as much as possible. Antivenoms can be used, this depends on species and region, Paravalent antivenom is commonly used over here to due to its action again most snake species in the area.

The other interesting case that I have seen in the last two days was a 7-year-old boy presenting with reduced level of consciousness and in respiratory distress. He also had a large mass in the suprapubic region of his abdomen. The history was given as shortness of breath for the past 5 days and a reduced sensation is both legs for the past day with no trauma involved. On examination he had wide spread crepitations within this chest, what appeared to be a very distended bladder as the mass in his suprapubic region and absent reflexes in his legs. It appeared this child had a chest infection and cauda equina. Once catheterized the bladder emptied and the mass dramatically reduced to a normal size. This urinary retention and loss of sensation leading to loss of reflexes in the lower limbs bilaterally are common symptoms in cauda equina syndrome. Unsure on the cause of this the patient was sent for imaging of his lumbar spine. There are many possible causes of cauda equina syndrome.

This is a condition that results in a compression of the end of the spinal cord where the nerves exit and travel further down the spinal canal before exiting. With secondary malignancy being unlikely (the most common cause within the UK at least), other causes such as epidural abscess may be more likely especially given the chest infection that was also present. The boy was sent for a xray of his lumbar spine as CT scans are not available.

It has certainly been an eye opener of a week.

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