Chaos and Tragedy in a Cambodian ED

By Remi Kessler & Natalie Catherwood   Ms. B was middle-aged and lying on a gurney without a sheet in the grossly under-resourced ED of the largest public hospital in Phnom Penh, Cambodia. She clearly had an altered level of consciousness, and she was not attached to the monitor that was behind the bed. Her open shirt exposed her to the entire ED, but her family had other concerns.   They were quick to leave as we made our way toward the bed. It became evident that she had not been seen by a doctor, despite her deteriorating condition and her family's persistent anxiety. We saw her chest rise and fall irregularly with fast, shallow breaths. Her glassy eyes failed to meet ours as we attempted to introduce ourselves.   We rapidly assessed her condition, simultaneously auscultating her chest. Her lung sounds were not normal. Upon closer listen, we heard an extra noise, similar to that of a heartbeat, just at the tail end of her expiration. Uncertain of what it was, we auscultated once more, closing our eyes to block out the surrounding mayhem. Her breathing became more labored until it dramatically slowed. That extra sound was still there, but brief gasps for air characterized her respirations as agonal. We held our breaths as we waited for her chest to rise again. We listened once more, this time unable to identify a heartbeat.   We felt for a pulse, struggling to identify its presence because of the girth of her neck. We watched as her heart came to a stop. It ...
Source: Going Global - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs