Travel to Quito

ER in Quito - By Robin Fillner - SALUD Program Guest blogger traveling in Quito. ...Please be aware that the following blog contains graphic descriptions of scenes witnessed in an operating room. Reader discretion is advices. Yesterday was pretty interesting. First, I attended rounds with the students. The patients we studied were in an observation room adjacent to the ER. The patients go there for a couple of days before actually being admitted, if necessary. We talked about different clotting times when taking warfarin, a blood thinner and different medication interaction when taking warfarin. The students participated in writing orders... and me too; I added cardiac diets to the cardiac patients. Most of the patients had pyelonephritis, a kidney infection. Today, I hung out in the ortho room. We examined about 100 x-rays and discussed fractures and dislocations, etc., in between patients with broken bones. The students are so quick; it was hard to find the fractures before them. After rounds yesterday, (don't read this if you have a queasy stomach but definitely read the end!) I hung out in the trauma room and there was a patient that was driven from La Costa, the coast, about 5 or 6 or maybe more hours away... that had been in a fight with another man regarding a land dispute. The angry man attempted to cut his head off with a machete or a hatchet; I couldn't understand which. But the patient had two cuts from the middle right ear all the way around to below his left ear. By the time I got there the patient already had a central line ( a main IV,) and was bandaged up. He had an ET tube and was being ventialated and had a midazolam drip running for sedation. There was no cardiac monitor in sight and I really don't think anyone had taken his vital signs. He was moving all his extremities which was impressive and we had to hold him down because there were no restraints, or side rails. I got to go up to surgery with him. When they removed the bandages, arteries instantaneously started pulsing with blood. I was so impressed that the patient was so stable! The doctors immediately clamped off maybe 10 or so sites to decrease the bleeding. Inside the wound, you could see that his cranium had been severed, and so you could see his brain. I had never ever seen anything like this before. Also, part of his cervical vertebrates were cut as well. My Spanish teacher said it is common for injuries like this (although more likely on extremities) to happen in the coast because machetes are the only source of weapons there. There was an anesthesiologist, a plastic surgeon, a vascular surgeon, neurosurgeon, and about 5 other people there to watch. I was so impressed with the nurses and the sterility of the room. However, I had to hold the patient for a while because he was on his side and the only method they had to keep his legs on the table was with tape. A little precarious, the doctors in the room took pictures of the wounds with their cell phones, which I thought was a little weird. Sorry if I ruined any appetites. The whole experience is really eye opening. There are a lot of differences in medicine here vs. the US. I will discuss some of them in the next blog.