Pediatrics

I just switched to peds yesterday and we were admitting. We admitted 24 patients yesterday. 24!!! That's nuts. I was there most of the day yesterday and clerked 5 patients. And we only had one patient die overnight (I mean "only" just because I'm coming from the adult ward where the death rate is so much higher) and he had obstructive jaundice. I didn't get to present any of the patients I clerked because it took 3 hours to see 4 patients this morning during rounds before I had to do my sally test talk. This is a talk we give to mothers and fathers of the children on the ward. It's informal and so much fun. I talked about stroke and people had a lot of questions which was awesome. I also mentioned sickle cell and there happened to be a woman whose 12 year old son has sickle cell and also a mother whose 9 month old was just diagnosed on this admission. Not only did they have a bunch of questions so I got to talk to them after the main talk and discuss what sickle cell disease is and everything about, but they were also able to meet and the older woman helped support and counsel the younger one. It was great to see.

A sampling of the patients that I saw today included a lot of patients with meningitis, including one that had a very impressive bulging fontanelle and very high pressure when we did the tap. I did my first LP today! All they use here is a basic needle and then reusable little glass jars. We wore sterile gloves but besides that there was no kit or anything. And it was so easy! I also saw a child with not just a stiff neck, but episodes where he would arch his back and his eyes would roll back and it was unclear if he was having seizures and/or meningitis or what was happening. Regardless he looked a lot better this morning. I also saw a lot of kids with pneumonia and with sickle cell pain crises. But the most common thing was malnutrition. The first patient I saw was a 1 year old who weighs 4.7kg, so 10 lbs. She has classic marasmus-kwashiorkor -- her face looks like an old person's face with sunken eyes, prominent zygomatic arches, a very distressing look in her eyes, and a very weak cry. She has pitting edema in both of her feet (which automatically qualifies her as having severe acute malnutrition) plus she weighs 47% of her ideal body weight. She was diagnosed with HIV in April and started HAART then. The mom is from Sudan and is separated from the father and is sick herself but before this didn't know she had HIV. She has no money and so is not able to get enough food for the baby, plus the baby has oral thrush and probably a number of infections that causes her to refuse food. The whole situation is really sad but it was also very helpful to evaluated a patient with severe malnutrition and to learn the protocol for treating it here. The thing that kills them most often and fastest is hypoglycemia, often related to hypothermia, and her random blood sugar this morning was 30. But we got her glucose quickly. Getting an IV in her  tiny little veins was a different story. She is holding steady for now though.

I also saw a lot of babies with severe dehydration due to diarrhea. It was helpful to see the classic signs of severe dehydration -- reduced skin turgor, sunken eyes, decreased capillary refill. And also good to see how good the care is in terms of nurses following the protocol for these common ailments.

All in all peds is super busy. The clinical officer asked me to come in and round with her the next 2 days because she will be alone. I wanted to take a day off finally but oh well! It's hard to complain when she was there was 7:30am until 5 today without eating lunch...