Airway Thursday

Its the last day today and I am the only one of the team up for breakfast so far. Not surprising really as Thursday was a busy day for everyone.

I had a deceptively leisurely start to the day as the Ortho team went to the University Hospital Le Paix for rounds and teaching. This was productive and they got some good pictures of the streets of Port au Prince in daylight which we haven't managed to see properly as you know.

Then it was back to the OR when they returned for the first of the hips that awaited us. First was a young gentleman who had broken his femur and had it fixed in another hospital. He came to Bernard Mevs when it became infected and the hip prosthesis had to be removed. The plan was to open it up, clean things out and put in a new hemi-arthroplasty. However it was not to be. After a couple of hours it became clear that a hemi wouldn't work as the cup in his pelvis had lost too much bone. Dave Amirault wisely bailed out as he began to lose blood. He needs a total hip and not a straightforward one. In the absence of appropriate kit and blood transfusion back up its back to square one for him meantime.

While all this was going on we heard that a patient was being helicoptered in with a big neck mass and a compromised airway who would require my attention. He got in just as the hip case ended and I went to see him in ER. Just as advertised he had a huge mass extending into his right chest and he was struggling to breathe. We decided we couldn't wait until the arrival of Haiti's one and only ENT surgeon and decided to intubate. Great teamwork was displayed by all, led by Jason Emsley. I topicalised his airway and with the help of my right hand man Brandon passed a bougie and subsequently a tube while the patient was awake. Success! Off to ICU to safely await further review or so I thought...

Ortho were productive in my absence and took a wire out of a shoulder under local. However activities were bumped by an appendicectomy the Bitars planned to do urgently and with a neonate in the other main OR we were on hold. Our plans were further scuppered when the autoclave packed in leaving the am with no clean hip instruments! So it was back to the barracks to await repair by the redoubtable Craig. 

Meanwhile in PICU the staff were treated to the sight of a parasitic worm crawling out of a tracheostomy! Yuk! Not the sort of thing you see in Halifax!!

After some McGuyvering the hip got underway around 7. Food for the OR team was ordered as takeout from the UN. Just when I thought the day was going our way one of the others ran across from ICU to tell me that there was a problem with the neck mass patient's tube. Yikes!Left Katy in charge of my patient and ran to ICU. He had got light and his tube displaced. Reintubation was difficult but I was ultimately succesful. However ventilation was challenging due to the extension of the mass into his chest. Sadly in spite of heroic efforts he succumbed overnight. Had he lived he would have required major thoracic/ENT surgery which would not have been easy here.

We finally sat down exhausted to fajitas and lemonade around 930. They tasted especially delicious after all that adventure. The night continued to be busy on the Paeds side with a lot of sick patients to manage. Plan today is a couple of cases then we will join the rest of the team for our delayed field trips to the El Rancho resort. Fingers crossed maybe our last day will go as planned.