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Ngwelezana Casebook in Emergency Surgery and Trauma

Ngwelezana Casebook in Emergency Surgery and Trauma

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A self-educating Q&A casebook aimed at medical students, junior doctors, nurses or those in rural or semi-rural environments who will have to manage surgical emergency & trauma patients.

Written by a British doctor and several of her local and expat colleagues whilst working in South Africa, & based on real cases. Also will be indispensable for doctors from western medicine working abroad in general surgery and trauma for the first time.
A self-educating Q&A casebook aimed at medical students, junior doctors, nurses or those in rural or semi-rural environments who will have to manage surgical emergency & trauma patients.

Written by a British doctor and several of her local and expat colleagues whilst working in South Africa, & based on real cases. Also will be indispensable for doctors from western medicine working abroad in general surgery and trauma for the first time.

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Published by: Abeyna Latoya Charlotte Jones on Feb 20, 2013
Copyright:Attribution Non-commercial

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11/16/2013

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Ngwelezana Case Book in Emergency Surgery and Surgical Trauma
A Brit in Rural SA.. The Foreword ................................................................................................... 3Authors ............................................................................................................................................ 4Acronyms ........................................................................................................................................ 5Ngwelezana Hospital....................................................................................................................... 6Trauma Centre Hierarchies ............................................................................................................. 7Rural Hospitals in SA ....................................................................................................................... 7How to read this book and so forth.. .............................................................................................. 8A pyrexial 14 year old with abdominal pain ................................................................................... 9A pyrexial 14 year old with abdominal pain in OT ........................................................................ 12A simple epigastric stab wound? .................................................................................................. 15A tachypnoeic polytrauma case .................................................................................................... 18Abdominal pain in a heavy smoker ............................................................................................... 22Male with dysuria and subsequent scrotal insult ......................................................................... 26Anterior stab wound to the neck .................................................................................................. 28An old gunshot to the chest .......................................................................................................... 31Urinary retention in an 8 year old boy ......................................................................................... 34Man with a facial swelling ............................................................................................................. 36Post chest stab pain ...................................................................................................................... 38A left sided red tap ........................................................................................................................ 41Haematuria after blunt abdominal trauma .................................................................................. 44Delayed presentation post MVA ................................................................................................... 46Patient with a wrist laceration ...................................................................................................... 48Snake bite and black ..................................................................................................................... 50Snake bite aftermath .................................................................................................................... 53Painful left foot in a diabetic ......................................................................................................... 55An odd number of gunshot wounds ............................................................................................. 58An odd number of gunshot wounds in theatre ............................................................................ 61Abdominal distension in a 71 year old male ................................................................................. 64Patient involved in tractor trauma ............................................................................................... 67Another stab chest ........................................................................................................................ 69Patient with multiple leg lacerations post MVA ........................................................................... 71Patient in a hot situation .............................................................................................................. 74A community assault ..................................................................................................................... 78Tractor traction ............................................................................................................................. 80Gunshot injury to the thigh........................................................................................................... 83A directed kick ............................................................................................................................... 85Managing a kidnapped patient ..................................................................................................... 87Neck Exploration ........................................................................................................................... 91Patients in a house fire ................................................................................................................. 93Another patient with abdominal distension ................................................................................. 96A patient with head trauma ........................................................................................................ 100
 
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An odd gunshot neck .................................................................................................................. 102
 Appendix ............................................................................................................................................. 106
 Burns Early Directed Goal Therapy ............................................................................................. 106Burns Admission Criteria ............................................................................................................. 108Burns - Wallace Rule of Nines ..................................................................................................... 109Trauma Assessment Form........................................................................................................... 110Ngwelezana Hospital Trauma Referral Sheet ............................................................................. 114
 
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 A Brit in Rural SA.. The Foreword
I spent my first few minutes by the patient engulfed in a chaotic flurry of chest compressions,
blind needles entering the patient’s assumed anatomical large veins and desperately squeezing
a bag of crystalloid in what was possibly dead space.
“Do everything you can doctor!” 
 
 –
yelledhis family who were inexplicably present by the roadside.Injuries incompatible with life; large open skull fracture, multiple fractured limbs, his totalblood volume on the floor, two medical students, two shocked paramedics and two British
doctors, new to South Africa. In fact I hadn’t even made it to work yet.. I’d just stepped off theplane at Richard’s Bay airport into the result of a road traffic accident involving a young man
and his motorbike.My experiences at Ngwelezana Hospital; a Level 2 hospital which provides regional and districtservices in KwaZulu Natal, have definitely altered my perspectives on healthcare as a doctor. Ispent my time bathing in a vast amount of trauma, general emergency and elective cases andwitnessed associated afflictions of my patients suffering from the HIV and TB pandemic.The spectrum of diseases and presentations are worth writing and learning about, simplybecause the population appear to be so resilient despite clinical observations and laboratoryresults. We all wonder how a patient with a pH of 6.8 and sodium of 178 could still be sat uptalking to us, or how a patient with a gunshot abdomen is noted to have several other scarsrelating to a thoracotomy, two previous laparotomies and a femoral artery exploration, stillmanages to survive!This book was compiled and written for all those working in rural healthcare in South Africawho manage these type of patients; even at Level 4 where early recognition and treatment of acondition is essential before referral and transfer to other hospitals. Unfortunately triage tosurvival is reliant on actually
making it 
to hospital, and it is well acknowledged that availableand efficient emergency transport is a true limiting factor at times.Inspired by the popular book on
Hlabisa Casebook on TB and HIV Medicine
, and my love of reflecting, managing and learning from each and every case I see, I present to you thiscasebook.Acknowledgements and gratitude go to all the patients and their families who participated,some of whom have tragically passed in their experiences illustrated in this book.And finally; to the Ngwelezana Surgery Department staff who have whole-heartedly supportedand taught me along the way; I will be back!Abeyna

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