Sunday, April 12, 2015

Emergency at the Tamale Teaching Hospital

On our third and fourth day at the hospital, Samaya and Kyla spent time in the Emergency department. Kyla spent the first day in triage while Samaya was on the emergency ward tending to the inpatients. In triage a form is filled out with the patient's name, where they live, why they came to the hospital, vital signs, how alert they are, and if they arrived with assistance. After this information is gathered it is then scored, and based on the score the patient is then placed under a color that indicates acuity. Once the patient was scored they were brought into the emergency ward for treatment or further intervention. Triage was very interesting because you were able to see many different health concerns like lacerations, abdominal issues, head injuries, broken bones and much more.

On the ward, Samaya had the opportunity to feed a patient via a feeding tube (they don't have a special formula like they do in Canada, and the families are expected to provide it. In this instance it was milo which is comparable to hot chocolate in Canada! Samaya also tended to various other health concerns such as broken bones, renal insufficiency, and concerns that were not yet diagnosed.

There was a young boy that had broken his neck falling out of a mango tree, so Samaya advocated for a neck brace as he needed a CT scan performed and it couldn't be done until the brace was in place. It took a bit of time and a few phone calls, but one was finally found!

The families on the ward are expected to perform a large aspect of the patient's care, and are to provide food, clothes, and a container in which the patient's foley catheter can be emptied. It's nice to see the family so involved in the care, and the nurses on the ward were amazing at interacting with the patients and their families. The nurse that Samaya was working with for the day attended the relational practice presentation at the university as he is a diploma nurse upgrading to a degree. It was so amazing to witness his way of being with the patients and their families, and was a great example of relational practice. Yay!!!

We left the emergency ward on our first day feeling happy with our contributions, and increasingly confident in our knowledge and abilities! On our second day in emergency, we were both working on the ward as triage didn't have any patients. The first thing that we noticed upon entering the ward was a teenage boy laying in bed. He did not look well, and upon further inspection we realized that he was absolutely soaked from head to toe and his eyes were yellow. We decided that we needed to change his bed and help to rearrange him as he was facing the wrong way in bed. When we walked up to him and introduced ourselves we quickly learned that he knew very little English, so communication was difficult. He was motioning for water that was at his bedside, so we gave him a bag of water without a second thought. Right away he starting pouring the water all over his body, hence the soaked bed. We had found the source! We were relieved that it wasn't sweat or urine, but at the same time also knew that he was running a fever as he felt warm to touch. We provided him with a cool cloth, and helped to change his sheets and clothes in order to make him more comfortable. As we were busy helping make him more comfortable, one of the doctors approached us and expressed his concern for our well-being while working in close proximity with the patient. He told us that we needed to ensure we were washing our hands thoroughly after caring for him. At first we were confused, and unsure as to why he seemed so concerned as we were wearing gloves. After we finished performing care for him, we stepped aside and had a private conversation with the doctor in regards to the patients possible condition. He stated that he felt the patient either had yellow fever, or hepatitis B or C. The doctor was very concerned for our well-being as he wasn't aware that we had in fact been vaccinated for yellow fever (it is a mandatory vaccine in order to enter Ghana!) The doctor then proceeded to mention that the patient wasn't doing well, and his only chance for survival was a liver transplant. He stated that if the patient lived in Canada, he most likely would have survived. This was an incredibly tough thing to hear, and we continue to think about the patient and wish there was more we could have done to help.

After this we noted a nurse feeding the same patient Samaya fed the day prior. The patient was in laying potion while being fed through the nasogastric tube which we were a bit concerned about. We approached the nurse and explained the rationale and importance of having the patient sitting upright during feeding. She was very receptive to our teaching and assisted us with re-positioning the patient.

Next, we spent some time in the procedure room where we observed and assisted with the suturing of an ankle. The patient came to the Emergency Department after her ankle was ran over by a car. X-rays were taken prior to suturing and no fracture was noted according to the doctor. While he was rotating her ankle to ensure proper positioning the patient screamed out in pain. The doctor was very concerned and asked for the X-ray to be reassessed as he felt there was a possible fracture. We were thankful to see this good practice and further investigation. After multiple Lidocaine injections (local anesthetic) the patient seemed to have tolerated the procedure to the best of her ability but still appeared to be in pain. The doctor explained to us that the procedure was not deemed severe enough to be a surgical procedure that required general anesthetic, however due to the severity of the laceration it required a fine balance of the Lidocaine injections. We felt the procedure was done well and appeared to be comparable to what we would see preformed in Canada. Overall we loved our time in the Emergency Department and hope to one day return as registered nurses.

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