Close Call In Honduras With A Nosebleed

I recently visited Honduras with a Head and Neck surgical team where we had a close call with a potential airway obstruction due to a blood clot. The case illustrates how a provider should never make assumptions, because if those assumptions are wrong, you can endanger your patient.

After a long day in the OR, while we were packing up to leave, a nurse from the ward ran in and said that one of the patient’s who had had a septoplasty that day for chronic sinusitis was bleeding. I immediately started setting up the OR again while our surgeon went over to the ward. Continue reading

Finding PEEP In a Bottle (of Water): Thinking Outside The Box

As you read this I am flying to Honduras with International Relief Team on a head and neck surgery medical mission. I will attempt to post mission updates from the hospital compound, pending internet connections. Participating in a medical mission to the developing world is never easy.

Medical personnel trained in a high tech environment take for granted the complex monitoring devices, multiple choices of drugs, and plentiful support peronnel which simplify our job. When medical volunteers travel to the developing world they are often unprepared for the potential hazards produced by outdated technology, unfamiliar and sometimes poorly maintained equipment, poor sanitation, limited supplies, and a malnourished, often poorly educated population.

Let me give you an example of one rather exciting case from early in my volunteer experience. Continue reading

Help! My Anesthesia Machine’s Not Working!

There is nothing quite as scary as being in the middle of administering an anesthetic and having your anesthesia machine fail. In my 36 years of anesthesia practice I’ve had this happen to me a few times. Knowing how to quickly troubleshoot your machine, and knowing how to protect your patient are important, potentially life-saving skills. It helps to have thought through the steps to rescue the situation before it happens to you.

Here I describe how I learned this lesson the hard way on a volunteer medical mission to rural Honduras. When my machine failed, I was poorly prepared and this forced crisis management that I could easily have avoided with a little forethought and preparation.
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Ventilate and Intubate But Don’t Forget Communicate

Failure to communicate, and making assumptions rather seeking true facts,  can endanger your patient. Many years ago I was participating in a volunteer medical mission to Kenya when I learned a valuable lesson in communication which I often share with my students. In this case, multiple providers made bad assumptions about what the others knew that led to a potentially dangerous situation involving intubation.
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Protect Yourself From Infection In The Workplace

I don’t know if you have been following the MERS outbreak in the news but it does raise some concern. The CDC issued a MERS advisory yesterday. July 11, 2015 ABC news story covering CDC announcement of MERS outbreak status.

There are several animal and avian viruses that show the potential of becoming easily transmissible to humans. MERS, H7N9 and H5N1 are already spreading in humans, although not easily. The last major jump from animal to human occurred with the 1918 flu pandemic where an estimated 40 million people died. Mortality from MERS is currently 330-40% in the Middle East and 10% in South Korea. As health care workers, how we approach infectious disease precautions will have a lot to do with how safe we and our patients are in the workplace. Continue reading

Communication Is Everything

For the last week I’ve been with  International Relief Teams on a Head and Neck surgical volunteer mission in Sula, Honduras where we safely completed 120 consultations and 37 surgeries in 5 days.

Part of the Internal Relief Team to Honduras 2013

Part of the Internal Relief Team to Honduras 2013 Dr. Whitten is on the right.

Most of the 6 team members had never worked together before, let alone met before. This is typical of most of the volunteer teams I’ve worked with. We meet for the first time at the airport, yet we arrive in country, set up a safe perioperative environment, complete our surgeries and manage sometimes serious intraoperative and postoperative excitement and complications as a cohesive unit. If you think about all of the politics and petty squabbles that occasionally occur in our home ORs areas this is pretty remarkable, given the challenges in communication that such groups face. Continue reading

When The Power Goes Out In The OR

I´m in Honduras with International Relief Teams as part of a Head and Neck surgical team. Here in Honduras, or in any developing country, the power supply can be unpredictable. With the violent lightning storms we´ve been having, the lights have gone off several times in the last few days.

Usually the hospital generator starts immediately, but this morning there was a delay in getting the power back on. As fate would have it, the power went out right after extubating a patient from general anesthesia and just as the patient began to vomit.

While power failures in hospitals in the United States are thankfully rare, they do happen. I was in one surgicenter in San Diego quit a few years ago when the power went out during a storm, and then lightning hit our emergency backup generator. Total blackout in the ORs. So one always needs to be prepared. Continue reading

Changing Your Oxygen Tank In The Middle Of Surgery

Greetings from Honduras, where I am serving as anesthesiologist for a Volunteer Head and Neck Surgical Team. We are at a small 26 bed charity hospital in the small town of Sula doing many different cases such as tonsillectomies and septoplasties for severe obstruction, and tympanoplasties for chronic ear perforations, among other cases.

Doing anesthesia in the developing world is always challenging, as you don´t have all of the equipment, supplies or even medications that you would normally use. Yesterday was a case in point. My anesthesia machine in Honduras gets it´s oxygen from an H cylinder. So in addition to watching all of the other monitors and dials we normally watch, you have to keep one eye on the manometer to make sure you´re is not going to run out of oxygen in the middle of the case.

All oxygen tanks contain liquid oxygen. As long as there is any liquid in the tank, the manometer will read full. Once the last drop of liquid has vaporized, and the oxygen gas in the tank starts to be used up, then the manometer reading will start to drop. And sure enough, when the tympanoplasty we were doing took longer because it turned out to be more difficult than expected, my manometer began to  plummet, even though I was running low flows. Fortunately I was prepared. Continue reading