Heather in Ecuador: Adventures in the Emergency Room

Every other weekend, Mike and I help in the emergency room when there is no clinic. We often encounter many interesting things that we would not see in the US, due to more modern medicine, greater health literacy, and vaccinations. One interesting case we had was a 5 week old baby who had abruptly stopped eating the morning prior, without any other source of illness. Parents delayed seeking care until he hadn't eaten in over 24 hours. When he arrived to our emergency, his fists were clinched, and he was foaming at the mouth. He kept having what looked like either muscle spasms or seizures, where he would get ridged and shake, and draw his legs up. Mike and I both suspected that he had tetanus. At 5 weeks, he would not have been old enough to get a tetanus vaccine yet, but in the US, most women get a booster during their pregnancy to pass temporary immunity on to their babies. No necessarily that case here, where most women never have a single prenatal check-up.

After we had given him a dose of anti-seizure medication, I checked on him and realized that he was no longer breathing and his heart rate was dangerously slow. Mike and I immediately started CPR, with both my hands encircling the little baby's chest, compressing 100 times a minute, while Mike gave breaths through a mask and ambu bag. Once his heart rate returned to an adequate rate, one of our doctors around that weekend is an Anesthesiologist, so she intubated the baby, and Mike and I boarded the ambulance. I gave the ambu bag, attached to the breathing tube, a squeeze every 1-2 seconds to breath for the baby, during the hour long drive to the next level up hospital in Latacunga. I watched the oxygen monitor to make sure the baby was getting enough aeration. Mike had to take over the breathing for the baby, so that I could pause to vomit, as I have had to do now each time, careening down windy mountainous roads in the back of an ambulance that has no windows.

When we arrived at the hospital in Latacunga, we had to keep bagging the baby for 15 minutes more, before they were organized enough to take over with their own staff. Unfortunately, the baby would have to be again transferred to a larger hospital two more hours away in Quito, because this hospital did not have a ventilator machine for a baby so small. By the time we got there, the intubated baby was limp, and no longer having muscle spasms, so our preliminary diagnosis of tetanus was now being questioned. It could also have been seizures secondary to a meningitis, but unfortunately we may never know for sure. In these types of situations, you have to just hope for the best, and turn over the care to the next best thing, even when it is so hard to do because you doubt the quality of care that they will receive when you leave them behind.

That same night, after coming back to Zumbahua from dropping off the baby in Latacunga, we had just drifted off to sleep, when there was a knock on our window, and we were called back up to the hospital. The doctor sleeping in the hospital that night had called us for back up, because simultaneously, there was a mother who had delivered her baby in the street on the way to the hospital, her baby arrived with rocks all over him; a child with a femur fracture who was bleeding into his thigh compartment and needing urgent transfer to Latacunga for emergency surgery before bleeding to death, and then came in another pregnant woman who was fully dialated and ready to deliver. We immediately transferred her to the delivery room, where she pushed twice, and the baby was handed to me. Finally after getting all the charting done, the newborn babies tucked in with their mother's, and the child with the femur fracture transferred, we went back to bed at midnight.

This all occurred the day after Easter. On Easter, we had another exciting day, with a man who presented to the ED, he had been in a glass bottle fight with his own brother, and was bleeding profusely from his hands and head. It took Mike and two other doctors suturing for hours to close up his 10 wounds, he had a bleeding artery ruptured in his head, a ruptured vein in his wrist, and a severed tendon in his other hand. The other 5 of us nurses, were helping facilitate supplies for the suturing and applying pressure to the arteries and veins to stop some of the bleeding. I had never seen so much blood come out of one person before.

Immediately after we got this guy cleaned up, a baby presented with high fevers and seemed to possibly be in shock. We discovered some stiffness in her neck and ended up having to do a lumbar puncture to rule out a meningitis. Luckily everything turned out well with this baby, who did not have meningitis, and was able to go home a few days later. On the weekends here, you never know what will present though the emergency room doors. It has been a crazy adventure and an amazing learning experience all at the same time.