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Friday, 9 April 2010

Emily Deness - November - Septic Shock

“It starts off as a quiet day, with most of the team away at the other base in Feina. It’s warm during the day but the evenings are getting cooler, with jumpers and scarves starting to make an appearance, along with blankets for sleeping.

I decide to have an early night and start dozing off at about 9.30pm. At 11.30pm the guard knocks on my door saying that Zakia, the midwife, needs me now. Zakia tells me that a woman who gave birth two days ago is being carried to the clinic by her family. Eclampsia instantly comes to mind.

I head straight to the clinic with Dr Eoin O’Donoghue, an Irish doctor who has been in Darfur since July. She hasn’t said anything since giving birth and has been experiencing fits. The fits last less than a minute, but she’s just not coming round properly.

Her eyes are open, but there’s no response. Surprisingly, her blood pressure is totally normal, if rather low. We were expecting it to be through the roof, so that pretty much rules out eclampsia.

We revise the magnesium sulphate protocol together, as we believe that it’s the only way to stop her fits and save the woman’s life.

Septic shock

The family says that she has lost a lot of blood. Her blood sugars are fine, but she has a slight temperature and a very high pulse. I suspect septic shock, so we give her antibiotics immediately. She has another fit, though thankfully it still lasts less than a minute.

We keep her airways clear and stop her from pulling the drip out; if she is suffering from septic shock, it’ll take at least 24 hours to ease off. We tell the midwife to make observations every hour and write down when the fits occur until we return first thing in the morning to give the next lot of antibiotics.

I give Zakia a radio and tell her to call me if the fits occur more frequently or are longer in duration.

In the morning I want to check on her straight away, but there’s an emergency in the clinic. A little boy, probably about eight years old, is crying relentlessly as some other boys have cut in a private place.

The staff sedate him, clean everything thoroughly, and stitch him up. We only hope that he won’t be scarred for life.

Thankfully it didn’t go through any vessels or tubes. We don’t want him to have problems urinating so we empty his bladder with a catheter before he comes round and give him antibiotics as a preventative measure and paracetamol. He comes round and his big tear-filled eyes are heartbreaking.

Still unresponsive

Meanwhile, the woman who has been fitting is still unresponsive, but didn’t have any more fits until the morning. Suddenly she has three within an hour. We give her more antibiotics as we want to cover everything.
My main concern is that the patient doesn’t hurt herself, so we make sure everything is clean.

Dr O’Donoghue administers diazepam to help stop the seizures. She has another fit within 20 minutes, but they seem to settle, so we are less worried about her pulling out her IV line or choking. 

The next day she seems a lot better and will go by truck to the hospital in Nyala.

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