The X-Ray You Should Never See
on Shona in Sierra Leone (Sierra Leone), 10/Feb/2011 18:06, 34 days ago
Last week I decompressed a tension pneumothorax in a 4 year old boy. This child had been admitted the week before with a week’s history of fever, cough, breathlessness and reduced appetite. His notes document widespread crackles and hepatomegaly and he was treated for severe pneumonia, malaria and then for pulmonary oedema. Three days ago an X-ray was requested. The following day he went off to Connaught Hospital (about2 miles away from our hospital) with no oxygen and got his x-ray. Yesterday his family picked up the X-ray from Connaught. The medical officer showed me the x-ray – left sided pneumothorax with mediastinal shift. Eeek! This is the proverbial x-ray you should never see, and it was taken a full 24hours before! Sure enough his signs now fitted the x-ray but amazingly was not haemodynamically compromised. With a somewhat large audience, I decompressed the pneumothorax with the biggest cannula I could find (a blue one!), heard a reassuring “hiss” and attached it to an improvised underwaterseal. Clearly this was only going to buy a bit of time and we don’t have proper chest drains, or suction, or underwater seals, or X-Rays, or very much oxygen. The medical officer contacted an NGO hospital (who have access to all the above) and he was transferred there. I was so happy to hear thathe has now got a chest drain in situ and is doing much better.