I got a call in the night last night from some team mates. They were with a 16 year old boy who had been in some sort of traumatic accident and was neurologically compromised and would I please some down to the clinic.....
Oh dear. I never like receiving calls in the night. If it isn't imminently life threatening people wait until morning to call me. If it is life threatening there is usually nothing at all I can do. I've made it a rule to not do CPR here because why? It isn't like I'm buying time until an Intensivist or even an ambulance arrives. The same goes for pretty much any acute life support interventions. Those are all stop gap measures to get someone into surgery or ICU, neither of which are going to happen here.
All of this is going through my mind as I'm headed to the clinic in the dark with my gloves and flashlight in my pocket. The kid was pretty much unresponsive except to pain which elicited some incoherent mumbling and tossing and turning on the table. (GCS of 11= moderate brain injury). The story was he was hit by a bicycle while walking home in the dark. I've come to be suspicious of almost every story I get here and this one was no exception. Nothing seemed to line up. The boy had a swollen eye with a tiny cut and a small abrasion on the opposite temple. That's it. No dirt, bruises or abrasions on knees, elbows or palms that would make it look like he took a tumble. Besides the swollen eye, his head and neck were normal. The nurse at the clinic had already given 500cc LR and was in the process of giving 1g rocephin though I'm not sure her rational because neither of his "wounds" were even deep enough to need stitches. I know that I'm going to die of drug resistant bacteria here because of misuse of antibiotics but that is for another post.
Where I'm going with all of this is that there was nothing we could do for this kid. The nearest CT machine is hours away and there is nothing that can be done for a closed head injury. I hate that feeling and it makes me want very badly to go back to work in the States where there is something I can do. Where my ACLS training is actually useful and my answer to practically every issue doesn't have to be "give it time and see what happens".