One week into our trip to Uganda, we take to the wards with our training group for some hands-on POCUS practice. At Masaka Regional Referral Hospital, in the middle of the male ward there is a man dying. He can’t be more than 35 years old, in a partial tripod, with his hands on the thin rusty metal bed frame, knees to his chest, and gasping for air. I lead our group to the bedside as my fellow selects the appropriate transducer and power ups the SonoSite. I ask our Ugandan trainee, a burgeoning Emergency Care Practitioner, if she could please tell me why this patient is dying. We get the patient positioned and she looks at the lungs: no pneumothorax, no B lines. She moves onto the heart and with some guidance and acquires a perfect parasternal long view. What do you think? I ask her. There is pericardial fluid, she says. Not only that, normal left ventricular function with pericardial tamponade. Now we must tell someone. Luckily at that moment the medical team is rounding in the ward. They have the patient’s chest X-ray in hand, which shows “cardiomegaly” with clear lung fields. They had therefore been treating the patient for heart failure with diuretics. A bit of debate ensues, but to see is to believe and once we show the team the echo surgery is consulted. One of our learners assists the surgeon for a bedside ultrasound guided pericardiocentesis. The patient is then taken to the operating theater. In this region, there is a high likelihood the patient has HIV and tuberculosis. Diagnostics are limited and he can easily be septic and anemic as malaria is also endemic. The patient transiently improves, but later dies. Our trainees learned the value of POCUS that day, the power it has in diagnosis and management. Perhaps next time a similar patient can be identified early and have a better outcome.
During our second week, a 20-year-old female presents for acute abdominal pain to the accident and emergency ward. POCUS shows a large amount of free fluid in her abdomen. We evaluate her pelvis trans-abdominally, but cannot appreciate an obvious ectopic pregnancy. This remains our top diagnostic concern. Unfortunately, there are no pregnancy tests available at the hospital and the surgeon will not take her to the theater without one. So, my fellow and I run the quarter mile into town to buy a pregnancy test. We return and the patient is positive. She is taken to the operating theater for a ruptured ectopic pregnancy. The next day we see her on the female ward, where she is recovering nicely. She sees our group and gives us a brilliant smile.
In Uganda we work with Global Emergency Care who runs a train the trainer program, elevated nurses to Emergency Care Practitioners. Is a great site for residents, fellows and faculty to be part of this teaching program and impact care in east Africa. The role for visitors is primarily educational and as mentors. Considerable time is spent in the clinical setting, but not in a primary clinical role.
You can visit Global Emergency Care at: Global Emergency Care