I'm a midlevel provider in a moderately rural part of Asia, I work in an overnight access clinic which is similar to the concept of a critical access emergency department, only we are only open overnight. We occasionally see some really ill people with nasty illnesses here, but every now & then we see someone that you don't understand how they are alive or if they're not a zombie. This is one of those cases.
A child is carried in by parents. Just on first glance – extremely jaundiced, sunken eyes, facial cyanosis, not really responsive, limp, gross abdominal distention. Aside from the obvious like jaundice & cyanosis, he looked incredibly dehydrated & ill. We took him straight back, got him on the monitor. He was quite hypotensive, tachycardic, hypoxic by SPO2, and tachypneac. SPO2 was being maintained in the low 90s with a non-rebreather at 4L.
One of our students got all the PHX and HPI – No real medical history, family travelled out to the countryside to visit extended family. About 3 days after they got back he became ill – nausea, vomiting, diarrhea, fever, increasing lethargy, breathing difficulties, etc. This was day 4 of illness. It was also stated the kid hadn't urinated since he started feeling ill (4 days).
We knew this kid needed to be in a big-city hospital and immediately started arranging that – but those transfers don't happen quickly. We assessed him and determined he had splenomegaly which we confirmed by ultrasound and his bladder was huge + full.
We got bilateral lines in the kid (he didn't react) and started giving ringers acetate (as opposed to ringers lactate due to liver issue, whatever is causing the jaundice). We placed a catheter, which he didn't react to either, and began a gradual decompression of the bladder. Urine was coloured a dark brown color with some red. This (and his spleen) pointed us to run a rapid test for malaria which was positive. He also had the characteristic "ricewater" diarrhea of cholera. We did a rapid test for cholera which was also positive.
We started a combination antimalarial therapy, one of the drugs being doxycycline which is also effective for cholera. He continued to look worse visibly and decline up until our transfer arrived, and he coded during the process of handing-over care to the transfer team. We did get ROSC quite quickly, kid got hauled off lights & sirens by the transfer team to the big hospital.
That was something around a year ago, maybe a year & a half. The other day one of the other providers ended up stitching the same kid up after a minor injury – I got a chance to see the kid got away remaining 100% normal from the illness last year, no neuro deficit from the code, no permanent issues.
Kids are fucking resilient.
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