Crazy/Hectic Day...#2

Well, being in the clinic where I see outpatients is not so bad.  I think the scary ones are the ones that need to be admitted right away, like the patient that died.  Another patient came in today and died shortly after.  I was the first one there, and I called the Dr. to come, but I think it must have taken him at least 30 minutes to come (maybe it was only 5 but felt like 30 because i was the only one there at first, well..with a bunch of nurses).  The guy came in and had no detectable blood pressure and not palpable pulses in his extremities.  He also had some bloody saliva coming out of his mouth, which I think was because he was biting his tongue.  Anyhow, there were so many things I wanted to do but weren't available.  I wanted 2 large bore IV's running, at least 16 gauge, but they only had 18 gauge ones in the hand. I wanted him on oxygen, but there's no O2 tank.  When I got the bag mask, there was a leak from somewhere, so it didn't do anything, and when I found the seal and haphazardly used a glove to seal it up, the bottom turned out to be not-inflatable, so it was impossible to get a good seal, which essentially made it useless.  Considering he had almost no blood pressure and heart beat was extremely faint, I started calling for epinephrine or norepi or hydrocortisone, and the pharmacist said there's none.  What the heck?!! No epinephrine?! How can you not have epinephrine?! Then after another 5 minutes, he finally asks if I'm talking about adrenaline, and I'm staring at him saying, "yes, yes, yes!!"  I didn't remember the dose, was flipping through my book trying to find it, and finally I find something, but later on I realized I think I gave doubled what I was supposed to.  Later, when the second dose was given, the nurse gave it IV, yikes....but not that much happened.  By this time, I had called the expat Dr. that just left, and she said it was probably expired.  At least I could hear and feel his heart beat now.  

Finally found out there were oxygen machines available, and they brought the machine, but it turns out the family had to buy petrol, which took FOREVER.  I had wanted to get a glucose level, but the Dr. had it with him, and when he came, he didn't have his glucometer on him.  When we finally got his level, it only said, "low."  By that time, the Dr. took over, gave him a bolus of glucose and lowered his fluids to prevent fluid overload.  By the time the petrol for the oxygen machine came (it was only a blow-by mask), the patient had already started gasping, and I couldn't heart his heart beating anymore.  The Dr. started CPR, but I don't think it was any use because he was only using his hands (not his shoulders), and the bed itself was springy.  So we took the man down to the ground, and I continued his CPR.  Honestly, by this time, I knew this guy had no chance, but we just continued.  We got the oxygen machine on, but by then, it was too late.  100% oxygen sitting there right next to nose was useless if he wasn't breathing at all!  He got a shot of atropine, and nothing happened.  And that was it.  His brother, who brought him in was so stoic, you wouldn't have thought his oldest brother just passed away. Meanwhile, the women started wailing.  They did his "last service" where they stuff all his orifices with cotton, wrap him up in a lapa, and carried him off.

Immediately afterwards, all I could think about was how I was stupid and probably exposed myself to some terrible disease because I did CPR with a gauze.  I had asked the Dr. for his mask, but he gave me gauze instead.  I should've just used my TB mask instead of that stupid gauze...or not do the breath part since CPR in Segbwema probably has a success rate of 1%.  The Dr. reassured me the patient probably wasn't infectious, but still, I'm afraid I caught something bad.  Biggest fear is TB or some crazy meningitis bug.  Ugh, I hope I didn't learn my lesson too late.  Pray, pray, pray!!!  Okay, biggest thing is to keep myself safe from now on!  Maybe I was being selfish, or maybe I've become hardened already...after less than a week?  I really wanted to intubate him.  Ugh...there is little of anything!!!