August 28th: Liberia

teaching sessions

In a single 24-hour period, we made the following diagnosis by point-of-care ultrasound:

• Intussusception in an infant
• Severe pulmonary hypertension in a toddler
• Enormous pericardial effusion in a young child
• Severe tricuspid regurgitation in a young woman with difficulty breathing after childbirth
• Resolving bilateral hydronephrosis in a young child with bladder injury

If the medical terms above leave you squinting at words on the page, suffice it to say that this is an impressive collection of diagnoses. Without the ultrasound, none of them would have been made. Furthermore, all of these findings dramatically changed the course of action for these patients.

The little girl with intussusception (intestines telescoping inside of one another and getting stuck) had been treated for days at another facility for a bacterial infection of her intestines. After the ultrasound, she went to surgery to reduce the intussusception and is now recovering. The child with severe pulmonary hypertension (where the right side of the heart has to work too hard) was started on diuretics to improve his heart function. The boy with the resolving hydronephrosis (fluid in the kidneys) was sent home. And late last night, we used the ultrasound to guide the pericardocentesis (drainage of fluid from around the heart) in the little girl with the pericardial effusion. She will now be started on medications for tuberculosis (the cause of the fluid).

In a setting where lab tests and other forms of imaging are limited by both availability and cost, point-of-care ultrasound is a game-changer. We have used the ultrasound to assess the repair of ruptured bladder with serial abdominal ultrasounds documenting no free fluid (or leak) in the abdomen. We have reassured ourselves with numerous normal ultrasound exams.

Late last week, the residents asked to ultrasound a woman with a complex hospital course with persistent abdominal pain with them. As the residents slid the probe upwards from her bladder to examine her uterus, we found a large fetus outside of it! We quickly moved our probe to evaluate for free fluid in her abdomen and found the tell-tale signs of blood in her abdomen. The woman was immediately wheeled to the operating room where she was found to have a ruptured uterus and a significant internal bleeding. The resident called later that evening to saying the ultrasound had saved her life. She was discharged home early this week.

 

– Alex Vinograd, MD, MSHP, DTM&H