Kigali, Rwanda January 2017

In a city of over 1 million people, full of motorcycle and bicycle taxis, it’s no surprise that the University Central Hospital of Kigali (CHUK) sees an astonishing number of trauma and orthopedic injuries. It’s second nature for the Rwandan emergency medicine (EM) residents to grab the ultrasound machine to do an E-FAST (Extended Focused Assessment with Sonography for Trauma) and evaluate for internal injuries and pneumothoraces. But pain control techniques such as nerve blocks for extremity injuries and for assisting with procedures like fracture reductions or extensive wound repairs are an essential skill set in emergency medicine – not to mention important for good patient care! The alternative would be time intensive conscious sedations in an already stretched emergency department or using large amounts of IV narcotics, which could be harmful for older patients. This past month we taught ultrasound-guided upper and lower extremity nerve blocks and coordinated a nerve block and musculoskeletal simulation lab to equip the Rwandan EM residents with the knowledge to manage pain using ultrasound-guided techniques. Shortly after reviewing and practicing nerve blocks, we were already putting these newly acquired skills to the test for a patient with a femur fracture who needed a femoral nerve block for pain control and to facilitate a wound irrigation that would have otherwise been very painful.

While teaching the residents during these last few weeks, we expedited care for patients who were diagnosed with pneumonia, heart failure, deep vein thrombosis (DVT), testicular torsion, an appendicitis, and cholecystitis. A pediatric patient who arrived with trouble breathing and a cough had a quick cardiac echo and lung ultrasound that showed a large atrial myxoma, bilateral pleural effusions, and a pericardial effusion. This bedside ultrasound helped direct the child’s care and facilitate a smoothly performed ultrasound-guided pericardiocentesis by one of the EM residents.

I don’t think the Rwandan EM residents could ever imagine a day without their beloved ultrasound machine. Since PURE has started working with the EM residents, they have gained impressive ultrasound skills to quickly diagnose patients, safely perform procedures, and direct patient care. And they continue to see the profound impact their ultrasound skills make on a daily basis!

Denise Fraga, MD, MPA
Emergency Ultrasound Fellow
Vanderbilt University Medical Center