Children's Ward round Thursday

[SKIP THIS POST IF YOU ARE NOT MEDICAL!]

Patients on the round today include
*  a 1 month baby presenting with an extensive florid rash with some open sores, flaking of the soles of the feet, nasal congestion but not bleeding, diarrhoea.  Mother had history of perineal lesions herself and loss of a previous pregnancy.  Ix confirm congenital syphilis.  Improving with benzyl penicillin 10 day course, topical gentian violet to sores.  Mum now improving with treatment herself.

* a 3 month infant with a persistent cough who had received all sorts of treatment in the community.  On examination has clear  paroxysmal cough and fine in-between.  Clinically pertussis. Covering with erythromycin.

*  a very heartbreaking 3 year old who was admitted very dyspnoeic due to gross ascites splinting her diaphragm.  Terribly wasted. Clinically some relief after insertion of drain.  Had been on TB Rx for 2 months but clearly not helping.  Scan seems to show a mass. Probable malignancy but not clear type.  ? retro-peritoneal.  Has had a transfusion as so anaemic and looks a bit better.  May be having exploratory laparotomy.  Parents probably can't afford the cost of that so are meeting with our Principal Nursing Officer Sister Esther to discuss help from the Good Samaritan fund that supports patients who cannot afford their treatment.

*  a 6 year old admitted semi-conscious.  Previously had "meningitis" aged 1 and subsequent right sided weakness esp arm.  Has some spasticity right side and up going plantar.  Now increased neck stiffness and proceded to fit.  Settled with diazepam.  Fundi ok [ophthalmoscope a bit faint but got there with perseverance!]  Wanted to give dexamethasone, found 4mg but that was all so gave that and then on-going hydrocortisone in equivalent potency doses as that's all we have in pharmacy so hope it helps.  We do have some ceftriaxone so using that.  Haven't LP'd yet as too unwell.  Prob meningitis, but is covered with quinine for cerebral malaria just in case while we wait for tests which should have been sent "urgent" but appear not to have been labelled as such so not back until Friday am!

*  a few young children with gastro-enteritis, prob viral

* a few pneumonia cases including a couple of neonates

*  an infant with florid herpetic gingivo-stomatitis in a great deal of discomfort, doing well with good old gentian violet and aciclovir plus analgesia

* a 10 year old girl with severe diarrhoea and abdo pain, stool giarida +++.  On anti-retroviral Rx and prophylactic co-trimoxazole since 2005.

*  an 8 yr old boy one day post-op laparotomy - found 2 perforations due to typhoid.  Disappointing as he had been in for the previous 3 days on typhoid antibiotics but clearly we caught it too late.

* a 6 year old boy one day post-op laparotomy for a traumatic wound when fell off bicycle.  Intestines were exposed through the wound.

*  Malnutrition kwashiorkor child with diarrhoea and possible lactose intolerance, hopefully secondary


*  a lad with burns - we are trying to sort out adequate analgesia for his dressing changes and use ketamine

*  a lad with a fractured femur going home today on crutches made in the workshop

Last week we had a child with probable Down's not previously diagnosed, aged 2.  So a wide range of cases and a fast turn-over.

We have oxygen concentrators but maintenance not very good - we are encouraging this.  I was able to get one working once I found a spare part in the stores that they didn't seem to know was there...

Nurses generally very good and will put in cannuale etc often.