Friday, June 7, 2019

Clinical Elective in Trauma Emergency Department at Groote Schuur Hospital, Cape Town, South Africa Part 2

Kelsy Greenwald, MD
Resident, Harvard Affiliated Emergency Medicine Residency

May 30, 2019

Bruising from a sjambok
The busiest times at Groote Schuur Hospital are weekend nights. On one such weekend night, we heard a bell go off, which would be a sign to everyone in the trauma section that a patient was being brought to the resuscitation unit. When we arrive, the EMS providers tell us this patient was involved in a community assault. This is a form of vigilantism. Distrustful of the local police force, a community mob will attack a person who was involved in a robbery or other crime. Instead of calling the police, the mob (often 20 or more people, including children) will take it upon themselves to punish the offender, often beating him with bricks, sticks, and sjambok (whips) until his family members call an ambulance or the police. Here you can see bruising marks from the sjambok.

The Lodox
The patient had multiple lacerations around his scalp, multiple skull fractures around his occiput, bilateral hemopneumothorax, right humerus and femur fractures, but luckily no intra-abdominal injuries. He was placed on a special stretcher that is used to take a full body x-ray with the special x-ray machine that is located right in the resuscitation room, the Lodox.

After receiving bilateral chest tubes, intubated, and given blood, he was stable enough to rush to the CT scanner (3 hallways away). Rather than a mobile ventilator, a doctor bags the patient the whole way, with epinephrine/adrenaline and fentanyl in their pocket. Only after first receiving a brain CT, showing a non-fatal head bleed, did the radiologist consent to further scans of the c-spine, chest and abdomen. The patient eventually went to the operating room with orthopedics. This was one of eight resuscitation patients of the night.

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