Day 41 Dalaguete, Cebu #DPC IVTT, IV Removal

Today was another day spent in the ward. I completed the normal tasks: IVTT's medications, syringe loading, vitals, etc. Today, however, was the first time I removed an IV from an infant. It was a little more difficult since the baby is scared and flailing it's arms, but it's basically the same procedure.

For the past month or so, the nurses have been giving me more paperwork to do and just countersign everything I do. It's interesting learning how to chart in a hospital setting. For example, when charting for vitals, I have to plot graphically the temperature and heart rate. This is so when the doctor looks at the chart of the patient, they can see quickly and clearly if the temperature and heart rate are holding steady. I'm not a doctor, not even a med student yet, but after working here, I've noticed that those two specific vital signs are usually good indicators for relative stability in a patient. If the heart rate is abnormal, you can almost be certain that the blood pressure will also be affected. If the temperature is abnormal, that often indicates something is wrong. Why aren't blood pressure and respiration rate good indicators? Blood pressure has a wider "normal" range. Simply eating or drinking something can change blood pressure by a degree of 10 - 15 points, so its often not the best indicator. In addition, hypertension is rampant here and almost every single person above the age of 40 is already on medication for high blood pressure. This means, sometimes, when taking the vitals, the BP of the patient is high because they haven't taken their medication yet or the medication is still kicking in.

Day 28 Dalaguete Philippines #DPC IM Injection, Intradermal Injection, Wound Care, IV Removal

Today was pretty busy and I got to perform a lot of direct patient care procedures

• 3 IM Injections
  
• 1 Intradermal Injection
  
• Wound Care
  
• Tube Feeding
  
• IV Removal
  
• and the usual syringe loading, vital signs, medication passing, and paperwork
  

The first two IM injections were for a patient who was involved in a mine collapse in Mantalongon. I injected two rounds of tetanus toxoid on the left and right deltoid muscles. Prior to those two injections I also performed an intradermal skin test injection to confirm a negative allergic reaction to the vaccine. My initial (albeit amateur) prognosis was a severe concussion because the patient seemed to be confused and had difficulty maintaining balance. However, after reading his chart, the doctor had diagnosed him with a ruptured eardrum and mild concussion. I wasn't there during the doctors initial prognosis or during the doctors diagnosing, but I'll haphazard a guess that his confusion might have been caused by his loss of hearing and his inability to balance due to the concussion further exacerbated by the torn eardrum. I'll also guess that tetanus toxoid was prescribed due to the likelihood of an ear infection. Tetanus here is almost as common as Dengue Fever, but since they can prevent tetanus with tetanus toxoid, I have yet to see a patient with tetanus symptoms.

The third IM injection was given to a pediatric patient – my first IM injection on a child. This one I was nervous about because the nurse told me I had to estimate how far to inject the needle. I'm not sure if there are different needle lengths for children compared to adults, but supplies here are short so the needle length used on this pedia patient was the same length I used on the full grow adult. With adult IM injections it's fairly easy because, most of the time, you can insert the needle fully without worrying about hitting a bone. However, this particular pedia patient was not only small, but fairly skinny, so I had to ensure the needle was inserted deep enough for the medicine to take, but not so deep as to hit the bone. But, like I had written in a previous post, confidence goes a long way in ensuring you can perform medical tasks correctly, and the nurses here are all very good at boosting my confidence. The pedia patient was the definition of calm and didn't cry or flinch during the injection. I was so pumped up that I had performed an IM injection on a pediatric patient correctly that, like an idiot, I totally forgot to tell the patient that they had done well. I'll have to remember that next time.

I was also able to perform another IV removal as well as tube feeding.

The nurse today also documented most of my direct patient care procedures with my video camera, but I won't post those until I can edit out faces and such. I will, however, post a few still frames here so you can check out a little bit of what I'm doing.

It is worth noting that every single person who appeared in the video or is captured on film is aware and has given consent that I am documenting them for educational purposes. I am extremely grateful for the people who have allowed me to do this and will do my utmost to respect their privacy and maintain their dignity.

It is also worth reminding you that, while it is standard operating procedure to wear gloves when doing any sort of direct patient care, supplies here are always low and/or nonexistent, so gloves are reserved for when risk of infection is great.

IV Removal

IM injection of tetanus toxoid.

NGT tube feeding.

Wound cleaning with providone-iodine (PVPI)