ECU update:
The ECU floorplan design has been finalized and construction on the future ECU building's roof has begun. I have been completing the final preparations for the inaugural MTC ECU Basic Emergency Care course Training of the Trainer session this upcoming Wednesday and Thursday.
ECU building construction phase one: new roof
Medical Cases:
This was another week with many fascinating cases. It is also important to remember that, like many other hospitals in similar settings, the team at MTC must constantly balance providing appropriate care within the confines of their resource limitations. There are times when the MTC staff would like to obtain more tests or refer patients to tertiary care centers, but these are not always options due to various factors such as the legal status of the patient, the patient's desire, the financial resources of the patient, and whether or not MTC's affiliated foundations can provide funding.
There was a young patient in her early 20s who presented with several months of shortness of breath, weight loss, fever, cough, fatigue, and decreased oral intake. On arrival, she was in hypoxic respiratory failure. She was cachectic, tachypenic, and tachycardic. On US she was found to have a massive left-sided pleural effusion, ascites, pulmonary edema, ascites, and a small pericardial effusion. This is not a case that would be commonly seen in the United States, but unfortunately, it is still a disease that is all too frequent in many parts of the world. This case is consistent with advanced tuberculosis. Her diagnosis was confirmed after an expertly performed thoracentesis by MTC staff, removing 500 mL of pleural effusion that tested positive for TB. This patient's presentation depicts the reason tuberculosis was previously referred to as "Consumption."
Despite TB being easily treatable with a combination of antibiotics, the WHO estimates a quarter of the global population have been infected with TB bacteria, and about 5–10% of people infected with TB will eventually get symptoms and develop TB disease. According to the WHO, in 2021, an estimated 10.6 million people fell ill with tuberculosis (TB) worldwide. At the same time, a total of 1.6 million people died from TB in 2021. Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV and AIDS). This is still the case despite tuberculosis being curable and preventable. For more information, follow this link to the WHO website.
Here are two cases with interesting US findings.
30s-year-old M history of alcohol use disorder (but stopped drinking alcohol 3 months ago) presents with 7 months of progressive shortness of breath, fatigue, leg swelling, and abdominal distension. Found to be in hypoxic respiratory failure with signs of volume overload. US shown below shows dilated cardiomyopathy and severe heart failure with reduced ejection fraction (HFrEF EF est. 5-10%), small pericardial effusion, large right pleural effusion, small left pleural effusion, diffuse pulmonary edema, small volume ascites, and plethoric IVC. Negative hepatitis panel, HIV, TB is pending. Overall, the presentation seems most consistent with alcohol-induced cardiomyopathy or wet berri-berri. He is being treated with diureses, supplemental oxygen, and ultimately will need a referral to cardiology service if funding can be obtained.
20s-year-old female who is 2 months postpartum presents with 1 month of worsening shortness of breath and dyspnea on exertion, symptoms she has never had before. She arrived hypoxic, but did not appear to be in acute distress. Mild intermittent chest pain but no pain on presentation, no leg swelling. No signs of volume overload on exam, no weight loss, fever. No hx of smoking or daily alcohol use. Her ultrasound shows very enlarged right ventricle, with normal sized left ventricle, no pulmonary edema or effusions, and normal-appearing IVC. Overall, it does not seem consistent with volume overload, but it is concerning for postpartum pulmonary hypertension or pulmonary embolism (blood clot). Performed bilateral lower extremities DVT ultrasound which were normal. Patient will require referral for a CTA of chest to evaluate for pulmonary embolism, although somewhat less likely given normal DVT US, and for comprehensive ECHO and evaluation by a pulmonologist if the CTA is normal. For now, she is receiving supplemental oxygen pending referral.
Random Musings:
Over the weekend, I had the opportunity to participate in the Thadingyut Festival, also known as the Lighting Festival, held on the full moon day of the Burmese lunar month of Thadingyut. The celebration took place at a local Buddhist temple where I joined a group of friends from MTC. This festival marks the occasion when Buddha descended from heaven after preaching the Abhidhamma to his mother, Maya, who was reborn in the heaven. The festival is a time of joy, gratitude, and reverence for teachers, parents, and elders, as well as seeking forgiveness for past misdeeds.
Wat Thai Samakkhi
Thadingyut Festival candle lighting
Other pictures from the week...
Interesting troll like statue (shout out to Mike T., a huge troll fan)
Burmese lunch at my favorite restaurant in town, Borderline Cafe & Collective: mushroom & morning glory stir-fry, potato curry with flatbread, yogurt mango drink. https://borderlinecollective.org/
Apartment building cat enjoying the back of my motorbike
This blog post fueled by a fancy Sunday coffee from the aptly named Sunday Morning Café
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