Casualty department

Geez, the week has gone quickly. Fridays are slower at the hospital, until things get crazy in casualties in the evening.

Today I spent my day with an 83 yo doctor who has been practicing for like 59 years! He is also retired, and just does weekly clinic. We had grand rounds in the morning, topic was on the new forms for psychiatric patient holds and their legal rights. The doctors were not very pleased with all the changes and hurdles.

The older doc mostly does dermatology stuff. When in doubt, freeze it off, seems to be the common denominator… Saw molluskum contageousum for the first time. Also learned that having those lesions gets you an automatic HIV test because of the higher prevalence in HIV positive patients. Nail removals, candida, dermatitis.

I went home in the early afternoon, and relaxed until my late night shift. This weekend is pay day, which means lots of ETOH with a side of violence. I arrived around 9:30pm, already the ambulances were busy dropping of patients.

In the resuscitation room were two young boys, maybe 5 years old, whom had drank their parents amitryptilline. One boy required intubation, both got activated charcoal. X-ray is not immediately available, but they have a portable wheeling one that came later. The hospital is a small community site, so they transfer him to Tygerberg academic hospital.

Next patient, 16 year old guy, out drinking with family and somehow things escalated and his nephew stabbed his neck with a broken beer bottle. You can see the picture above. Right over his posterior triangle and barely missing his carotid. The hole was huge when we reflected his skin. He consented to me taking his picture. When I showed him the pic, he said “holy shit, f*** f***.” I don’t think he had any idea how severe the injury was. The pic sobered him up for a short time. The attending sewed him back up, good as new. He was transferred to tygerberg for an angiogram of his neck

Another younger guy was stabbed in his chest. Exposing the wound, you could see the bubbles of air coming out. X-ray would take a while. Given the skin crepitus from air, and hyperessonant left chest to percussion, he bought himself a chest tube. Its really neat how much they use physical exam, and do it well. Chest tube placement was just like the states.

Casualty is a pretty crazy place. From the back area with Whitney Houston playing from the stereo, to the ample blood soaked bandages from stab victims, to the flickering light in the stab room. The interns and staff are great teachers, and just really fun people. I’ll be doing more late night casualty shifts in the future.

Broken bottle neck stab



All better


stab/resuscitation room


Pic of Silvan and the views from our student flat.