Stories about: Critical Care Medicine

My critical care crusade: Why low-resource countries need more than primary care

critical care crusade

“I know that my child died because I am poor.”

These are words I will never forget. They were uttered by a dejected mother as she watched us, her daughter’s medical team, desperately try to resuscitate the child.

She was right.

Because she could not afford the antibiotics to treat severe pneumonia,  her daughter died when the infection overwhelmed her little body.

As a Pediatric Critical Care specialist, I am trained to help children survive their most acutely ill states. I fight death, in the literal sense. Over the last few months, while working in Rwanda and Liberia, I have all too often found myself staring helplessly at parents and family members as they watch their young children succumb to disease. Much of the western medical advances that allow us to minimize childhood mortality rates have not yet made it to these countries.

In Sub-Saharan Africa and other low resource areas, preventative strategies and primary healthcare are the focus of governments and ministries of health. The need for basic healthcare services will always be present, but tertiary healthcare systems — including critical care — are becoming more important as childhood mortality rates decline. These supplementary services must be incorporated into the fabric of existing healthcare structures.

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Challenging Case: Aspiration of a Pretzel

pretzel aspirationA 2.5-year-old boy presented to South Shore Hospital Emergency Department (ED) during a severe snowstorm having aspirated a chocolate-covered pretzel.

On arrival he was awake and crying, but would begin falling asleep when not stimulated, raising fears of hypercarbia and impending respiratory failure. He was in severe respiratory distress, with suprasternal and subcostal retractions and biphasic stridor. He was tachycardic, tachypneic, with an oxygen saturation of 84 percent on room air. Prior to arrival, his mother had performed the Heimlich maneuver, and emergency medical services had administered racemic epinephrine to alleviate continued stridor and cough, with minimal improvement. …Read More

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