Thursday, March 13, 2008
before i get to the point, allow me to quickly take you through another resus.
i was a community service doctor in qwaqwa (absolutely unpronounceable to the western ear. there is even great variation between the nguni and sotho pronounciations). although i had been a mere house doctor the previous year the system was such that i was the senior on call. the house doctor called me to casualties. the patient's eyes were dilated. the ecg looked flatline. the house doctor had already given adrenaline to no effect. then i saw a lonely qrs complex on the ecg. it almost seemed out of place.
"give atropine!" i yelled. shortly after the atropine, the ecg improved, but only to a rate of 40. the other thing that happened which took me completely by surprise is that the pupils became pinpoint. this shouldn't happen with atropine. and then i realised. the patient had been poisoned with an organophosphate-like-something. that night we pumped 160mg atropine into him. amazingly, he made it.
this was one of a number of poisonings around that time, so when my dog was poisoned, if i had been less distraught i might have thought to pump it full of atropine. as it was i watched in horror as it convulsed and died in my arms. my cuban neighbour learned from my mistake. he stole atropine from the hospital. when his dog started convulsing and seriously threatening to die, he fulled it up with atropine and it survived. that was the first cuban canine resus i saw.
another cuban friend produced the second. in qwaqwa, biliary (a canine disease carried by ticks which is not dissimilar to human malaria) was common and killed entire litters of puppies. there was, however, one old feral dog that seemed to be immune. he belonged to no one, was completely tick ridden and survived everything. he was also the father of all the litters that were systematically wiped out by the disease. one of my cuban friends took one of these semi-wild puppies as a pet. when it got sick i advised him to dissociate himself emotionally and move on. after all it was just a pavement mongrel that was worth nothing. he disagreed. he told me that, like malaria, biliary in dogs is fatal because of haemolytic anaemia, so therefore all he needs is a blood transfusion to keep him alive. if that works he will become like his father, the dog that can't be killed.
apparently blood transfusions in dogs are not as complex as in humans. they don't have compatibility problems. any dog can donate to any dog. how do i know this? because after the cuban friend of mine drew blood out of the old dog and injected it immediately into his sick puppy, i went to the trouble of finding out about this point. amazingly enough, his puppy was the first dog in about 5 years at the hospital that survived to adulthood. and it became an immortal like it's father before him.
so, in conclusion, cubans know how to resus, even if the patient is a canine.
in the series.
resus with hands tied behind my back.