10 June 2013
Today we shadowed
Dr. Labuschagne (Dr. L for simplicity), who is an opthomologist at the state
hospital associated with campus. He also serves as the Head of the Clinical
Simulation Unit and is a lecturer in the medical school. To start, he showed us
the simulator dummies they have, which are ridiculously intricate. For example,
“Sim-man” can blink, sweat, cry, foam at the mouth, convulse, bleed, and even
talk! He has 19 microphones to give different heart sounds/murmurs, lung
sounds, and bowel movements. Furthermore, he can tighten his jaw to constrict
his airway, allowing for a tracheotomy to be performed by students. He will
turn blue in the face if oxygen levels get too low! The coolest part is that he
can respond to medicine. A label with an identifying microchip in it can be
attached to a syringe which is then filled with water. “Sim-man” can identify
the microchip and volume of water so as to ensure the student is giving the
correct “medication” at the appropriate volume. Another dummy, “Sim-mom,” can
actually give birth and can be set up for a C-section or other labor
difficulties. There is also a “Sim-baby” that can cry and be used for various
medical studies because the students are not allowed to interact with real
infants. All dummies can change heart rate and breathing rate, as well as undergo
defibrillation without shorting out.
Dr. L
showed us around the general medicine, pediatrics, ICU, and various wards of
the campus associated state hospital. We also met some 5th year
medical students and we shared details about our different medical routes
between the States and South Africa.
Next, we
went to the Central University of Technology (CUT) campus to observe an emergency
responders exam for third year students. A simulation was set up where a dummy
was lying on the ground in a shed on a farm. The victim had vomited, defecated,
and was convulsing with copious amounts of saliva pouring out of his mouth. He
was also sweating profusely. There was a smell of chemicals in the air with a
table covered in bottles of various chemicals. He had lost his wife and two
daughters in a fire a few months ago. Figured out the diagnosis yet? Ok I’ll
give you a big hint, the main culprit was organic phosphate. If you’re like me
you’re probably like, “Alright this guy obviously tried to end his life with
internal poisoning, but how the heck do we keep him from dying?!” Then Dr. L
mentioned the term SLUDGE, and a flash back to Dr. Henson’s Human System’s
lecture about the nervous system came charging into the forefront of my memory.
Atropine is the solution! SLUDGE is a mnemonic for salivation, lacrimation,
urination, defecation, gastrointestinal upset, and emesis (fancy word for
vomiting). Nerve gas and pesticides (like organic phosphate) can cause this
pleasant array of sensory overload due to a massive discharge of the
parasympathetic nervous system. The treatment is atropine, which acts to compete
with the stimulated nerves to shut them down and bring the patient back toward
stabilization.
Afterwards,
Dr. L took us to National Hospital, another state hospital down the road. There
he showed us the optometry and opthamology wards. He even let us observe each
other’s iris with a split-lamp. He also showed us to the surgery theatres and
HIV ward, sharing with us that 30% of South African’s have HIV. He also showed
us some amazing statistics that South Africa is short in specialists by 8,000
doctors and short in general practitioners by 7,000 doctors.
Later that
afternoon, we sat in on Dr. L’s lecture about diseases and tumors of the iris,
choroid, and retina. I learned that brushfield spots are only found in Down
syndrome patients and saw some pretty ridiculous pictures of tumors gone WAY
wrong (especially with retinoblastoma: YIKES!!!).
I also got
to join in a heart dissection class. They were dissecting pig hearts in
correlation with a trans-esophageal echocardiogram. Each student had a heart
and a square with a red dot at one end and green dot at the other. The square
was used to orient their view of the pig heart with that of the human heart on
the recorded sonar pictures. They dissected the tricuspid valve and mitral
valves, orienting their pig hearts to with the views of the sonar so as to as
to gain an understanding of how to navigate a probe to gain different views of
the heart.
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