Introduction
Discussion
1. Strengthening the emergency healthcare system within Brikama hospital
2. Integration of emergency care between community villages and the hospital
Patient numbers | Total | Emergency | Resuscitation given | Outcome |
---|---|---|---|---|
1,52,63 | 3 | Obstructed Labour | IV glucose x3, oxygen x1, normal saline bolus x2, CS x3 | 3 mothers alive, 1 infant death |
8,12,13,18,19,22,25,29,30,31,32,34,37,41,46,56,57,68,99,103, | 20 | Ante-partum Haemorrhage or miscarriage | CS × 6, IV glucose × 2, IV Normal saline × 19, lateral tilt × 1, oxygen × 2, leg elevation × 2, blood transfusion × 1, IV antibiotics x1 | All mothers alive, 7 infant deaths |
3,40,43,45,85,91,94,101 | 8 | Eclampsia and 2 cases of severe pre-eclampsia | IM/IV hydralazine × 4, IV magnesium sulphate x6, CS x2, Diazepam × 1, oxygen x1, airway opening x2, oropharyngeal airway, suction x2 | 7 mothers and infants alive, 1outcome unrecorded |
1,2,10, 14,36,45,54,93,100,101,104, | 11 | Pregnancy Induced Hypertension without severe pre-eclampsia or eclampsia | IV hydralazine × 6, IM hydralazine × 2, CS × 3, | 11 mothers and 11 infants alive |
4,10,15,16,44,53,59,72,76,77,84,89, | 12 | Twins × 4, breech × 6, or compound presentation × 2 | IV glucose × 5, CS x4, vaginal breech x4, IV normal saline × 5, blood transfusion × 1 | 11 mothers alive, 1 breech fractured femur, 4 fresh stillbirths (one breech head could not be delivered) 1 outcome unrecorded |
7,10,16,17,20,26, 27, 28,33,50,66,69,82,86,87,88,90,101,102 | 19 | Prolonged labour | IV glucose × 16, IV antibiotics x1, IV normal saline × 3, ventouse at home × 2, urinary catheter × 1, CS × 9, | 19 mothers alive 1 stillbirth |
65,81,83,92,96,97,100,106 | 8 | Postpartum haemorrhage | IV normal saline x5, misoprostol x2, ergometrine × 4, oxytocin IV × 1, blood transfusion × 5, IV antibiotics × 2, repair tear × 1 | 7 mothers alive 1 outcome unrecorded |
39, 53,58, 83,97, | 5 | Severe anaemia | Oxygen × 1, blood transfusion × 5, IV normal saline × 3, IV antibiotics × 1 | 5 mothers alive |
20,21,36,51,55,62,70,71,73,74,75,87,93,102,107 | 15 | Primagravida | IV 50% glucose × 7, IV normal saline × 4, CS × 4, ventouse × 1 | 15 mothers alive 1 stillborn infant |
38,42,47,49,53,66,67,78,79,80,88,90,106,109 | 14 | 4 or more previous births | IV normal saline × 4, IV glucose × 3, blood transfusion × 1 | 13 mothers alive 1 unrecorded 2 stillborn (twins) |
26,75,95 | 3 | Infection in pregnancy | IV 50% glucose x1, IV antibiotics × 3, CS x1 | 3 mothers alive 1 stillborn infant |
5,29,45,64,84 | 5 | Preterm labour | 5 mothers alive 1 infant stillborn | |
9(3 patients),11(2 patients),108 | 6 | Road accident | Airway opening x3, compression for bleeding x1, IV normal saline x2, Pain control, | 4 survived and 2 died |
6(3 years),24(3 weeks),35(8 days), 61(2 years) | 4 | Paediatric emergency | Airway opening × 2, oropharyngeal airway × 1, IV Normal saline x2 IV glucose followed by infusion × 1, IV antibiotics × 1, Assisted ventilation with bag-valve-mask and oxygen x1, compression to stop bleeding × 1, blood transfusion x1 | 4 survived |
23,39,48,60,64,98,105 | 7 | Miscellaneous (asthma, loss of consciousness, severe vomiting, retained placenta, dehydration and shock, staff member in labour) | Anti-asthma treatment x2(salbutamol, hydrocortisone, aminophylline), oxygen x1, IV normal saline x2, IV glucose x3, retained placenta removed after urinary catheter x1, IV antibiotics × 1 | 6 pregnant mothers and their infants survived. One man with dehydration and shock died |
3. Training in the recognition and management of emergencies
4. Monitoring and evaluation
CONDITIONS RESUSCITATED | TOTAL | DEATHS |
---|---|---|
Ante partum haemorrhage | 17 | |
Postpartum haemorrhage |
20
| |
Massive haemorrhage |
2
| |
Eclampsia |
23
| |
Severe anaemia |
21
| |
Shock |
22
|
3
|
Severe sepsis including malaria |
33
| |
Road accident |
7
| |
Severe pneumonia |
10
| |
Birth asphyxia |
45
|
3
|
Burns |
9
| |
Complications of labour/delivery |
12
|
2
|
Major medical problems (epilepsy, diabetes, airway obstruction, severe dehydration, severe anaemia, malnutrition, apnoea, hypoglycaemia, heart failure, hypertension, liver disease, gas poisoning) |
17
|
3
|
Major trauma (gunshot, stabbing, fracture, head injury) |
9
|
1
|
Severe asthma |
10
| |
Unknown |
36
|
1
|
TOTAL
|
293
|
13
|
-
Need for oxygen in ambulances (currently being implemented country-wide)
-
Great care and close observations when oxytocin is used in multiparous mothers in labour
-
More blood available in the blood bank
-
Calcium gluconate to be always available as an antidote for magnesium sulphate toxicity
-
Misoprostol to be available in all health facilities
-
More training in the use of intra-uterine tamponade catheter for post partum haemorrhage
Sustainability
Additional developments
-
a new one day course of training for senior nurses and doctors in the use of morphine for treating severe pain. Morphine is rarely used despite its low cost. Reasons for this include the logistic efforts required to control and monitor its use and the possibility of misuse.
-
a one day course on the recognition of the clinical signs of child physical and sexual abuse
-
a one day course for ward cleaners on infection control, including an enhancement of their duties to include the training of patients/relatives in hygiene.
-
attempts to establish blood banks with national programmes all over the country to decrease avoidable deaths due to haemorrhage and severe anaemia. One of the main problems has been the high and prohibitive costs of suitable refrigerators and frequent loss of mains electricity, resulting in variable periods without power. The use of a generator to maintain power in the hospitals 24 hours a day has proved too expensive in terms of fuel and a new technique based on a small pharmacy refrigerator designed for use in tropical countries that requires only 110 watts of power, runs from a large battery (220 ampere hours) with an inverter and automatic switching system and supported by solar power is under development.