Shock

One of the children hospitalized for dengue went into shock today. His blood pressure was low, his heart rate went up, and his extremities were cold. What happened was that his blood vessels were leaking fluid so he didn’t have enough blood in his circulation to maintain a healthy blood pressure. The doctors gave him fluids by IV, but his blood pressure failed to respond. The only option left was to put a catheter into one of his large veins (a.k.a. a “central line”) in order to both increase his blood volume and give him medicine that would increase blood flow to his vital organs. His parents were both in tears as the resident informed them of the procedure that needed to be performed. Within minutes, a surgeon arrived in the infectious disease ward, and they began the procedure. I observed from the back of the room as a resident and two nurses held the boy firmly in place to keep him from moving during the procedure (which was done under local anesthesia, so the boy was awake for much of it). After injecting the anesthesia, the surgeon made an incision to the right of the groin and then set about to locate the femoral vein (which leads in to the Vena Cava – the route by which all blood returns to the heart). However, the procedure did not go smoothly, as the first catheter did not go in correctly and had to be removed. A second surgeon then arrived on the scene and after much effort was able to succeed in inserting the central line. The entire process lasted over an hour. It was made the more difficult by the fact that every now and then a nurse would relax her grip of one of the child’s limbs and he would kick or flail his arms. There was a collective sigh of relief when the whole thing had successfully terminated. Poor kid. He´s only three years old. Boys Playing on the Street