Dr Larry Stock's Blog
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Dr. Larry Stock MD, FACEP is an American Emergency Medicine Physician with many years of humanitarian aid experience. Larry is an Emergency Medicine specialist with extensive experience in teaching/training, leading/organizing, and practicing Emergency Field Medicine, in man made and natural disaster zones. Larry is indefatigable, and has been, and will continue to be integral to AAI's medical response to the disaster. Larry is on the American Board of Emergency Medicine Diplomat and Examiner, Clinical Associate Professor, UCLA School of Medicine Assistant Medical Director, Emergency Department, Antelope Valley Hospital Attending Physician, Emergency Department, Harbor UCLA Medical Center Volunteer Emergency Medicine Physician: 1996 Bosnia, 1999 Albania, 2000 Kosovo, 2003 Liberia, 2004-2005 Sri Lanka, 2005 Kashmir/Pakistan with AAI, 2000-current Thai Burma Boarder |
19th October 2005
I have only slept a few hours a night for the last 3 days. I guess there has just been too much adrenaline pumped into my body since I decided to come to Pakistan with AAI. LA, Osaka, Bangkok, Karachi and now this evening the capital, Islamabad. Last night I read each news article in the daily paper as if it was an intelligence report preparing me for my mission. I formed a concept for a project and wrote up the rational and the projected medication and supply needs. Tonight we started our patient care work. We volunteered at the PIMS hospital emergency department. PIMS is the largest and most respected hospital in Islamabad. They have been receiving surgical cases since the beginning of the disaster. They have been doing general, orthopaedic, and neurosurgical head and spine cases around the clock.
We worked in the emergency receiving area. The real emergency cases go straight to the ICU. The open foyer was full of wall to wall beds with injured patients. Most had been seen and were awaiting surgery, with mixed in new patients who had not yet been seen. We started at one side of the room and went counter clockwise doing rapid rounds searching for patients who were quietly deteriorating or who might have been overlooked. We found a new patient who had multiple fractures and would require surgery. We identified a woman who was well with a broken rib and a partial lumbar spine compression fracture that could be sent home with pain management. We found a patient who was hypotensive with crush syndrome and muscle break down (rhabdomyolysis) with needed IV fluids to save her kidneys. We met corridors of patients with long bone fractures, spinal cord injuries, and kids who seemed to take all this in stride while they sat in a sea of injured souls.
We were the assigned the task of identifying the most healthy/stable patients who could be transferred out to other hospitals for care, creating capacity for the next days surgical case load. We discovered a woman who had a hip fracture whose diagnosis had eluded the surgeons who have been working around the clock for 11 days.
When we completed this task we popped up to the surgical ICU. There we met the ICU medical director. 6 of his 15 beds were occupied by patients with full blown tetanus (lock jaw). The Pakistani health system only gives one tetanus shot to infants rather than the complete series. The talented and scientific ICU director had researched the latest treatment using magnesium sulphate. While historically tetanus carries at mortality rate of about 60%, he has been able to achieve a survival rate, prior to the earthquake, of more than 90%. These current cases though are not as promising as there rapid onset of symptoms (5 days after injury) bodes poorly for there chances to survive.
I am exhausted. It is almost one am, and time for me to finally take my res