I wish that I had had better investigative equipment. I wish that I had had more energy and time to write things up on the spot. As we all know you cannot relive the past. So in my old age I dwell among memories. Some of them very special memories. And that includes this little girl.
She presented short of breath with a high fever, a very tender neck and looking into her mouth you could see a big retropharyngeal bulge, which meant we knew why she had her temperature and was having difficulty in breathing but that bulge was abnormal in a kid of that age in my experience. The X-Ray quality was terrible. We did not have CT scanning or even a decent viewing box in the wards. The following picture shows how we looked at films.
We tried for a soft tissue lateral film and a lateral bone film.
Please don’t be too critical of the films! In the upper soft tissue film you can see how far the air tube is away from the cervical spine. In the lower bony film you can see two bodies which look abnormal.
Where we were, you did something or let nature take its course! Your decision may have been very different from mine but we
- Decided that it probably wasn’t TB and started her on high dose antibiotic.
- With oxygenation and gentle sedation I did a tracheostomy under local anaesthetic.
- We aspirated a huge amount of pus through a large needle through the mouth when she was fully anaesthetized with the trachy in place. This was sent for mcs but had to go to a private lab outside the hospital.
- Made a POP encircling her forehead, strengthened a strip down the back of her neck and encircled the chest.
It was not TB but sensitive to our antibiotics. She was on this treatment for 6 weeks, except that her trachy was removed after several weeks when her temperature was down, and by testing she could breath around the tube comfortably.
Either inspite of us or because of us – she got better and went home after about 10 weeks. She wasn’t always happy to have a photograph taken!
Medical Memoirs 