Luca Saraceno tells how doctor wife died on Westlands road as crowd stared

 

I wish that one day I may see many public ambulances running through the streets of Nairobi rescuing its citizens in need of urgent care, I wish I may be finally sure that quality basic and referral health services are provided to all citizens, regardless of their census and status and in a way that truly prevents death and suffering. On that day, hopefully not too far, I will hold my daughter’s hand and I will tell her: “Believe me, my daughter, your mum died like a hero. You need to know that your mum wished all of this, and you need to trust me when I say that she contributed as much as she could for this to happen, not only during in life but also through her death”.

 

Damage Control Resuscitation

Damage control resuscitation is aimed at helping to avoid or diminish the Lethal Triad of Trauma Management: Acidosis, Hypothermia, Coagulopathy. It has three core concepts:

  1. Acute Coagulopathy of Trauma
  2. Permissive Hypotension
  3. Massive Transfusion & Hemostatic Resuscitation

Acute PID

Diagnostic criteria;

Minimum criteria for clinical diagnosis (one or more of the following minimum clinical criteria should be present) are as follows:

  1. Bilateral lower abdominal (uterine) tenderness (sometimes radiating to the legs)
  2. Cervical motion tenderness – Positive cervical motion tenderness is defined as increased discomfort from a normal pelvic examination, as stated by the patient. Of note, cervical motion tenderness is neither sensitive nor specific for gynaecologic pathology, is a sign of nonspecific peritoneal inflammation,
  3. Bilateral adnexal tenderness (with or without a palpable mass)

One or more of the following additional criteria can be used to enhance the specificity of the minimum criteria and support a diagnosis of PID:

  • oral temperature >101° F (>38.3° C);
  • abnormal cervical or vaginal mucopurulent discharge;
  • presence of abundant numbers of WBC on saline microscopy of vaginal fluid;
  • elevated erythrocyte sedimentation rate;
  • elevated C-reactive protein; and
  • laboratory documentation of cervical infection with N. gonorrhoeae or C. trachomatis.