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    Girl saved by a well-placed needle

    By Petty Officer 1st Class David M. Votroubek
    Combined Security Transition Command –Afghanistan

    KABUL, Afghanistan - A little initiative, a little improvisation, and a teenage girl lives. By using bits of medical equipment designed for other purposes, some encouragement from their mentors and great skill, Afghan doctors were able to perform a life-saving procedure for the first time on a patient at the National Military Hospital.

    One of those mentors is Lt. Cmdr. Bradford Volk of Combined Security Transition Command-Afghanistan. He is one of 23 Navy medical specialists with a Medical Embedded Training Team that trains and equips the Afghan national army medical staff of NMH.

    As a family physician, Volk often works with doctors in the pediatrics ward, and first learned of the patient during a discussion with Afghan physicians about supplies. He asked if they knew of any interesting cases they could look at together, and this case was it. In fact, her case was so compelling that a small crowd soon gathered at her bedside to hear the discussion.

    What Volk found was an eighth-grader who could barely breathe or even sit up.

    Four months earlier the 15-year-old girl had been at the top of her class, but was now very near death. Her circulation was so poor that her extremities had actually started to turn blue. This was caused by a build-up of fluid around her heart and lungs, known medically as pericardial effusion. The fluid surrounding the heart eventually constricts the heart and begins filling the lungs, causing the patient to be unable to breathe. The only way to relieve it is by inserting a long needle into a sac to extract the fluid surrounding her heart.

    She was in need of immediate care. Although the Afghan doctors realized this and knew what needed to be done, they weren't sure if they could. It had never been done at NMH before.

    Lt. Cmdr. Frank Grassi, a mentor who specializes in internal medicine, helped convince the Afghan doctors that they could do the procedure. Mentors don't actually treat patients, but instruct, advise and guide the ANA doctors while they do it. And in this rare case, encourage those doctors if they aren't sure.

    Grassi was glad that they did. On New Year's Eve, the Afghan doctors removed over 600 milliliters from the patient, which is more than a drinking water bottle. This was the most fluid Grassi had ever seen from any patient before, let alone a small teenage girl. He believes she would not have survived another three days otherwise.

    One reason why the doctors were reluctant to try the procedure was that the hospital had no pericardiocentesis kits to do it with. Fortunately, the girl's slender build enabled them to improvise with an intravenous needle and a catheter. By using an ultrasound machine designed for prenatal care, they were able to guide the needle to just the right place.

    But according to Dr. Mirwais Amiri, the Afghan cardiologist, it was still very risky. Considering her chances of surviving a trip to India very small, he was convinced to do the procedure with what he had.

    "It was high risk, but I did it," Amiri said proudly.

    Volk believes that by his team helping the Afghan doctors to be successful, other doctors could also gain confidence in their abilities.

    "The best thing we did for this patient was instill confidence in the Afghan doctors," he said.

    Another positive outcome from this case is that pericardiocentesis kits are now included in the next budget plan for the hospital.

    The patient's father, who is an officer in the ANA, will take her to India in the next few days to see specialists to diagnose what caused the pericardial effusion in the first place. She won't be healthy until the cause is found, but by her doctor's taking a chance, she now has a chance for the future.

    NEWS INFO

    Date Taken: 01.03.2008
    Date Posted: 01.03.2008 13:54
    Story ID: 15164
    Location: KABUL, AF

    Web Views: 763
    Downloads: 664

    PUBLIC DOMAIN