We had our first plowable snow fall on Saturday night in St. Paul. It was a good warm-up for the road crew as it was only a couple of inches of fluffy snow and there was not so much morning traffic, being Sunday.
My first good news was from the American clerk, telling me I better get my passport replaced as it's becoming unacceptably worn. I spent about $90 on adding pages a year ago, so this was not happy news. The only other notable event was a two-hour delay on the tarmac in Miami. Seems they overloaded the aircraft with fuel and had to take some off. This involved two fuel trucks: one that didn't work and one that did. Traffic was light leaving the airport. The presidential palace is still in ruins but the streets seemed cleaner than August 2010.
Monday morning we made rounds with Hugh. The most interesting patient is a gentleman who fell of a roof on Friday. He had seven hours of surgery to place a sign nail in his L humerus and repair an olecranon fracture. He also has a pelvic fracture that has not been treated surgically. Post-op he had fluid problems and his hemoglobin was 7.5 on Sunday. This morning he still has rales but the edema is better. He had a SaO2 of 86% that increased to 89% after moving him around in bed. We plan to put an external fixator on his wrist fracture and examine the wound tomorrow. He can't see out of his right eye and the pupil responds poorly to light. I suspect it's a post-op optic neuropathy, as he was lying on his left side during surgery, his systolic blood pressure ran in the 60s-70s and he got between five and ten liters of isotonic fluid. Not much to do on that but wait and hope.
Monday morning we made rounds with Hugh. The most interesting patient is a gentleman who fell of a roof on Friday. He had seven hours of surgery to place a sign nail in his L humerus and repair an olecranon fracture. He also has a pelvic fracture that has not been treated surgically. Post-op he had fluid problems and his hemoglobin was 7.5 on Sunday. This morning he still has rales but the edema is better. He had a SaO2 of 86% that increased to 89% after moving him around in bed. We plan to put an external fixator on his wrist fracture and examine the wound tomorrow. He can't see out of his right eye and the pupil responds poorly to light. I suspect it's a post-op optic neuropathy, as he was lying on his left side during surgery, his systolic blood pressure ran in the 60s-70s and he got between five and ten liters of isotonic fluid. Not much to do on that but wait and hope.
After rounds Kathleen, Jen and I went to visit an orphanage run by the family of one of the HAH staff members. The place seemed pretty full to me, but the only students there were the boarders. The children in the neighborhood who attend the school were excused because today is a holiday. Jen shared the Sinter Klaus candy that her boyfriend Erik gave her. The paper and colored pencils that Kathleen bought were a big hit, too. 
After lunch Jen and I worked in the operating room, checking out the anesthesia machines and organizing our supplies. They have nice new monitors since I was here in August 2010. We have six cases booked for tomorrow.
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