The last day was a busy day with more complicated and sicker patients than we cared for over the last few days.
An eleven-year old boy arrived with a cold, headache and a history of fainting during running. The latter complaint drew my attention. He had fainted twice during exercise and on one occasion he was unconscious for ten minutes and his lips were blue during that time. Ouch! He was overweight, which is uncommon in Nicaraguan children, but otherwise his exam was normal. I arranged an ECG, which was also normal. No evidence of QT prolongation, ischemia, or ventricular hypertrophy. In Canada, a paediatric cardiologist would likely due an echocardiogram, a 24 hour holter monitor, and a treadmill test. After reviewing this with Dr. Flores, I am hopeful that a cardiology consult and echocardiogram can be arranged in either Rivas or Managua.
An eleven-year old boy arrived with a cold, headache and a history of fainting during running. The latter complaint drew my attention. He had fainted twice during exercise and on one occasion he was unconscious for ten minutes and his lips were blue during that time. Ouch! He was overweight, which is uncommon in Nicaraguan children, but otherwise his exam was normal. I arranged an ECG, which was also normal. No evidence of QT prolongation, ischemia, or ventricular hypertrophy. In Canada, a paediatric cardiologist would likely due an echocardiogram, a 24 hour holter monitor, and a treadmill test. After reviewing this with Dr. Flores, I am hopeful that a cardiology consult and echocardiogram can be arranged in either Rivas or Managua.
A 33 month-old boy had an open fontanel. The soft spot should close by about 20 months of age. His head circumference was at the 85 percentile. I asked Marta, the clinic nurse, to inquire about seizures and the mother described "absence" spells. Likely this boy has hydrocephalus. In Canada, he would have a CT or MRI and EEG, a pediatric neurosurgical consultation for the hydrocephalus, and a pediatric neurology consultation for seizure control. His neurological exam was otherwise normal without any evidence of increased intracranial pressure, but this will develop without surgical intervention. After discussion with Dr. Flores, I am hopeful that a surgical consult in Managua can be arranged.
Kate and Sian came by and presented a cake to the clinic staff to thank them for their hospitality during their stay.
While they were in the clinic they presented an information session on anemia with a poster they designed for the class.
In lieu of working at the clinic today, we decided on a road trip to Gigante, the fishing village where all the children we saw on Monday and Tuesday live.
Kate and Sian came by and presented a cake to the clinic staff to thank them for their hospitality during their stay.
While they were in the clinic they presented an information session on anemia with a poster they designed for the class.
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