By Choong Shoon Thai
Medical emergencies can happen anywhere, and when they happen in this community, the primary care provider is sometimes best placed to provide the immediate care required.
A Hand in Time
I was called to the emergency room of the clinic to attend to a case of “hand amputation”. The patient’s hand had been cut off above the wrist and the ends of his radius and ulna bones could be clearly seen. The cleanness of the cut meant the blood vessels were well-constricted with remarkably little bleeding.
I instituted first aid measures and called for help from my colleagues at the same time. We learned from the patient that he had been attacked nearby by someone wielding a parang*. In the aftermath, he had escaped to our clinic, leaving his severed hand behind. The success of reattachment surgery depends on the hand being kept cool, and on the surgery being performed as soon as possible. Time was critical, and I did not want the ambulance to take the patient to the hospital without his hand!
Leaving the patient with my colleagues, I followed the trail of blood. The amputated hand was lying on the pavement beside the main road, some three hundred meters from the clinic. We wrapped the hand in gauze moistened with saline and placed it into a clean plastic bag inside a cooler box with ice, and it accompanied the patient to hospital in the ambulance.
We learnt later that the hand had been successfully replanted.
*A parang is a large knife with a long and heavy hatchet-like blade.
Commentary
While we may sometimes view primary care as consisting mostly of chronic disease management and treating coughs and colds, medical emergencies can and do present for management.
Over years of working in a polyclinic, my colleagues and I have attended to acute asthma attacks and myocardial infarctions. We have also encountered trauma situations, such as when road traffic accidents occur in the vicinity of the clinic. I recollect the dramatic episode of a severed hand successfully reattached in the accompanying vignette. A picture drawn by medical students depict another case of a chopped-off finger.
When we practice in a clinic, we have an ethical obligation to be able to respond to, and to manage patients in emergency situations. Under the Private Hospitals and Medical Clinics Act, the clinic must have resuscitation facilities for emergencies and adverse reactions to any form of treatment provided, the means to set up an intravenous infusion, and the means to maintain a clear airway.
When attending to an emergency situation, remain calm and recall your training, and call for help early if you need it. And, as with all medical encounters, we need timely and detailed notes of our findings and treatment.
——- Dr Choong Shoon Thai
Choong Shoon Thai works in a polyclinic and also runs a weekly Dungeons & Dragons game.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
