Pre operative care-at_hospital_kachinga_sichizya


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Pre operative care-at_hospital_kachinga_sichizya

  1. 1. Kachinga Sichizya, FCNeurosurg(SA) Beit-Cure Hospital, Lusaka, Zambia
  2. 2. CHALLENGES IN AFRICA COMMUNITY Ignorance of problem Lack of acceptance by parents Stigmatization by community Witchcraft suspicion Ignorance of available medical help Poor/unhygienic enviroments Financial constraints Late presentation
  3. 3. CHALLENGES IN AFRICA MEDICAL CHALLENGES Lack of knowledge/understanding of problem Fear of likely poor outcomes and suspected poor QOL Lack of surgical expertise to manage SB/H Lack of facilities No ultrasound facilities for antenatal diagnosis
  4. 4. CHALLENGES In the third world, we still have a long way to go before we can manage SB/H properly The biggest challenge is knowledge and understanding of the condition of SB/H There is lack of emphasis in training of medical personnel at all levels: TBA, nurses, CO and even doctors. This must change There are no facilities for ante-natal diagnosis, so we are not prepared for such a birth Most of these children are born in unhygienic conditions and are exposed to unhygienic practices such as applying cow-dung to the lesion
  5. 5. COUNSELLING FOR FAMILY Inform/educate family about condition and prevention Create realistic hope Parents don’t know what has hit them. Take time to explain the condition of the child and how to prevent recurrency Tell them: treatment will help the baby but not cure. Child may need other operations(VP shunt, correction of limb deformities etc) Child will need CIC management Give info in leaflet
  6. 6. ON ADMISSION Assess general condition of the patient: The majority of patients present late They are not ready for surgery They are septic, dehydrated and with very dirty wounds Some are anemic
  7. 7. Pre-op assessment CLINICAL EXAMINATION: Head circumference/start chart Brain ultrasound if need be Body temperature Nutritional status, weight, hydration Other deformities: weak limbs, club feet, open anus General condition of baby
  8. 8. Pre-op management Rehydrate the patient Workup the patient for sepsis and anemia Do pus swab of the lesion for M/C/S FBC If Hb is low, either transfuse pre-op or cross-match to transfuse on the day of surgery If the child is septic, start on broad spectrum antibiotics until sensitivity results are ready In case of severe sepsis, there may be need for debridement before closure can be contemplated
  9. 9. Pre-op management WOUND CARE: Keep baby in prone position(on tummy) to avoid pressure on the wound and to prevent stool coming onto wound and avoid the pain keep the lesion clean use normal saline for cleaning open wounds cover with sterile dressings Only give antibiotics when signs of sepsis appear
  10. 10. Many thanks for the attention