Man vs the Monsoon

Note: The purpose of this site if to provide free open access medical education (FOAMed) in the context of rural and remote health. Though all stories have been inspired by real cases, all identifying details such as names, ages, locations and background descriptions have been thoroughly changed to ensure the absolute privacy of the patients, families and communities we serve.

The Situation

The monsoonal rains had been keeping most people indoors, the storm had been roaring and the seas were rough. The soon-to-be-patient was a 45 year old Australian crew member working on a Chinese container ship passing through the northern Torres Strait. He had been soaked by the storm while attempting to secure a dinghy to a pilot boat that was traveling with the main ship. On his approach to the boat a large wave washed over the dinghy and tipped it backwards and then upside down into the ocean while the motor was running. The man was dragged underneath the dinghy. He attempted to surface, but came up against resistance of the hull of the pilot ship. Disoriented, he dove again, trying to find a way to the surface and avoid the hazards of the propeller and other boat.  Eventually he surfaced with air above him and whilst being tussled in the waves grabbed onto one of the tires hanging from the pilot boat. He held on tightly to the tire as the wave crashed over him. Sometimes the waves went over his head, he swallowed water and he gasped for air. The sole crew-mate with him was unable to pull him back on board. Continue reading “Man vs the Monsoon”

A 7-year-old boy with Omnipresent Oedema

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 7-year-old boy presented to the Primary Healthcare Centre one afternoon after school with his grandmother. She was concerned that his eyes had become quite puffy over the past few days. He had been swimming at the local pool over the weekend and she thought it might be because he had been wearing swimming goggles. He denied any pain around his eyes, diplopia or blurred vision. He also noticed that his school shoes hurt when he put them on. Continue reading “A 7-year-old boy with Omnipresent Oedema”

The Flying Death Adder

Note: The purpose of this site if to provide free open access medical education (FOAMed) in the context of rural and remote health. Though all stories have been inspired by real cases, all identifying details such as names, ages, locations and background descriptions have been thoroughly changed to ensure the absolute privacy of the patients, families and communities we serve.

The Situation:

The school day had ended, and dusk was approaching on one of the pristine islands in the Torres Strait.  A 10-year-old girl and her friends were slowly making their way home when they came across a death adder on the road. The group armed themselves with sticks and approached the snake. Making a game of it, the snake was flicked into the air with a stick and landed on the road again. On the second throw, the snake was inadvertently hurtled directly at the girl by her twin brother. Its fangs collided with her index finger of her open hand leaving one tooth lodged in the pulp.

Continue reading “The Flying Death Adder”

Two 20-year-old Males with Impending Sense of Doom

 

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

It was a quiet afternoon in the Emergency Department when a call came from the Ambulance Office informing us of 000 call from a boat out on the reef. “We’ve been told told that there are two young men out there who are both unwell and feel like they are going to die.” We didn’t receive much more information than that, and waited until a helicopter went to retrieve them, where they were both winched from the ocean. Continue reading “Two 20-year-old Males with Impending Sense of Doom”

24 Hours as the On-call Doctor in the Torres Strait

 Note: The purpose of this site if to provide free open access medical education (FOAMed) in the context of rural and remote health. Though all stories have been inspired by real cases, all identifying details such as names, ages, locations and background descriptions have been thoroughly changed to ensure the absolute privacy of the patients, families and communities we serve.

24 Hours as the Doctor On-call in the Torres Strait

Manning the on-call phone for the Torres Strait is one of my favourite jobs. There is a doctor rostered to this job at all times and entails being the first point of call for any medical query in the region.

The Background

The Torres Strait is a spectacular group of remote islands located at the very tip of Queensland between Cape York and Papua New Guinea. The most northern islands are only 4km offshore from the PNG mainland. The region spans 48,000 square kilometres, which is an area bigger that Switzerland or Holland, and is comprised of 274 islands though only 17 are inhabited. The Northern Peninsula Area (NPA) comprises five communities on the northern tip of Cape York Peninsula. The population of approximately 14,000 are spread over the Torres Strait islands and communities in the NPA. Continue reading “24 Hours as the On-call Doctor in the Torres Strait”

A 62-year-old Male with Dreadful Dysuria

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 62-year-old Male trudged into the Emergency Department on a Friday night. There was a downpour of rain outside as the wind was whistling through the windows and doors. This weather came as no surprise to anyone – it was after all the wet season. He complained of dysuria, urinary frequency and hesitancy for over two months. There was no blood or pus in his urine, no bowel symptoms, no abdominal or flank pain and no fevers. He had visited his GP a few weeks ago who diagnosed a urinary tract infection and given him a course of Trimethoprim.  Urine cultures at that time grew sensitive E. Coli. But his symptoms never seemed to have resolved and in fact now were worse. “Just fix the problem doc!!” were his words.

His had diabetes (on metformin and gliclazide); hypertension (on ramipril) and hypercholesterolaemia (on a statin). He was a ex-smoker, non-drinker, not currently working and enjoyed gardening.

Continue reading “A 62-year-old Male with Dreadful Dysuria”

A 25-year-old Female with a Mysterious Myalgia

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 25-year old previously well female presented to the remote area nurse on an outer island somewhere in the Torres after being carried into the clinic by her family. She had woken that morning with severe muscle pains in her neck, back, abdomen and hips. She described the pain as ‘just like a cramp’ and denied joint pains, nausea, vomiting, fevers and bowel or bladder symptoms.

The patient had been Crayfish diving the day prior but can’t remember being stung by anything in the water. She ate cooked boxfish the night before – a regular meal in her family. She didn’t drink alcohol and denied drug use. Continue reading “A 25-year-old Female with a Mysterious Myalgia”

A 40-year-old Male with a Serpiginous Foot Rash

This case has been inspired by events in the Torres Straits and details have been changed to ensure patient anonymity.

History

A 40-year-old male presented to his primary health care practice during the wet season somewhere in the Torres during the wet season. He had an intensely itchy rash to his right ankle for the past five days. It started out as a small but painful raised erythematous lesion then began to migrate around his ankle. The rash was found nowhere else on his body. He didn’t have a fever, abdominal pain, diarrhoea or cough. He had recently been doing some gardening barefoot around a flooded creek and described the water to be quite muddy and contaminated. He is an otherwise well male with no past medial history, regular medications or allergies. Continue reading “A 40-year-old Male with a Serpiginous Foot Rash”