Moonlighter - Recap

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Moonlighter - Recap

This is our final recap of our "Out on a Limb" Case Series!  If you missed the initial "Moonlighter" case and discussion you can check it out here.  There were a number of great responses to the questions which we'll recap below.

Q1 - What are your options in handling this situation?

You have a few options in handling this situation. As many of the respondents chimed in, the wound definitely needs to be cleaned out and closed and the patient requires antibiotics as soon as is reasonably and safely possible, especially since the injury is already 6 hours old. The first option is to complete a sedation and multilayer repair in the ED yourself. As many people point out, this is not an excellent proposition unless there are extreme extenuating circumstances.

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Trouble Abroad - Recap and Commentary

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Trouble Abroad - Recap and Commentary

The responses provided so far have been phenomenal, both insightful and provocative.  I am truly impressed.  As mentioned by several of my colleagues, many of these cases are deeply personal, not only because they involve highly vulnerable populations, but also because they may put clinical providers in harm’s way.  When we begin to discuss ethics, especially global health ethics, there is often no single correct answer to a given scenario.   We often deal with hard science and hard facts but sometimes you just have to go with your gut and do what you think is right.  If you missed the first case and initial discussion, check it out here.

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Out on a Limb - Moonlighter

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Out on a Limb - Moonlighter

You are a 4th year EM resident moonlighting on your first day in a remote area as the solo provider that has minimal availability to consulting services. The nearest major hospital is approximately 100 miles away.

A 5 year old child enters your ED at 3 am with a large, complex laceration to the face from a dog bite which will likely require sedation and a layered closure.  His injuries were sustained approximately 6 hours ago. The wound is complex and will require a multi-layered closure and there are a couple of areas of tissue avulsion. You have 1 or 2 cases of similar experience from approximately 1 year ago on your plastics rotation...

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Out on a Limb - Troubles Abroad

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Out on a Limb - Troubles Abroad

You are an EM resident from the US working in a rural South African hospital as part of a global health elective.  The political climate is such that a prolonged government strike is leading to severe staffing and resource shortage.  There are no disposable gloves and many procedures are performed barehanded.  One day during rounds in the Labor Ward, the Chair of the department asks you to draw blood from an HIV-positive woman in labor as the team is presenting the patient in her room.  The only remaining gloves in the hospital are a few pairs of sterile gloves reserved for emergency cesarean deliveries.  There are high rates of HIV-exposure and many staff members are currently on post-exposure prophylaxis.

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Out on a Limb - "Is there a Doctor on Board?!"

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Out on a Limb - "Is there a Doctor on Board?!"

You are enjoying a cocktail on the way to Hawaii on a well earned vacation when a voice comes aloud overhead, “Attention all passengers. If there is a doctor or health care provider present, we ask that you please come to the front of the plane immediately.” From your vantage point in the back of the plane, it becomes clear very quickly that no one is volunteering. You find yourself being stared at by a plane full of people as you make your way to the front, to find a morbidly obese Caucasian female with a flight attendant at her side. You start your encounter…

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