This week our Global Health pathway held another joint simulation with our colleagues from OB/GYN, EM, and surgery. This time, our interdisciplinary teams triaged the care of a 19-year-old pregnant woman who presented with fever, HA, vomiting and fatigue for the past several days. Fleeing violence in her native Sudan, the patient had recently arrived in a Ugandan refugee camp (in a malaria-endemic region). The patient was critically ill and altered but astute investigations by our teams discovered the cause: malaria. Shortly thereafter, the patient suffered a tonic-clonic seizure and coded (sequela of cerebral malaria). The team performed a resuscitative hysterotomy and delivered a live infant.
Following the simulation, we discussed the epidemiology, pathophysiology, diagnosis, and treatment of malaria. We also discussed the multiorgan failure that accompanies the most severe malaria cases, including cerebral malaria, the most severe consequence of Plasmodium falciparum. Finally, we discussed the role of resuscitative hysterotomy (aka “perimortem c-section”) and why removal of the fetus from a gravid uterus is potentially lifesaving for both mother and neonate (if viable). Cardiopulmonary resuscitation is less effective in the third trimester because of aortocaval compression, and the procedure should be done regardless of viability of infant for maternal benefit.
Kudos to Ian Drobish for representing Internal Medicine and using his training to make an early diagnosis of malaria!
