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<i>SHOUTING COMMANDS</i>
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This young man sustained
a mine injury;
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he badly injured the left leg,
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so actually he has lost the
ankle and the foot at the field.
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Landmine it has mechanical force
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when it blows away
part of the limb,
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with bones, muscle, nerves,
blood vessels and so on.
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He have a lot of foreign bodies,
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the soil, the stone, metallic
fragments, pieces of wood
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pieces of clothes,
parts of the shoes,
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anything which was around the
mine, will be taken away
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by this massive force and
then get into the body.
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The primary thing is to save
the life of the patient
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and then the second thing
is salvaging the limb.
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The worst cases they
die immediately
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because the injuries are
really; really bad.
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They very seldom are complaining
about the pain immediately
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because it is some kind
of reaction from the body
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that the patient
doesn’t feel the pain.
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Would you please tell him
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that he is going to the
Operating Theatre now?
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This patient probably will
need a blood transfusion
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and then after the operation but
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we have to see how much he is
bleeding during the operation.
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He is extremely traumatized
psychologically at the moment.
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The physical pain will also
come now after the operation.
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It depends how the victim
has accidental contact
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with the mines.
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If he has stepped on the mine
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the whole leg will defend
the rest of the body.
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So usually they
don’t have injury
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injury to the abdomen or
the chest or the head.
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It opens the soft
tissue along the bone
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starting from the ankle to the
next joint, that’s the knee.
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So the principle is, what
is dead, should be removed.
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Otherwise it will threaten
the life of the patient.
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<i>MUSIC</i>
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He didn’t bleed much luckily.
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The tibia and the fibula, the
two long bones of the leg were
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quite ok but the soft tissue
was injured up to the knee.
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So a below knee amputation
was performed immediately
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removing all the dead tissue,
that is the muscle the bone,
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the skin, the nerves and the
vessels which were dead.
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And then we left the wound open
to be inspected after five days.
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And he is lucky enough
to save his knee
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so he will have a
below knee amputation
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which will be refashioned after
five days so he will have
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a prosthesis with his own knee,
that is quite important.
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<i>MUSIC</i>
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<i>MUSIC</i>
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The laparotomy case
from last night...
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And you will have,
which is yours?
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We start with this one,
which is the smallest.
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The nine month one.
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The little.
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Emergency surgical Centre
was opened in 1998.
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The major group was mine victims
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and we still have between
5 to 10 patients
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from the mine
explosions every month.
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And nowadays we are also
getting patients from Vietnam
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and from Thailand.
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When the patients are
coming from the rural areas
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they are normally coming from
the very, very poor families
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and it’s the threat and the risk
for these people every day.
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Good morning.
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Everybody has a relative or
a family member or a friend
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who is disabled because
of the mine injury.
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In this country there are
no psychologists who are
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supporting these patients
after this kind of accidents.
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So they have to make their
own rehabilitation,
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the mental rehabilitation,
and in this hospital
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it is the other patients
and our nursing staff,
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because they have a lot of
experience from the mine victims
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so he will get a lot of help
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during the time he
is treated here.
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<i>MUSIC</i>
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Thank you, so we will
organize the wheelchair.
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We’ll take you to the ward.
You can just lie down.
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He’s doing amazingly well
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but the nurses already on
the male ward have said
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that we have to get this
patient as soon as possible
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away from the
intensive care unit.
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Because there are patients there
that are severely injured
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and he doesn’t have any
peace on that ward.
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Go very slowly...
one, two, three!
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Okay, good.
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It’s better that he comes
to the normal ward
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where its more
peaceful and he can
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discuss with the other patients
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and start thinking
about something else
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other than his own injuries.
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Yes.
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Hello, how are you?
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He has a headache did
he get any Paracetamol?
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He got already?
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Let’s hope that his
relatives are coming today
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and will cheer him
up a little bit more
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and ah, because it always
is encouraging them
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to have this idea in
the head that one day
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I will go home from
this hospital.
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Okay, good. See you later!
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He is extremely calm and
it seems that he is not
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voluntarily starting
any discussions
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with the other patients.
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And I hope that this is
not going to develop
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into any kind of depression
after this injury.
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This morning on the ward the
doctors were discussing
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about this operation day
tomorrow because it has been
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planned that he will get
primary closure for the stump.
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In case the stump is infected
or not doing very well
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that they have to amputate
above the knee and
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it means for the patient a lot
because the function of the knee
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is very important for a
person who wants to walk.
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We will have another X Ray,
this is the primary one.
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The plan today is just to
have a look at the wound
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and if we found the
wound clean enough
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we will do a closure by
refashioning the stump.
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There you see the skin
has started to die,
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the muscles are a
little bit darker,
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if the tissues have not died
the bone is not live, leaving
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them behind will compromise
the life of the patient.
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The magnitude of the tissue
destructed is very high.
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We don’t have any more
chance to save the knee.
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So now I will go for an
above knee amputation.
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It is always sad, when you have
to make such a big schism,
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it is always sad.
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The main thing is to save
the life of the patient.
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But for the sake of his life
you have to cut his limb,
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remove it so that
he can survive.
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It is bad that he
is losing his knee.
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But we can’t do better.
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You can see the difference
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between the previous
and this tissue.
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Here, this is good
and clean tissue.
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Thank you very much,
thank you guys.
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I thought that he would make
it with below knee amputation.
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When we had a look
it was not so good.
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The skin and the muscle and the
muscle and the bone were not
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healthy, they were in the
process of slow disease.
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Then we had to remove
above the knee.
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We have removed as short
as possible the bones.
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And I hope this time
he will make it.
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Today he has been in the
Physio for the first time
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which is of course a very,
very big experience
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because they really have to
start training his muscles
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and he has to find
his balance again
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and he has to learn
walking again,
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but now this time
only with one leg.
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Mr Yorm.
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This patient no fever and
he at 9.30 on 17th DPC.
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But does he feel the foot
is where it used to be
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or the foot is moving up?
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Especially during the night
he feels that the foot stay.
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Because what’s going to happen
is his feeling of the foot
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is going to start
moving up up up
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and when it reaches the
stump it will go away.
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This is not forever,
this pain will go away.
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Happy smiling face.
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Is he going with the relatives?
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He call his father already.
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Excellent, so nice for you.
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All the best, so see you around
in case you have problems ok?
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So, your father is there.
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Good. Ok Bye bye.