Perhaps it was a mistake to show a group of visitors around the Hospital as, passing through the adult medicine high dependency unit, we noted a young man of about 30 years clearly in serious trouble with very laboured respiration and looking exhausted. He was attached to one of our few monitors which was displaying his heart rate as 190 beats per minute. That would be too fast even for a neonate and was clearly unsustainable.
So later I came back to review him and noted a number of physical signs including a very distended jugular vein in his neck [left hand photo]. As a paediatrician I don't see so many adults usually, but as we don't have a consultant Physician here, I felt obliged to review him and did work out he was in serious heart failure with a gallop rhythm, pulmonary congestion and this very high jugular venous pressure [JVP].
After some mental gymnastics to recall adult doses, we sorted out some treatment and happily this and prayers seemed to make a difference so that by the next morning his pulse was down to a much more acceptable 90 a minute and his JVP much reduced [right hand photo].
So later I came back to review him and noted a number of physical signs including a very distended jugular vein in his neck [left hand photo]. As a paediatrician I don't see so many adults usually, but as we don't have a consultant Physician here, I felt obliged to review him and did work out he was in serious heart failure with a gallop rhythm, pulmonary congestion and this very high jugular venous pressure [JVP].
After some mental gymnastics to recall adult doses, we sorted out some treatment and happily this and prayers seemed to make a difference so that by the next morning his pulse was down to a much more acceptable 90 a minute and his JVP much reduced [right hand photo].
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