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27 year old man that's "all muddy inside!"

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Thanks all....

To tell the truth the only way that I figured it sort of out as when I started Googling for the heavy metals used at the mine. He had no joint/skin aches/pain, no headache, no fever. Malaria was no where on my DDx.

But shit, stroke scale neg, ECG neg, drug test Neg, BGL WNL, suspicion of heavy metals dropping on my DDx, pain free, afebrile, vitals WNL (no, doesn't mean I didn't look), no sig history, no meds, no allergies, etc, etc....

Then decided that malaria was huge here, so just lobbed a hail Mary and gave him a malaria test and it was positive! If that sounds smart, it wasn't really, it just happened to be the only test left in the clinic that I hadn't given him yet. But the symptoms didn't match...so I started searching for things that might fool a malaria test, and that bumped me into rereading about malaria, and then I stumbled onto the cerebral malaria, and though it didn't seem to be a perfect match, I went and got the LN medical manager out of bed and brought her in.

I'd not done it before because I didn't have any malaria symptoms, and the level of medical care here is very primitive so I didn't think that she's have much to offer with concern to a neurological patient..

But she said, "Oh yeah, this is cerebral malaria. They often present like this. His liver is hurting him, that is why he keeps trying to touch it. The parasites can make the liver very sore. It is in his brain now. We will treat it, probably he will be ok...or he will die. We'll see....."

This clinic sees about 3-5 malaria cases per day, though most are not cerebral, and most from PNG have such a heavy resistance that they get little more than mild flu symptoms.

They are experts so I let them treat him. I don't remember the meds. Two vaccinations and some pills, a Litre of fluid and off to bed. 12hrs later his mentation issues had resolved, but he had a gnarly fever....

They gave him another injection the next day and sent him on the bus to Lae...that was the next bus leaving...

chbare I was pretty sure that you would get it figured out, but was also confident that you wouldn't queer it until the learning had been gained...

You know what's funny. I'm not religious, but I do have some weird theory about energy and such. But I remember earlier in the day thinking, "Man, I'm in charge of training, but they don't seem to know anything really. Where in the hell do I start?" And then, as often happens, the EMS Gods came and kicked me in the gnads and I had to be saved by the folks that 'don't know anything.'

Such is my life in EMS...

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Wow. I'm impressed. I take my virtual hat off to you sir.

Thanks Brother, but like I mention above...way more about getting lucky on a WAG then any real competent medicine...

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After consulting with my pillow, I woke up thinking you should ask the locals as they should recognize endemic diseases, then I turned on my computer and there it was! It jumped right off the screen at me! Brain Malaria, of course! To bad it was mongomedics post I was reading.

Solid work brother!

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