Did the neck exploration ( Ludwigs angina, google that) today. Every thing is like the first time here. Kinda funny if your not tired. Anyway, I asked Andrew, the best anesthetist here to do the case. Explained the threat to his airway, ketamine. It was a bit of a flail, really gross, really stinky...maybe anaerobes. Got A LOT of pus!! Transverse incision at base of his neck, R. side, big cavity. Stuck my finger along his trachea up to the mandible and then down onto the supraclavicular fossa. Couln’t get behind the trachea where I thought the tract might go. Swept over to the L. side, not so much. No tonsil sucker, just a big thick black tube connected to weak sxn but it worked and sucked pus. I then made another incision at the supra sternal notch, watching out for the plexus of veins that is always there, With no bovie and no good sucker that would have been scary. Looked for a cavity behind the sternum: none. 2 drains and packed open. Waking up was crazy. We moved to the "minor theater" as a recovery room. He was bucking, coughing pus, had low sats for a while( yes have oximerter!) and hallucinating. Bottom line: right now he is better, but I am afraid there is more and I'm sure he is bacteremic. On Ceftriaxone( max dose 2gr q 12) and Flagyl. Want Clinda but there is none. I'm afraid the family will run out of $$ soon, Tomorrow: CXR to look for air fluid levels, collections. I know, why wait???....because "sababu tech anakwanda nyumbani" (tech went home).

Worried. Never see this in the US.

Best of all I went and got the dental tech( Barnabis is gone) who sent this pt home with H2O2. last week. He said " he looks better!! Ha!!

I told him the pt. was going to die from a preventable infection that never should have happened.. meaning :"you screwed up Bub". I don't think he got it.

More to come.....