Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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354 Surgery and Healing in the Developing World
Figure 8. Picture of close
suctioned drain apparatus.
A rubber glove used as a
Heimlich valve on a chest
tube.
Heimlich Valve
The tip of a finger can be removed from a rubber glove to act as a one-way
Heimlich valve after attaching to a chest tube (Fig. 8). The chest tube can then be
allowed to hang at the patient’s side. If the finger (valve) is staying open on its own,
it may be dampened to make it stick shut.
Foreign Body Removal
Removal of foreign bodies may be performed using a variety of commonly available
medical supplies and some creativity. For example, a coin in the esophagus has
been removed by passing a Foley catheter beyond the coin, inflating the balloon and
then slowly withdrawing the catheter. In addition, a ureteral stone removal spiral
basket has been used to remove bronchial foreign bodies form children. The configuration
of the basket allows ventilation while the basket is in the airway.
Fluid Resuscitation of Baby
If desperate to establish intravenous access and no Intraosseous needles are available,
a baby can be turned and held upside down, fluid infused into its rectum and
the buttocks taped shut. After 30-60 minutes, veins should be visible and a standard
IV can be started.
Versatile Tool
A Leatherman, or similar multi-tool, can be very useful in the surgical camps
(Fig. 9). The Leatherman Wave has proven itself to come in handy on numerous
occasions. Most multi-tools have saws and files that can be useful during orthopedic
procedures. Having one sterile and available is prudent if instruments are short.
Figure 9. A Leatherman
Wave multi-tool used during
surgical procedures.