Thursday, April 03, 2008
I Wanna Be Sedated
I haven't updated for a while, although it has not been for lack of material. Things have been busy in the Peds ED. It seems like every shift is clogged up with sedations. Like I have said before, I like kids-- I just don't particularly like dealing with their parents.
The other day, I got called over the intercom to go into Room 7 for uncontrolled bleeding. I wasn't quite sure what to expect. When I walked into the room, I saw a relatively calm toddler seated on the bed with blood oozing through the dressing on his head. His mother was pacing back and forth uttering all sorts of obscenities while her "friend" sat in a rocking chair by the child's stretcher, shoveling Doritos into her mouth.
The situation? Rottweiler vs. Toddler
As I unwrapped his head, I couldn't get a good view of the oozing wound. He had a second laceration on the top of his head that went down to the skull, and there was an odd flat spot on his head. I notice an orange crumb fall on the sheet and and look up to realize Mom's friend is eating her chips over my patient's bleeding head. I am already annoyed.
I tightly wrap up my patient's head injury, fill out consent forms and personally take him to the CT scanner. He's only 4, and there's a good chance he won't hold still for the scan. Mom is still doing nothing to comfort her child (unless swearing is the equivalent of a lullaby at home), so I hold him in my arms, and place his turbaned head in the headrest of the CT scanner. One of our nurses gave him a stuffed dinosaur, and as we wrap him up burrito-style for the scan, I place the dino on his little chest so he has something to look at while the machine buzzes around his head.
Luckily, the scan's clean... no skull fractures. I pick boy and dino back up and back to room we go, where he gets hooked up to the monitor, and we start pushing the sedatives (midazolam, atropine, and ketamine in the Peds ED). His eyes spin and "Mom" laughs at the drunken expression on his face. She doesn't want to stay for the repair, and I kick Dorito-muncher out of the room.
His cuts are deep, extending through the galea down to the skull. The bleeding has finally stopped with the pressure dressing. My attending and I are deep into repairing the wounds when random Ortho resident walks in, and goes, "Wow, what layer are you guys at?"
"That would be skull," I answer, tapping the hard surface with my suture needle.
"Shouldn't ENT be doing this?" he asks. (Ear, Nose, and Throat Surgery is the substitute for plastics at my hospital.)
"Why would two strong, independent women need ENT?" I answer, gesturing at my attending. Who let this guy in here? He's about as helpful as Dorito-woman!
He says something about another patient to my attending and ducks out.
Several absorbable sutures and staples later, the wounds are all closed. Luckily for the kid, his injuries were all in the scalp area. Although he will have some huge scars, there's not a mark on his face. "Mom" finally returns a bit more calm. They don't exactly seem to be the most reliable at follow-up, so I go over wound care and antibiotic coverage three times with them. We also gave him IV antibiotics. "Mom" still has done nothing to comfort her son, and Dorito-woman interjects some helpful anecdote about something she saw on TV.
I was ready for my own chemical-induced nap by the time they left, and had to exchange white coats as mine now had blood all over the shoulder. I think that The Ramones said it best.