Saturday, April 5, 2008
Friday Night with the Kids...
Ok, so let's jump right into this:
The E.D. was busy and "standing room only" when I got there. We had so many providers (attendings, residents, and PA's) that I actually didn't pick up a chart for 1/2 hour. I got my bag settled under the counter (we don't get lockers, so it's first come, first served space), filled my lab coat pockets (scripts, pens, penlight, stethoscope, pregnancy wheel, etc), and pulled out the newest EM journal I brought to read "in case things were, hmm, not the S word or the Q word, umm.. "calmer" later in the evening.
Finally, I picked up my first chart: "toothache." Great. I looked at the clock. Six thirty p.m. on a Friday night is not a good time to be coming into the ED for a tooth complaint. I went off to see the extent of the damage and wondered what I might be able to offer.
It was a 7 year old who's mom had tried to get her into a dentist's office, but wouldn't be able to for another couple of weeks. She a had a cavity in one of her back molars that went all the way into the pulp of the tooth. Very painful. I went off to find my attending and to see what was able to be offered. Luckily, WCHOB has a dental service, and so I was able to consult the dental resident who came down and prescribed antibiotics, pain relief, and got her an earlier appointment. One down, nine more hours to go.
Since I am running late, I will briefly highlight what I saw last night:
13 month old who fell and bumped his head. Dad works in the neuroradiology department and sees what can happen with even minor head trauma. I examined the child, gave the parents assurances, and sent them on their way - Dx (means diagnosis) = minor head injury.
10 year old with left arm pain after falling while playing soccer. Dx = left distal radial buckle fracture. She broke her forearm bone close to the wrist. Splint for her, and she will follow up with ortho for a cast. No gym for 10 weeks.
13 year old with "nipple swelling" and left arm pain after getting into a fight at school. The nipple swelling was normal due to hormones. Dx = gynecomastia. The x-rays didn't show a fracture. Dx = left wristsprain. Ace wrap and ibuprofen.
18 month old with "nipple swelling." Actually, this little one did have an abnormal breast mass. By this time, it was almost 10 p.m. We didn't have an ultrasound tech in-house, and this wasn't an emergency. She will definitely need to have follow-up and probably a biopsy of the mass. We sent her out with instructions for follow-up with her pediatrician. If I get any follow-up I will let you know. Dx = breast mass.
3 year old with a severe asthma attack. This was my longest patient in the E.D. in terms of disposition. He ended up receiving 3 rounds of nebulizer treatments and his oxygen saturations never got any better than the low 90's. He ended up having to be admitted. Dx: hypoxia, asthma exacerbation.
2 year old who mother reports wasn't "drinking enough." We gave him some pain control since he'd recently had a tooth pulled, and then gave him something to drink, he did, so he went home. I honestly don't know the diagnosis since my attending was "cleaning house" when he came on shift and discharged the patient on his own.
18 year old with cramping and vaginal bleeding. She was just about 7 weeks pregnant. After no seeing anything on the ultrasounds and finding a lot of clots on my vaginal exam, we drew some blood levels and sent her home with instructions to return on Monday for a second set of lab draws. If the numbers go up, the pregnancy is still viable, if they go down, she most likely miscarried. Dx: threatened miscarriage.
And, finally, 20 year old with concern about STD exposure. Sex with Boy A who had a history of an STD. Then sex with Boy B about a month later. A couple of days ago Boy B said she'd given him an STD. I took cultures and treated her for STD's. I also advised her on the importance of wearing condoms and birth control.
And, that was it for patients. I am running off for another night of fun with the chillin's. Also, Hockey USA is in town for several tournaments. I wonder how much ortho trauma we might be seeing tonight...
**on a side note: I want to thank "D" (Donna) for including my blog while doing a stint as Guest Editor on the Magic Smoke blogsite.
Thank you, D!