Thursday, April 10, 2008

You Give Me Fever...

Four out of the nine patients I saw this shift came in with a complaint of fever. We usually say that anything over about 101.5 is significant and should be seen. As I commented in a prior entry, it seemed as though all fevers coming in were 103. Tonight, at least I got some variety. Anywhere from 100.4 to 105.2 (yes, that last one is correct, it was recorded in the hospital ED).

So, our main job when a child presents with fever is to find out where the fever is coming from. Usually we have a visible source (runny nose, cough, vomiting & diarrhea, infection in the ears, etc.) But, sometimes a child just has a fever, and it becomes our job to rule out all of the bad things that it could possibly be: bacteremia (infection in the blood), meningitis, etc. All of these involve large scary needles. And, in my case, learning to do procedures.

I did my first successful lumbar puncture (LP or spinal tap) on my 15 month old with a fever. It was nearly a "Champagne Tap" but a few red blood cells sneaked in there, darn it! I got the spinal fluid on my second pass, and I honestly think the blood came from my first pass which was unsuccessful. However, I got the tap, and that's what counts most. Also the fact the child did not have any signs of infection in their spinal fluid. We can't forget that.

Also, today I got my first official thank you from one of my patients:
Dear Nurses and Doctors, I liked all the nice things you did for me. Ainsley
(In case you can't tell, that's a picture of me at the bottom.)

Today I saw:

constipation - seriously, these kids need to eat more veggies

ulcerative colitis in a 17 year old - I really feel bad for this kid. It's a horrible disease and the consequences of it are going to affect his entire life.

abdominal pain - seriously, if it's anywhere from 7 to 10 out of ten pain, I want to see you writhing on the bed and crying, not sitting back, asking to eat a sandwich and telling me "it hurts so bad."

fracture of a metacarpal bone in the hand - broke it on Easter Sunday, didn't think to get it seen until it was probably re-broken today. I splinted it and he'll see ortho in about a week.

jaundice - my second case, a 3 day old, very yellow, immediately placed under lights

and my 4 fevers.... the last was still being seen when I left, so I will find out tomorrow what happened. The other three were discharged and will follow up with their pediatricians.

And, that's it for tonight's patients. Or, last night's patients since it's almost 2 in the morning. I have my next shift tonight, and we'll see what the evening brings.

Overheard in passing:
- dog bite to the face, plastics came in to see
- broken tibia/fibula - ortho came in to see, and set in the ED
- domestic dispute and father got so angry he lifted the couch on which a 4 day old was lying, and the infant fell to the floor. He was being seen and will probably end up with a CT scan.

Here's my seal pic for today. 2900 seals out of the allotted 275,000 have been killed so far. The seal hunt was suspended un-officially for the last week, and it is set to resume tomorrow. Thick ice and fog may be keeping the sealers away for another day. The price per skin has fallen, and there's reports that even more sealers may chose not to participate as the cost of fuel has risen. However, the hunt has now changed to the area of the Gulf of St. Lawrence and "the Front" where the majority of the killing is usually done, so numbers of seals killed are expected to rise exponentially in the next several days. With continued pressure on the EU to ban seal skins & products, hopefully an end is in sight.


nightmaremom said...

sounds like an interesting night...   I hurt.. can I eat?  Now that is just out there and actually kind of funny......  only kind of.

lv2trnscrb said...

that was a cute thank you note and she drew you pretty well!!! that dad that got angry and overthrew the couch needs to be shot; geesh!!!


kirkbyj05 said...

I cannot believe that father hurt his own child in that way!  Life is so cruel to some babies and children.  I wonder what the future holds for this little mite?
Hmm...I remember having those lumbar punctures when I was ten and had polio in the fifties.  I hated curling up in a ball and needed a male nurse to hold me still as I remember struggling so much, then having to have my pjamas changed as I was so hot from the struggling and fear.  The poor Doctor!  It's such a difficult and dangerous thing to do for them. I wasn't any help at all.
I had forgotten about that until you mentioned lumbar punctures.

Jeanie xxx