The culture in the ED at MCM is to call the on-call Pediatrician for any peds cases. This is ok in most situations but there were a few kids who needed an ER doc…
10 f with R knee pain and warmth, no trauma, could not ambulate. XR neg. Tapped her joint, equivocal cell count (I’m not exactly sure what it was because they used a different scale), ended up getting IV abx and washed out by ortho.
6 m/o severe vomiting/diarrhea illness. Vitals not recorded. Weak cry, no tears, color very poor. First time in my life I have seen cap refill truly delayed maybe 8 seconds. Ended up getting an IV in the head and I taught the Ethiopian RN the trick of fixing up a 3 way stop-cock to a bag of NS and a 20cc syringe then just giving the kid a syringe/kg. After that was done cry was vigorous, cap refill ~3 sec, and to my delight the baby looked and acted truly pissed off instead of lethargic.
Getting set up with the 3 way stopcock. Parents were fine with photographs (which I didn’t know Andrew was taking). Actually they were fine with anything once the kiddo started to look so much better!
Best case of the trip was a 2 hour old male, delivered via C/S for fetal distress at OSH. Apgars 1,3. Meconium noted. Intubated prior to arrival. Arrived via an ambulance with a dad frantically asking up if we had a NICU. Child looked bad, glucose wnl, SpO2 79% on bagged 100% FiO2 though his tube. Attempted suction with no relieve. Exchanged tube and original found to be plugged with meconium + other crap. Still hypoxic to low 80s with dec breath sounds on R. R sided chest tube (actually a neonatal endotracheal tube) placed with rush of air, sats 90s. To NICU where as of my last day (day of life #4) he was extubated and breathing on his own!
For anyone reading it was a great reminder or the algorhythm you should go through in your head when you are dealing with hypoxia/desats in the recently intubated patient: DOPES
Dislodgement of endotracheal tube
Obstruction of endotracheal tube
Equipment failure (e.g. O2 disconnected)