ER- a place where every minute counts. And more so in a pediatric ER, where sometimes the only thing important in helping a child get better is to get an IV line in him. There are times when you feel very comfortable examining children regardless of how small they are, even at the nth hour. But sometimes, it affects you deeply in mind and emotion, in ways you don't understand. And you wonder if you are the only one who's uneasy...and ashamed to admit.
Time in the ER goes fast. It was 15 mins that I had stepped in for my ER shift, and I was giving the third combi- neb to this very tight 2 year old boy, who's heaving chest made me nervous. I thought to myself, he will need to be admitted. I glanced over to his dad standing near the window, who clearly looked impatient and frustrated. His child had already got 3 treatments in the clinic before he was sent here, but his distress persisted. Sometimes, talking to the parent is the toughest part. They seem to want quick results. "Why hasn't my child improved? ". It was the 4th time he was asking me that question. As if responding to my cues, he walked over to me and took the mask from my hand and sat down next to his child. I told him, mustering up a straight face, that, if he doesn't improve with this, we will have to admit him. He didn't look at me. He pursed his lips, continuing to look at his child who was breathing in the white fumes of albuterol. I stood there for few seconds and then taking the chart, I went up to the station and scribbled orders for magnesium sulfate. The nurse came up to me and said that she will prepare a bed and get a monitor ready. I gave her a half smile. The nurse knew my thoughts already.
As I was to pick another chart to see a new patient, the overhead speaker screamed "pediatric trauma alert". I saw my attending rush to the trauma station. I dropped the chart back into the rack, and hurried towards the trauma area, picking up some blue gloves on the way. I caught up with my attending who told me that this was a 8 month old baby who had been flung in the air. That's all we knew. Well, when you hear such things, you imagine the worst, you anticipate the worst, and you...pray! The patient hadn't arrived yet and I went to the trauma cart and started picking torniquet, IV cath, alcohol pads , syringes and all the things I thought I would require. I put them all in my coat's pocket and walked to the trauma nurse to get the full story. Apparently, there was an altercation between the baby's mother and her ex-boyfriend. The mother was holding the baby and he had gripped the baby by his ankles and flung him across the room. It was a distance of 5 ft. We didn't know what injuries the baby had sustained. In a minute, we saw the EMS bring in a stretcher with the baby strapped and with a C-collar. There was a woman, I guessed, the mother, with some abrasions on her face, walking along with the stretcher. The trauma surgeons had already started cutting his clothes. As they were clearing his spine, I took a quick glance over his entire body and heaved a sigh of relief. He was awake, looked alert, a little stunned perhaps, and had no obvious signs of external injuries. But I knew I couldn't relax, as we didn't know whether he had passed out the instant, the incident happened. I quickly took his right arm and tied the torniquet just above the elbow, scrubbed some alcohol on his antecubital area. I couldn't see a vein. I patted the area a couple of times. I still couldn't see a vein. He was a chunky baby. I released the torniquet and reapplied to his wrist. As I scrubbed the back of his hand, I felt enormous pressure building in me. I couldn't see a vein there. Every passing second was pounding. I had to get the IV cath in. I knew I had no time. I held his hand flexed, removed the cap of the needle and slid it through the skin, blindly. No blood. I retracted the needle half-way and glided it in another direction. No blood. The baby had started crying by then. I took a deep breath and retracted the needle again and changed its path just slightly, and I saw a line of red blood in the cath. I slid the cath completely in, retracted the needle and released the torniquet the same time. A few drops of blood stained the sheet, as I stabilized the cath with a tape. But it wasn't over yet. When I tried flushing with saline, I met resistance. I peeled the tape out and manipulated the cath and put the tape back on. This time the saline went through easily and I screwed the tube of the IV fluid bag to the port of the cath. I took the arm board and wrapped the arm and the board together with a kling so that the cath doesn't kink, when the baby moves. As I removed my blue gloves, I noticed that the baby had stopped crying and was moving vigorously. "baby, you did good", I thought to myself.
The trauma team ruled out any injury and we planned to observe the baby in our ER. It seemed like forever, but only 15 min had passed by. I rushed back to see my patient who would've been done with his nebulization by now. He was lying quietly on the bed with a monitor attached to his body. From a distance of 6 feet I tried to figure if his breathing had improved. I couldn't really tell, his chest moved the same way. I asked the nurse to give magnesium sulfate and walked over to his dad to tell him our next plan of action. He looked defeated. But I was hopeful that his son would turn a corner soon. I rotated the monitor so that it could face me, while I sit in the nurses station. I knew I had to look out for dropping BP. I sat down and resumed writing orders for him. He would need another bolus of saline. The rack for new charts was empty. I was happy, as there was enough on my mind already, to be concerned by another disease, another patient, another parent.
Another 15 minutes passed by. The 8 month old baby seemed very active and happy and was now drinking milk from his bottle. He was so oblivious to what had just happened to him, something he will never remember ever and I was happy for him. I saw the asthmatic boy talking to his dad. He was sitting up and pointing at the TV and saying something about spongebob. I smiled, he had certainly turned a corner. I went over to him and listened to his lungs. I could hear breath sounds, unlike before. His chest was still heaving slightly but not as bad as before. I called the floor resident and gave a sign out on him and proceeded with clearing him for admission.
The long hand of the clock struck 12. That hour was over. There was a new chart in the rack. My next new patient.
