Monday, February 25, 2008

Holy cow!!

Yesterday I was on call. It started off with a painful social admission (noun: 1. patient admission to hospital NOT due to medical problems but because of social reasons; 2. administrative nightmare, whereby intern spends ridiculous amounts of time making phone calls, sending faxes, and NOT practicing medical skills). Yes, I spent about 6 hours on ONE patient who was admitted for reported abuse. I know, I know... I should be more more compassionate. It is sad. Don't get me wrong, there's nothing that ruffles my feathers more than the topic of child abuse. But these cases take so much time, you end up neglecting your other patients who have real medical issues. Which was what I did half the day yesterday.

But that's not what the holy cow is about. So around 9:00 pm I got a call from the ER saying they had a kid they wanted to admit. 7 year old with fever and chest pain, concern for pericarditis (noun: 1. inflammation of the pericardium, which is the sac that encloses your heart). We go down to see this kid and he's sitting in bed looking kind of miserable. Cute kid! Reddish hair, sweet little voice. He originally had a temperature of 105 and a heart rate of 170 (very fast for his age). When we got there his temperature and heart rate were normal, as well as the rest of his vital signs. He said his chest hurt a little, but otherwise felt okay. We chatted with our supervisor and ended up sending him to the pediatric ICU for observation.

Two hours later, the kid ended up decompensating. His blood pressure dropped, his heart rate went back up, and he seemed to be going downhill fast. It turns out he had developed a pericardial effusion (fluid around the heart) and was going into early cardiac tamponade (a condition where the fluid is compressing the heart to the extent where it can't pump efficiently anymore). He ended up being intubated and they had to go in with a needle and drain the fluid from around his heart ("they" did, not me... stick a needle in a kid's chest, are you kidding??). He's now stable but has a tube coming out of his chest and could very well have died.

Holy cow.

Lesson learned: KIDS ARE SCARY!! He looked so stable when we saw him in the ER. That's why they teach us pediatric residents to be aware of how fast kids can "crash". This kid sure did, and I'm just glad he was in the right place when he did.

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