Peds ER: First Procedure!

So today was pretty exceptional because I got to actually DO something! It was the busiest I've ever seen the peds ER.  I actually didn't get dinner. AWESOME!

Not that bad
15 y.o. female comes in with an 'intense' headache since thursday. Had headaches on and off since tuesday that start in the back and then spread over the cortex. Had one episode of vomiting this morning (1am) and has had a temp of 102.4 since this morning despite tylenol and motrin twice a day. She is photophobic and claims to have shooting pains down her neck. It hurts her to tip her chin to her chest. She complains of general myalgias (muscle pain). She has some horizontal nystagmus when looking to the left. Most medical professionals will start thinking meningitis-- at least I did.  So I decided to present to the attending instead of the resident to expediate the process.  And of course, I was apparently so wrong. He said she didn't look that sick. He said i shouldn't go over the resident's head unless she was really sick. Which apparently it was just a 'bad virus'. I felt very stupid.


The KNEE
17 y.o. male comes in after a football game injury to his knee. It looks like this... (yes, this is the actual knee! we're allowed to take pictures at the hospital!)

He says its painful and is unable to bend it. And the doctor says it needs to be aspirated. And I got to do it!!  It was pretty awesome shoving a needle in there and pull ing out over 120cc's of blood. Traumatic bursitis-that's the diagnosis the doc's think. The problem is a bursitis shouldn't be bleeding. He was given dilaudid and started hugging the entire staff as often as he could. Which was sorta adorable.  It filled up again within 10 minutes, so we called the ortho guys. Blood should be clotting, by now. So the senior resident comes down and yells at us in front of the patient's mother that we are incompetent and why didn't we aspirate it, and then why didn't we send the aspiration to be cultured. We're like its blood, not an infection. It happened because of an injury.  He's like didn't you get an xray? MRI?  We're like what else could it be? He's like cancer! And his mother is basically peeing herself at this point. He proceeds to explain that ER docs are the people who couldn't make it in any other specialty. He continued to berate the ER resident about all her decisions and almost had a stroke when she told him I aspirated the knee.  The patient told him that he thought I did a good job, but the ortho guy decided to aspirate it himself, which he did and of course it filled up again even bigger than the first time.  Then he decided to order and xray and MRI. Which showed blood above the knee cap of course.  So he called the attending and she wanted to operate for exploratory surgery.

It was an intense experience. First big argument between physicians that i've witness. I just thought that ortho resident was an ass. But I got to aspirate it! which was awesome...


more later...