Challenging pint-size patients
Saturday, November 21st, 2009It was an epic battle. Weighing-in at 23 pounds and wearing a pink puppy-dog shirt, she didn’t seem the formidable foe. Yet as I washed my hands, she seemed to realize I was about to do a physical exam – and was not at all happy. For the past few days the infant had a high fever and was increasingly fussy. With all the concern of H1N1 on the news, the mother was appropriately worried and brought her child to be evaluated. The kiddo wiggled and squirmed as I tried to peak in her mouth, palpate for lymph nodes, listen to her heart and lungs, and examine her belly. Last but not least it was time to look in the ears. One of the first lessons I learned in pediatrics was to examine the ears last, as it’s the part of the exam that little ones tend to dislike the most. I laid her on the cart, and she grabbed and pulled at the stethoscope around my neck. With a stronger tug she probably could have given me quite a head butt! It took the help of both mom and dad to hold her down, which only frightened her more.
I finally managed to look in her ears with the otoscope. Her left tympanic membrane was bulging and appeared an angry shade of reddish-pink. It was an ear infection (acute otitis media). The child was sent home with a 10-day course of amoxicillin and instructed to take Children’s Tylenol and Motrin for pain and fever control. With any luck, the feisty kiddo would be feeling better soon.
This month I have been doing a rotation in Pediatric Emergency Medicine through Ohio State. I am at Nationwide Children’s Hospital in Columbus. As the only hospital in the region capable of providing specialized care for kids, it’s a very large facility. With the completion of a new 12-story inpatient tower in a couple years, it is poised to become the second largest children’s hospital in the country.
With over 75,000 visits each year, the emergency department is a bustling place. Adding the H1N1 pandemic to the mix, there is never a shortage of patients that need to be seen. The majority of kids I have seen are found to have some sort of infection (i.e. ear, urinary tract, or viral upper respiratory infections). Yet the diversity of medical problems seen in emergency medicine has allowed me on any given day to help care for a child with new onset diabetes, a head injury, or appendicitis. As a Pediatric Level 1 trauma center, the hospital commonly sees children injured in major car accidents and fires.
It has certainly been interesting to be a student during this influenza outbreak, and seeing how hospitals have “ramped up” to accommodate the increase in patient volume. The majority of kids with suspected H1N1 that I’ve seen in the ED luckily did not require admission to the hospital, and were sent home with instructions for supportive care. On the other hand, at least once a shift there have been children with respiratory distress or pneumonias that required admission, sometimes to the intensive care unit.
This rotation in the pediatric emergency department is definitely keeping me busy. I’ve enjoyed the complexity of the diseases I’ve seen, as well as the occasional “challenging” 23-pounder sporting pink puppy-dog shirts.
