Well, I've had a lot of interesting trauma calls lately. I also had one really bad make-you-reconsider-your-job call. I'll post about those probably in the next couple days. Right now, I'm headed to the bar to drink with a few friends.

Pedi Tube

Well, I got my first pedi intubation the other day. I was actually supposed to have already been leaving work but we caught a late call and I was stuck with the paperwork. I had just finished the report when calls started dropping. A call drops for a seizing toddler and no trucks available. Calls to the 2 nearest towns for mutual aid get nothing because they are already all on calls in their own cities.

I get on scene and she is STILL seizing. According to the mom, the kid has a history of seizures and the mom already gave her some Dialstat (it's a rectal form of medication to make her stop seizing).

When I actually looked at her, she's mottled and her hands and lips are blue. Ask the mom some more questions and come to find out that she found the little one in bed seizing after putting her down about 30-45 minutes prior, gave her the Dialstat and waited 10 minutes to see if it would work before calling 911. Also, apparently since the kiddo hadn't taken a nap that afternoon and the mom puts her normal seizure medications in her nighttime bottle, the kid fell asleep after only drinking a few ounces. So, since the mom didn't want to wake her up and make sure she got all the medicine, she just put her to bed.

We ended up having to intubate the kid and transported her to the closest hospital that would take her.

When we get to the ER, the doc in the room (who none of us had ever seen before) starts bitching about her having a 4.0 tube. Doc says "Well, since you put too small of a tube in, I'm just going to retube her with either a 4.5 or 5.0." I told the doc, there's no air leakage and she's being ventilated fine, the 4.0 was a perfect fit for the chords and I think that the others would be too big. Kiddo chooses this time to start seizing again. Doc looks at her and goes "Well, I'm not going to tube her now. I'll wait till she's no longer seizing." I know, she's SO smart!

So, the doc orders Ativan. First dose doesn't stop the seizure. Doc orders more. Second dose doesn't stop it. Doc orders Dilantin. Dilantin doesn't top the seizure. Doc orders a THIRD dose of Ativan. The kid is still seizing. I tell the doc "The other med that we used stopped her seizure the first time. Maybe that will work better than the Ativan now." Doc gets all snarky and says "We don't use that medicine here on pedi patients. We use Ativan."

The kiddo is STILL seizing and you can tell the doc is starting to sweat about it. The doc from the PICU comes down and tells the other doc that they should go ahead and hang a maintenance drip of Phenobarb after they give Ativan and to call for them to come down and take her up to the PICU. (He didn't know that the kid had already had 3 doses of Ativan and one of Dilantin.) So dumbass doc says "Okay, will do" and the PICU doc leaves.

Yup, STILL seizing. We've now been there for about 40 minutes and she's been seizing for at least 35 of it. So then the doc says "Well, it looks like the Ativan is starting to work and break the seizure." and gives me this smug ass look. I looked at the kid and look at my supervisor and told my supervisor "I think she's posturing. She's still seizing AND posturing." Supervisor looks at the kid and says "Yeah, she is." The kid is now DECEREBATE posturing while still seizing.
Me to the doc: "I think she's posturing."
Dumbass: "No, we're breaking the seizure."
Me: "She's still seizing, but now she's posturing."
Dumbass"She's getting better. " Turns to the mom: "Don't worry, she's doing good. She'll be fine."
Supervisor tells me "DP, let's go. They've obviously got this handled."

I hate dumbasses! The mom is just standing there, not upset or anything. Just standing there like everything is fine. After all, the DOCTOR told her everything is fine.

More coming soon

I apologize for the lack of recent postings. I will be posting soon, have had some interesting calls recently.