Journal Entry
And yet another hellacious night. That's three in a row, just in case you're not counting...
And I'd rather fight drunk indians than babies. For one thing, the babies win two out of three...
Occasionally a toddler will come in who has fallen and hit its head and then starts vomiting... and everyone knows that vomiting is a sign of a serious head injury. So the parents bring them in and the ER doc orders a CT scan.
Now, in order to do a CT scan of someones head, that someone has to remain pretty damned still for about five minutes. This is not a whole lot of time, but it's critical... the CT scan is worthless if there is motion on it.
People who are drunk and/or combative we can hit with a lot of drugs and get them still for the required time. Toddlers, however, are an entirely different story. Their sensitivity to the drugs is always a matter for concern, so we start out with a light dose, then increase the dose until it works.
Or until we get scared that the drugs might do more damage than the benefit that the CT scan offers.
The major problem, usually, is time. Last night I spent five hours between the time the exam was ordered and the time that the exam was cancelled.
Some of these little kids can take enough drugs to put me under and still be roaring. Sometimes, in kids, the drugs have the opposite effect, it seems.
It's very frustrating for everyone involved, especially the parents. The parents last night were very understanding, much more so than usual. Generally, the parents transmit their feelings of anxiety and/or anger to the kids, and we get a reinforcing circular behavior pattern going... this is really bad when it happens.
Usually, before the idea of getting a CT scan is abandoned, enough time has passed that the doc and the parents are pretty sure that there has been no life-threatening damage done. This case last night was one of those. The fall happened at 20:30 and we gave up on the CT at 04:30. The child was exhibiting absolutely no neuro symptoms by then, and indeed she was thriving on the attention. She had absolutely no intention at all of going to sleep and missing anything!
She was a really cute kid, too.
So, anyway, I x-rayed damn near everyone in Topeka last night, and I'm tired. One more night...
More tomorrow....