Sunday, August 5, 2007
i has a hard day at work today
today was a toughie at work. the first part of the day went well, if slow. its a nice change not to be slammed the second you walk through the door, but when it's slow the day sort of dragggggs on. you are much more conscious of the passage of time. and then around 4pm i got slammed anyway. i had a patient that was a 7wk old status post a fall out of father's arms on friday (today is sunday) and down a flight of stairs, largely on her head. she was transfered to our facility from an outside hospital on friday after a ct scan showed a mild brain bleed. she was kept over night and discharged home on saturday after a follow up ct scan showed no change. all of our head injury patients get iv lines placed. all of them. it is better to have it and not need it than to need it and not have it. children die for want of iv access. anyway, this baby was a tough stick on friday and it took multiple attempts for them to place the line. of course, when she was sent home on saturday, they pulled the line.
today she came in for increased lethargy and vomiting. mom reported vomiting 12x in the past 8-12hrs. basically, nothing was staying down. mom also reported that she was getting over a gi bug. so then the consideration is gi bug vs exacerbation of head injury. either way, the baby was getting an iv placed. i think it goes without saying, that putting a line in a 2 mos old is not easy under the best of circumstances. and these were not the best of circumstances: the baby had vomited most of the day and was probably quite dehydrated. it was even harder today considering that all of the best places were used up on friday. i'm pretty good at placing lines, but i tried twice and couldn't get it. another nurse tried once and couldn't, and finally a third nurse with the 4th stick total today placed the line. i wish i could say it is unusual to have to stick so many times for a line, but it isn't in a baby. newborns have veins the size of threads, which you are trying to thread a catheter into, and older babies have slightly bigger veins which are generally completely obscured by their fat pads. anyway, the mom just cried the e-n-t-i-r-e time we were placing the line. she bawled straight through. i know it is hard to see your baby get stuck, but that was really hard to take.
and then as i was leaving we had a 4mos old come in by ems and that baby looked like crap. the color was all off, and she was bruised. mom says the story is she left the baby with dad, and when she came home the baby was lying in the crib not breathing, with her eyes rolled back. she reports that dad reports the baby fell off the sofa to the floor, he picked her up and put her in the crib. uh huh. sure. i'm going to go out on a limb here and say i don't think so.