Pediatric emergency work is challenging. It’s a weird combination of truly sick kids, kids who are sort of unwell, kids who are 100% fine, and, once in a while, kids who are at risk of actively dying. All in the same shift.
I had some experience in it back in medical school, though in a different hospital in a different city. Which basically means starting from scratch when it comes to the logistical things. But clinically, it’s been a wonderful few weeks of refining differential diagnoses and procedural skills. And much in the style of my last few posts, I thought I’d share some little pearls about both working in and visiting a pediatric ER.
Carry on, dear reader.
- To peds ER staff: be nice to parents. And I don’t mean just tolerating them, really be kind. Even if their chief complaint seems silly and their reaction a bit much. They’re worried and came to you for help. And sometimes those silly-sounding presentations can turn out to be something else.
- To parents: be nice to the staff. We appreciate your concern, but there’s never a good reason to be rude or aggressive towards the people who can potentially help your child. It just creates a lot of unnecessary animosity.
- Upper airway congestion =/= wheezing, but it can mask it!
- Popsicles. For everyone.
- Be afraid. Don’t be paralyzed by your fear, but be afraid of those worst-case diagnoses and lower your threshold to check for dangerous things accordingly. The chances of something bad showing up to ER is much higher than if they showed up to clinic.
- Med students, I’m sure you’ve heard it before, but don’t stand when you can sit.
- Also, med students be gentle with the first year residents. Some of us have never taught before, and we can totally tell when you think we’re crazy.
- Trauma cases are often about speed. It’s a race to find those life-threatening injuries, so if you find one (but also if you don’t), say so loudly! Don’t be afraid to shout over the noise, it’s more important that everyone knows air entry is crap to their left lung than being polite.
- Anybody coming into the trauma bay gets a glucose check. Every single patient.
- Eat something. Parents and staff both. Just eat, you never know if you’re going to get a chance later.
- Use your consultants. Even if you’re not in a big centre, specialists are a phone call away and they’re generally happy to hear about anyone you’re concerned about. Trust your sick/not sick compass. If you get resistance, make sure you mention it to someone. It’s their job to hear you out, not shut you down.
- It’s probably not Ebola. Just sayin’.
- If it’s possible in your centre, keep unimmunized kids away from the others. ER should be a place to get better, not to pick up rubella.
- Shift work can make you more depressed, more tired, and less effective. GET SLEEP. Lots.
Hope you all had a wonderful Thanksgiving, enjoy the lovely fall colours!