It’s rare that I deal with pediatrics. In the last week and a half, I’ve teched two serious pediatric cases, both two-year-old girls. My last serious pedi case was at least two years ago, maybe three.
In the first recent case, Mrs. Turquoise and I were toned to go up on the interstate for a young lady who was seizing in a car on the side of the road. By the time we arrived, the kid had stopped seizing. She was clearly postictal but was very upset, feeding off the (understandable) significant stress of the mom, dad, and grandmother who had been riding in the car with her. Mrs. T and I strapped the tyke into a child seat built into the back of the airway seat in the ambulance and transported her to the hospital. Mrs. T drove, mom sat in the CPR seat, and I sat on the head of the cot facing the airway seat, chatting with the little girl. She only had a rudimentary grasp of the language but mom and I tried our best to console her as we drove to the hospital.
On arrival, the ED had a number of tests that had to be performed to determine the source of the seizures. Blood and urine needed to be drawn. An IV had to be started to get the blood while the poor dear had to be catheterized to obtain the urine sample. Mrs. T, the parents, and I helped the ED staff by holding limbs and trying to distract the child during these procedures. The little girl was a trooper and tried to have a good attitude but ultimately did not understand what was happening and was in discomfort. The six or seven adults sang the A-B-C song over and over to her in unison, trying to distract her from the unpleasant procedures.
The adults discussed the fact that the girl would hate that song for years to come but would have no idea why.
In the second case, a different partner (Sam the Eagle) and I transferred a little girl with a broken femur from a feeder hospital to the regional trauma center. Femur fractures are rare on small children and might arouse suspicion; in this case, the girl had pulled a very heavy rock onto her leg from above and the stated circumstances, demeanor of the parents, and overall condition of the kid pointed to accidental, if freak, injury.
Although the kid was doped up on painkillers by the time Sam and I arrived to transfer her, any movement of the affected limb was clearly very painful and elicited screams. This is an emotionally draining situation for caregivers; the staff at the hospital where we picked up the kid were obviously distraught; the parents, of course, were worse off.
The kid had not yet been splinted when we arrived and we ended up helping the ED staff to immobilize the broken femur for transport. The kid screamed and cried the entire time.
No one likes hurting a little kid, even to make things better in the long run. The little girl seemed to understand that we were trying to help, though, and would become calm, interactive, and friendly when not being subjected to painful stimuli.
After the injury was splinted, we moved the child to the cot. Sam and I had attached a special kid harness to the cot to allow us to effectively restrain the patient in the moving vehicle. Moving the child the two feet to the cot was unpleasant for her and for the adults in the room. We packed towels around her to minimize stray movements.
Once the patient was on the cot, we moved her to the ambulance. Sam and I were very careful to lift the cot over any bumps along the way. We gingerly placed the cot in the bus; Mom got in and sat in the CPR seat while I sat on the crew bench. Sam drove, carefully avoiding rough patches of pavement; a very difficult task on Vermont roads.
The poor little kid was exhausted; the injury had occurred seven hours previously. In addition to the stress of the injury, she had missed her nap.
The transfer took about forty-five minutes. There was a 2.5 - 5 minute cycle during the trip;
- The patient would be in pain. Her heart rate would be 135 – 140.
- The patient would relax and start to fall asleep. Her heart rate would fall to 115 – 120.
- She would experience a hypnic or myoclonic jerk; a common twitch that many people experience just as they start to fall asleep.
- The involuntary movement would aggravate the fracture and the poor dear would wake up screaming. Her heart rate would shoot back up to 140.
Mom held the girl's hand while I scritched her back to help her back to the relaxed phase of the cycle. Mom sang ‘Baa, baa, black sheep, have you any wool’ repeatedly to try to relax the patient.
I found myself reflecting on the earlier case and that again, a perfectly good song had been ruined for this individual through the use of that song as a distraction during a period of negative stress.
I’m fine working with adults; over the past several weeks I’ve teched an open tib/fib, a separate bad car accident, a significant burn, and a number of iffy medical (as opposed to trauma) calls. I’m all set with those. Little kids, though, wear me out.