I got your back!

Yesterday I was in the peds ER again. We had had a couple of interesting cases. One was a 28 day old female infant that started having a fever at home at 11:00 am. The mom reported that they took the temp with home ear unit and it was 102 degrees. She waited until 12:00 and took the temp again and it still read 102 degrees. So she called her pediatrician and the office was closed for lunch. She waited to call back and decided she would just head into the office to be there at 1:00 when the office opened. However her doctor called her at 12:45 as she was driving in and he said if the temp really was 102 just go straight to the ER. 

So she and her husband arrive at the ER at about 1:00 with the feverish child. We immediately take the temp and it is 99.5 degrees. So the baby gets the full work up. Blood culture, straight catheter for urine culture and lumbar tap (spinal tap). With a child this young there is no messing around. The infant was poked and prodded and not too happy. It was the parent's first child and they were very angry and the discomfort of the baby and acted as thought we were trying to torture the infant. It was uncomfortable to say the least. 

We had the parents wait outside while the spinal tap was done. Unfortunately the spinal fluid had blood in it which made it unreliable for the lab so it could not be used. The spinal tap is done to rule out meningitis and the CSF is collected and measured for protein, glucose and WBC's also the pressure is measured as well. These tests can help rule out viral and bacterial meningitis. If blood from the procedure taints the CSF then the test will not be useful. The other labs came back and indicated a possible UTI. 

The source of infection appeared to be the UTI. So we started the infant on antibiotics and had the baby admitted into the peds unit where she will be seen by the pediatric hospitalists. We spoke with the pediatrician who normally cares for the infant and he wanted to admit her so we obliged, Most likely the infant will be monitored and continue treatment with antibiotics and then released after 24 hours to complete the antibiotics at home. 

Then I had about 10+ cases of complete crap. Be stings, 5 year olds with fevers, bent finger, bruised leg, sore tongue etc. Mostly hyper anxious parents. The issue here is that even though we know it is mild or does not need emergency attention once they enter our ER we become liable and must do a complete work up. The parents see this work up as validation for there concern and think "it is a good thing we came in, look at all the concerned people running around!" The reality is we want to say, "you must be joking! you brought your kid in because his forearm itched after he rolled around in some wool sweaters in the attic" What can you do? 

Smile, that is what I do, and I think about job security.