It started off as one of those days... We're post-intake (call) and so I got to work early so I could round on my old patients, before we did the post-call round and saw all of the new patients.
There were 25 admissions yesterday.
There were 25 admissions yesterday.
Kiddo A: my 2 and a half year old who has cor pulmonale (heart failure from a non-cardiac cause) has gotten better w/ diuresis, but it is now PAINFULLY obvious that the problem is that the kid needs his tonsils and adenoids out. The cardiologists signed off after they did their echo. Apparently the kid needs a neck xray before the ENT docs will see him. And I fucked up and wrote his name on the wrong list so it didn't get done yesterday!! Argh, wasn't too thrilled to figure that one out this am. Hospital day # 10 for this kid. So, he finally got the xray this am, and I asked about getting the ENT docs consulted. To which I hear I need to get the radiologist to read the xray. Well, at 3pm when all the other urgent stuff has been done, I enquire about getting the xray read, to find out that it has to be read earlier in the day, that they are gone by this time. And, then my coworker guestimates that it could be months before he goes to surgery...
Kiddo K: Day of life #70, born with transposition of the great vessels, with NO shunt who was admitted with sats in the 30s (who knew that was compatible with life), and eventually had an atrial septostomy, and I've been caring for him for almost a week now. We're waiting to make sure the kid gains some weight and to get the cardiologists final blessings before sending him back to his home hospital. Yesterday, we tried a trial off oxygen. He failed. Back to a sat of 30. (his goal is >70). So back on oxygen he went. This am, the oxygen mask is (no nasal prongs his size) hanging close to his air passages, and sats are 60...
Kiddo K: a cool 3.5 y/o who has some congenital renal/bladder issues (history of posterior urethral valves) who has been in the hospital for a week. Reasons not worth going into. Who I couldn't FIND this am. Don't get me wrong, this happens back home often w/ medicine patients, but not w/ kids. He'd been in isolation on another ward, but we were taking care of him, and he was due to be transferred back to our ward... So, after walking between the wards twice, and looking for the familiar face (and he's a cutie!), I gave up and decided to ask the nursing staff... but, and this is a great part of the day: It was the time of the day where the nurses start their shift with singing. There is no interrupting the am ritual of morning song, and no interrupting morning report (which lasts for an hour). I figure that at some point, the kid will appear (I don't even think the kid should be in the hospital, and I make a mental note to see him before I leave).
So, needless to say, it was a bit frustrating this morning.
But, there were some really good things about this morning as well. Some of the kids that I have been taking care of for the past week are starting to look much better. Baby S and baby T are both starting to put on a little bit of weight, and are even starting to show a bit of personality. They look much different than when they were admitted a week ago. Instead of examining them from head to toe each morning and a looking for new problems, instead I enjoy picking them up and examining them while I carry them around. In some ways, it feels like a leap of faith to let them leave the ward, which will hopefully happen in a few days.
We eventually got around to starting our post-intake ward around, and again, we hit almost every chapter of a peds textbook (there was no cardiology stuff today). Some notes I made during rounds.
1-We're taking care of an infant who is in acute liver failure. The reason is not entirely clear. The best working etiology is that we are seeing another possible case of Reye's Syndrome. There was debate on the ward round as to whether this kid was a candidate for intubation and for the intensive care unit. After some lengthy debate, the child was intubated after discussing w/ the ICU if there would be room for him.
2-We admitted two children with diabetic ketoacidosis, both are new onset. It was oddly refreshing to see a medical condition which I feel fairly comfortable with. However, I realized that my usual management was a bit different. Whereas, one of the new onset kids was in mild DKA, and could have been managed with subcutaneous insulin, both were managed with IV insulin coverage. I was also curious to see what kind of insulin regimen these children would to go out on. It looks like we will be covered on three times daily regular insulin and then intermediate insulin at 10 p.m.
3-We had another organic phosphate poisoning. We seem to be averaging about one on each call.
4-I admitted a three-month old who has been jaundiced since birth. This is the first admission for this condition for this child. I can't quite piece together all the details, but apparently when the child went for immunizations yesterday, the general practitioner noticed the jaundiced and referred the child to us. I am not sure how the jaundice was not noticed during the previous immunization visits. The working diagnosis is some form of biliary atresia. However, just before leaving, the CMV came back w/ positive IgG and IgM... perhaps this is fallout from congenital CMV?? I need to read up on that tonight.
5-Mumps: We admitted a child with mumps as well last night. However this is not just simple mumps. This child also has bilateral ear infections, is malnourished, and likely has HIV +/- TB.
6-Congenital Myopathy?? We rounded on a new three-month old who is admitted for hypotonia. We're talking flaccid like a rag doll. And she's been this way since birth.
7-Pneumococcal pneumonia...
8-Hep A: were seeing a three-year-old who was diagnosed with hepatitis A a few weeks ago. However she is having worsening jaundiced and appears to be going into liver failure.
So, it is quite a busy service....
I kept a list of things to read up on tonight, but it is too extensive to hit all the topics.
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