#paeds emerg

On my last shift, I had a pair of chonky 3-month-old twins come back to our department because one of them had suddenly developed rapidly worsening stridor; when they were seen initially, they both had fever, cough, and nasal congestion. Unsurprisingly, they were COVID+; unfortunately, this quickly evolved into croup for one of the chubby beans. He was crying and barking away while his twin slept completely unawares; he struggled to breathe and was so upset, making it harder for himself to breathe because of how upset he was… the classic moderate croup-er that was just too young to be soothed with words and distraction alone.

Of course, when the beans are this mad/anxious and working this hard to breathe, there’s no way you can get them to take any oral medications. My nursing colleague and I attempted to decrease his stridor in whatever ways did not require him to swallow–I put him face-down in my arms with his chubby little cheek smooshed against the lateral condyle of my elbow, rocking him and patting his little diapered butt. Eventually that calmed him enough to stop crying, and his stridor improved enough for my nursing colleague to get him to take a few puffs from an epinephrine MDI. His stridor got a bit better still and now could be heard faintly as the chunker dropped off to sleep, probably exhausted from crying and breathing so hard.

Unfortunately… we already knew this little guy would start screaming again if we moved him, and he was now too sleepy to actually swallow any oral meds… so we weighed the options with his caregiver and opted to give his steroid medication as an intramuscular injection, since then we could at least ensure he received the whole dose. Predictably, the little guy was NOT happy to be poked while he had finally nodded off, so I resumed rocking him and patting his little butt.

Maybe twenty minutes later, after all his medications were in, I arranged the little bean in his mother’s arms in the same prone position as he had been in mine; he protested stridorously for a few minutes before settling back to sleep. (During this transfer over to mom, we all became acutely aware of the string of drool from the beany bean’s face down my elbow and reaching literally all the way to the floor… I was honestly kind of impressed.)

Thankfully, the steroids kicked in as expected and when I checked back in the next few times our little chonk was fast asleep in his carseat with no stridor and no work of breathing. Eventually he and his brother were discharged with an anticipatory dose of oral steroids in case his brother developed similar symptoms, and instructions to come back if those symptoms returned or worsened. The babies’ poor caregiver looked so exhausted (but relieved).

Unsurprisingly, I woke up the next morning after this shift with very sore arms… I guess soothing chunky chunkers is actually good weight training…?

If there aren’t any kiddos in your life, you may not have realized this, but kiddos love pressing buttons. You know that visceral satisfaction you feel when you get to pop some good bubble wrap? For the little beans, every button, no matter how mundane it may seem to us, is like bubble wrap.

The other day I got on the elevator and a mom rushed on behind me, pushing her stroller with one hand and carrying her little bean in the other. I had my finger on the “door open” button to ensure they could get on, and I saw the kiddo’s wide, curious eyes trained on my hand at the button pad.

“Could you press the button for me?” I asked her, indicating with my finger which button I needed her to press. She nodded and squirmed excitedly in her mom’s arms until her mom brought her over. I stepped out of the way so she could press my floor button. She squealed with delight, giggling and beaming at me behind her tiny teddy-bear print mask. Her mother chuckled and showed her which button to press next for their destination, and she very excitedly mashed that button too.

The little peanut was just so happy by her opportunity to press buttons (and come to think of it, a lot of kiddos also just enjoy elevators for some reason) that she couldn’t stop grinning and wiggling in her mom’s arms. When we arrived at my floor I waved at her as I stepped out of the elevator, and she chirped, “Byeee!!!” and continued to wave at me until the elevator doors closed.

Children experience life and joy in a different way than adults; we are simply privileged that their experience is so willingly and enthusiastically shared.

My friend explained to me how their PICU call shifts work in their residency program… they essentially just have them sprinkled into their regular schedule to keep them on their toes… they call it, “PICU Guest Call”, and it, according to him, “keeps [their] skills and the fear of acuity in check”.

My immediate response: “PICU TONIGHT: FEATURING LUDACRIS”

No PICU for 3 months then BAM! PICU!

B*TCH, YOU THOUGHT YOU WERE CALM AND COMPETENT, BUT THEN:

#WORSTDKA

#TRAUMA #TRAUMABUTISITFORMEORFORTHEBEANS?!

#ALLTHEPRESSORS

#HOWMANYLINES?!

#LABSQ30MIN (#YESTHAT'SACTUALLYATHING)

#WHATWASTHELASTGAS???

#THANKGODFORTHENURSES

#THANKGODFORTHERTs

#SENDHELP

On a recent shift, I had an adorable little 3.5yo bean who was loving her distraction bubbles while we applied an upper extremity splint for her fracture. She was having an absolute blast, dancing around and chasing her bubbles… unfortunately for us we were chasing her in turn, but overall she ended up having a very enjoyable splint application experience

On my last shift we had a little 3yo bean with a cutaneous abscess that required an incision and drainage. He was extremely unimpressed with me as I did the exam, assessed with POCUS, and applied the topical anaesthetic… Then, as we were doing the procedure, he was essentially screaming the whole time. Interestingly… he was not really screaming in pain, just in rage.

“I just wanted a brownie!!” he wailed. (We had tried to appease him with a popsicle but it was a no-go.)

“We are almost done buddy! You are doing so great, you’re so brave.”

“NO! I AM NOT BRAVE!! LET GO OF ME AND GIVE ME A BROWNIE!”

“We will fix up your [skin] real quick and then you get to go home for a brownie.”

“I DON’T LOVE THIS!” he yelled.

To be honest, I was a little stunned because it was just such an endearing thing for him to say. I looked at his dad, whose eyes were crinkled in silent laughter as he tried to soothe his son.

“One day your dad will probably tell you about this,” I said as we applied a dressing. “Maybe it’ll be when you graduate high school and he’ll tell you about how you got through all this for your brownie.”

His dad pulled him in for a cuddle and whispered over his kiddo’s shoulder, “Oh, I’ll definitely remind him about ‘I don’t love this!’.”