A bad accident involving a bus full of kids (6 years) happens in a large city. I guess ER turns into a madhouse when suddenly ca 40 kids come in, a lot of them severely injured. 3 adults were on the bus, two severely injured, one DOA. How are procedures for identifying kids and getting them reunited with their families when the waiting area fills with panicked parents? Some of the kids are unconscious/not able to tell staff their name. MC is the dad of one kid, how might things happen for him?
Hey there! Welcome back.
You’re making some assumptions about the way kids are distributed after a crash like this which aren’t exactly true. Let’s walk this back to the scene and talk about triage.
First, the kids who are DOA don’t go to a hospital. If the crash is this bad, and some kids aren’t breathing, EMS will try to position their head. If they don’t start breathing, they’ll give them a few quick breaths with a bag-valve-mask (BVM). If they still don’t start breathing, that child is “black tagged” and EMS moves on to people they can save. They simply won’t have the resources to invest in unsalveageable children when there are others – the severely-injured-but-still-living – who can be helped.
Covering the bodies with a sheet is polite, here, but are often hard to come by. These kids may simply be laid out and exposed.
Next are the “red tag” children. These are kids who can’t follow commands or who have severe blood loss, as demonstrated by their vital signs, or have some severe life-threatening injury (e.g. evisceration). These kids will be airlifted or driven to the closest pediatric trauma center.
All of this depends on exactly where this happens. In or near a big city, these kids will go to a pediatric trauma center, where specialists can care for them. If there are two around, no one center will get overwhelmed.
All infants go to trauma centers, injured or no, full stop.
Next are the “yellow tag” kids. These are ones who are hurt and cannot walk, but are not life-threateningly injured. These will be distributed around to other receiving hospitals. This is the first group of kids who aren’t in immediate, life-threatening danger, so they’re more stable, and will go further to keep the pressure off of the trauma centers.
Finally are the “green tag” kids, those who either are uninjured or have only minor injuries. These kids can, and absolutely will, wait. They can be packed off to the hospital multiples at a time – you can fit up to 4 in an ambulance – but only after everyone else (save the dead) are evacuated first.
What this means is that hospitals will get steadier streams of kids. First the red tags, then the yellows, and finally the greens. The reds need immediate attention and surgery, the yellows need beds, the greens can sit and wait in the waiting room with staff to keep an eye on them.
This same procedure, by the way, goes for any mass casualty incident, whether that’s an active shooter event, a landslide, or a bus crash: the dead stay still, the nearly-dead get balls-to-the-walls care, and everyone else can wait at least a little.
However, you ask, what does this mean for my dad character?
Dad’s gonna have a hard time with this.
Kids will be asked by responders on scene who they are, and the unconscious or unable to speak will be identified by peers or adults; EMS will track the names and units and destinations and relay.
Incident command will be established at the scene of the accident, but no system is perfect, and which kid goes to which hospital with which crew can be hard to track, especially with the critically ill – you don’t always know their names. Typically, the bus company will coordinate with the incident commander and the hospitals to find out what kid went where, and someone – the school, the responding agency (police or fire, whoever has command in this region), or the bus company will have a hotline for parents to call. That doesn’t mean anyone actually knows anything. These incidents are chaotic, misinformation always spreads faster than the truth, etc.
So your dad’s kid might have been airlifted a hundred miles away and no one knows that in particular. They might know a kid was airlifted but not whose.
At the hospital itself, they’ll make every effort to identify the kid, from EMS, from the kid, etc. Backpacks, if they came, can also be used for ID; the name on a notebook might be all they have at first. (What if the notebook is borrowed? Interesting question. Misidentified kid.)
Hopefully, by the time the kid’s dad shows up at the ER, the ER will have an idea of who’s who and what’s what; kids might have phones and “Mom” might be called (almost always “mom,” because reasons that are too much to go into right now on this already hella long post.) Dad will be asked who his kid is, and that name will be compared to a list; docs might ask him for a description if they have an unidentified, or some identifying feature (clothing, hair, eye color, etc. all matter).
Worse comes to worst, Dad might have to travel to different hospitals. Hospitals get very tight-lipped over the phone after major incidents because of privacy concerns and the sneaky, bastardly ways media tries to get information.
So the general procedure will be: 1) Call the hotline, 2) Call the hospital, 3) Go to the hospital, 4) Provide info and description of kid, 5) Find kid OR go back to Step 1 and start over.
#Repost @doctordconline (@get_repost)
🔴I used a mnemonic:👉EDF ICE RED
Delivery of head and shoulders. .. Now, it is upto you to understand these steps
If you like this video, then tag @@ your friends.. From @twas_medical
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Leo, Newfoundland (10 m/o), La Verne & 2nd St., Long Beach, CA • “He’s being trained to be a therapy dog, so we’re sitting here socializing. He’s been the top dog in every class so far. The hope is for him to work with pediatric cancer patients. I’ve had four and they’ve all worked with pediatric cancer patients. It’s amazing the smile he’ll put on a sick patient’s face, even if just temporarily.”
One dead, three wounded in a High School shooting near Spokane, Washington. Shooter taken into custody. My prayers go to Freeman High School. ❤️
“Michael Harper, 15, a sophomore at the school, told The Associated Press that the suspect was a classmate who had long been obsessed with past school shootings.
Harper said the suspect had brought notes to Freeman High in the beginning of the year, saying he might get killed or jailed and that some students alerted counselors.
The shooter came into the school Wednesday carrying a duffel bag, Harper said. After shots were fired, students went running and screaming down the hallways, the teen said.
Harper said the shooter had many friends and wasn’t bullied, calling him “nice and funny and weird.”
Schaeffer, who didn’t release any information about a possible motive or the age of the suspect, said the shooting was especially hard for first responders, many of whom have children at the school.
A two-lane road into the community of about 500 people near the Idaho border was clogged with vehicles. Some people abandoned their cars on the street to make it to their children.
Cheryl Moser said her son, a freshman at Freeman High School, called her from a classroom after hearing shots fired. “He called me and said, ‘Mom, there are gunshots.’ He sounded so scared. I’ve never heard him like that,” Moser told The Spokesman-Review newspaper. “You never think about something happening like this at a small school.”
Providence Sacred Heart Medical Center and Children’s Hospital received three pediatric patients, spokeswoman Nicole Stewart said. They were in stable condition and surrounded by family, she said.
Authorities didn’t immediately release the ages of the victims.
Stephanie Lutje told The Associated Press that she was relieved to hear her son was safe after his high school near Freeman was put on lockdown. She commended the school district for its communication.
“It’s been amazing, within probably 15-20 minutes of hearing about it, I’d already received a phone call, I’d already received a text message saying that their school is OK,” she said.
She still worried for others she knew, including a co-worker who had yet to hear from her son, a sophomore at Freeman.
“My stomach’s in knots right now,” she said.
Gov. Jay Inslee said in a statement that “all Washingtonians are thinking of the victims and their families, and are grateful for the service of school staff and first responders working to keep our students safe."”
Please share more of your patient stories! I love them!
Okie dokie! Here’s a good one, I think.This one is close to my heart.
We had this patient with multiple heart defects about a year ago. He was born, had surgery, then came straight to us. I had him for a weekend once he was stable. His dad was so, so, so in love with him. He and his wife would say goodbye to me, and then try to leave the room. But dad would just stand at the door way, staring at his 3 or 4 week old firstborn, hooked up to 2 chest tubes, a Pneumovac, on Vapotherm, a central line, and A-line. And the dad was smiling. He’s just so happy that his first baby is still alive. His wife literally had to drag him out of the room so they could go home.
This baby’s parents would watch medical shows at the bedside. They would ask me questions about the medical stuff on the show and how accurate they were. Of course I didn’t know a lot of it that wasn’t related to Peds, so I would go researching published journals on our hospital database for answers lol. We had a lot of fun together. The whole unit got to know this family very well. They were always smiling, always positive, always hopeful - but also realistic with their expectations.
This baby started to decline over the next months. He was able to go home for 5 or 6 days, then got readmitted, and never got to go home. He ended up passing away one summer night. His heart was failing, his kidneys were failing… He was brady’ing from 130 to 90 to 40 and then nothing, and then come back up to 130 and start moving around. It was so hard to see his parents go through this - watching their baby literally be on the brink of death, then spontaneously have a heartbeat again . They decided that it was their baby’s way of saying goodbye. He wasn’t my patient that night, but I was in the room helping out. I was next to his dad as he held his son, watching his heart rate go up and down. We had to pull his breathing tube out, but it’s impossible to do that when you feel your son moving in your arms, and then stop, and then move again. His son moved around, then brady’d, then stopped moving. The dad said, “Ok. We’re ready. Let’s do it.” Then his son suddenly moved and had a heart beat. And of course every time that happened he would say, “No no no. Wait. No.” Can you blame him? How could an parent remove the only thing keeping their child alive? The dad looked around the room at all the nurses and doctors around him and said, “I’m sorry. I’m sorry, you guys. I have no idea what I’m doing right now.” We all whispered it was ok. And with a shaky voice, I managed to choke out, “Nobody ever knows what they’re doing in situations like this.” He started sobbing. And I remember not being able to see anything because of the tears welling up in my eyes. Then dad finally said to his wife, with one of the most heartbreaking smiles I have ever seen in my life, “Ok, baby. Let’s do this.” He looked at the respiratory therapist and said, “Ok. We’re ready.” Their baby passed away peacefully in his arms.
That was one of the hardest shifts I’ve ever had to finish. I remember choking back tears as I documented. I remember pastoral care next to me, trying to make sure I was ok! (Kind of embarrassing. I felt like I was diverting attention to me and away from the family!) This happened months ago, and I still remember every second of that night in that room like it was yesterday. I will never forget that torn look in that dad’s eyes, trying to decided when to pull his son’s breathing tube. How does anybody ever make that decision??
At the end of the shift, of course, OF COURSE, the parents were all smiles, thanking everyone for everything we’ve done. The dad came up to me and thanked me for being the first friend they had on the unit, for being the first to make them feel at home. I think there was more he said to me but all I could hear was my own sobbing as I hugged him and his wife.
Like many nurses say, there will be that one patient who will change the way you practice nursing. There will be that one patient who will remind you why you do what you do. For me, it was this baby and this family. Their baby was a very, very sick patient. And no, I didn’t know everything about his treatment and diagnosis or plan of care. But trust me when I say that it is so so so much more than that.
When you are ready to have your baby, begin labor. Contractions will tell you that your labor is starting. When contractions occur every five minutes, your body will be ready to bid and get the baby.
During the first stage of labor, the cervix slowly opens, it expands to about 4 inches (10 centimeters). At the same time, they thins. This is called effacement. You should not push until the cervix is fully effaced and dilated. When it does, it begins the period of expulsion baby. Crowning is when the child’s skull becomes visible. Shortly after the baby is born. Follows the placenta that it fed.
Mothers and babies are carefully monitored during labor. Most women are so healthy enough to have their babies through a normal vaginal delivery, which means that the child slips through the birth canal without surgery. If there are complications, the baby may be removed surgically with a caesarean.
Credit :- @medicinaclinica
#video #instavideo #child #pediatrics #cesarean #cesareanbirth #surgery #surgeon #usmle #university #usmlestep1 #usmlestep2 #doctor #doctordconline #nhs #nurse #nursing #hospital #patient #medlife #medicine #mbbs #md #amc #plab @doctordconline
Pediatrics (neonates to school age; adolescence is another
topic) is probably my least favorite specialty to deal with and they are one of
the hardest to help at times with all the elements that go with the patient.
Whether it is dealing with the sick child or the distraught parents, we must
sift through the physical findings and the information from the parents to
understand what is going on. This gets especially sticky when it comes to some
upper airway complications in the younger group.
Two very common upper airway problems in the younger
populations include Croup and Epiglottitis. Both can be dangerous, but require
different management when treatment is concerned. This article will give you a
brief overview of the pathophysiology, signs and symptoms, treatments, and key
points to remember.
Commonly a viral infection (RSV, adenovirus, influenza A and B, etc.) of the
upper respiratory system for ages 6 to 36 months. Major inflammation has occurred
in the larynx, trachea, bronchi, bronchioles, and lung parenchyma; causing obstruction
of the airway. As the swelling progresses supraglottic the patients with begin
show signs of respiratory distress. Further along, the patient’s lower airway
may begin to begin having atelectasis, due to the lack of air keeping the
Croup is a slow progression of inflammation. Noticing early that
the patient has upper respiratory issue is key in the management. Due to the
smaller airway of children, we must not hesitate to seat
Signs and Symptoms:
The most common sign of croup will be the seal like bark with inspiratory
stridor. With this means that the patient is in respiratory distress and
quickly heading to failure. If you hear the seal like bark, check the lower
lung fields for crackles, because possible atelectasis may have begun.
Commonly more serious during night, awakening them from
sleep. Other signs to know include:
Emergency treatment for croup is a humidified air and a dose of corticosteroids.
If in further destress, racemic epinephrine will assist with edema. ETCO2 and
O2 readings will help determine if there is retention of gasses, which may lead
to acidosis. ABGs will be needed to confirm this as well.
Usually, patients will be able to return home to be
monitored. Family should watch for difficulty breath and be using humified air.
Antipyretics will assist in keeping fevers down as well.
Influenza type B, streptococcus pneumoniae or aureus may cause epiglottitis.
The epiglottis is a small flap above the glottic opening, which is used to
prevent foreign objects entering the trachea. When the epiglottis is infected,
with will swell, narrowing the airway for the patient. Increased work of
breathing may occur and soon my might have a patient in respiratory failure.
Epiglottitis is a more acute problem, with sudden onset and
quick changes to mentation form the restriction of airflow.
Signs and symptoms:
As the epiglottis swells, the child may begin to develop stridor. When stridor
occurs, we must ask the question is this an object or is this medical. Other
signs that might point you towards epiglottitis will be:
Tripoding or nasal flaring
most important thing with these patients is to ensure they have an airway. Do
not try and examine the patient, especially if you are a paramedic on scene
(Load and go). When gathering a medical history, it is especially important to
ask for vaccination in the pediatric population. Today, Influenza vaccinations
are given to children, but we do have a set population now that do not vaccinate
their children. X-rays of neck will be done and a visual examination may be performed.
Keep the patient calm at this time, further agitation may cause the airway to
Patient will commonly receive an antibiotic, such as
ceftriaxone, to help with the bacteria. ET tubes may be places in severe cases
and usually remain for 24 to 48 hours. Trachostomes may be required, if a ET
tube cannot pass the glottic opening.
Both Croup and Epiglottitis can be dangerous to
pediatric patients. If you have a child that has stridor and any signs of
distress, they will need immediate attention.
Out of hospital, assume epiglottitis and rule it
out when you can. This load and go for you
Croup X rays may show steeple sign, but
A “code” is the emergency alert system that is typically paged overhead in hospitals. It varies by facility but typically there is a color associated with specific emergencies. When we say that someone is “coding” or “about to code”, that usually means that they’re about to go into arrest and/or die.
Code Blue is pretty common for most places and refers to a cardiac arrest/respiratory arrest situation. It pages your anesthesia team, ICU team (if not already in the ICU), the nursing supervisor, respiratory therapy, and other folks depending upon your hospital (our notifies our chaplain as well).
Code Red is pretty common for a fire code, usually meaning that someone pulled a fire alarm, smoke has been detected, or there is an actual fire.
Code Pink means a pediatric patient has gone missing. There is a similar, though different color, for adult patients who are missing.
Other than that, there can be a variety of other colors that link up to various emergencies including environmental type problems (i.e. loss of hot water, electricity), weather emergencies, active shooter/bomb threat, patient elopement, crazy patient or family members gone wild and needing security, or internal/external disaster. Really depends upon your facility and their emergency response team.
Had to suture a kids hand because he cut it with a piece of glass while he was playing, and he was putting on a brave face but was pretty scared, and seeing me lay out the material didn’t really help. Every time I laid something out he would say “Aw that’s gonna hurt.”
So I inject some lidocaine, he cries a little, and afterwards he is just AMAZED that he doesn’t feel anything. Like, jaw to the floor amazed. And he would let me know by telling me “It doesn’t hurt!”
Finished up, and he just kept saying how much it didn’t hurt in pure astonishment.
Notes: As always, thanks to everyone who has read, reblogged, commented, liked…whatever you’ve done to support the fic. It means the world to me. And just a reminder, I’m more than happy to chat about this or any of my other fics if you pop into my inbox.
In this chapter, Lucas gets his introductions to Topanga. And Maya. And then he and Riley do some sharing.
“It’s lovely to meet you Lucas.” Riley’s mother is the picture of
poise as she smiles and shakes his outstretched hand–warm and not at all what
he’s expecting after making the rounds in the dining room. “It’s always nice
when Riley actually gives us a peek into what her life is like now.”
The barb, presented behind the veneer of courteous small talk
lands just as intended; Riley’s grip on his hand tightens and out of the corner
of his eye, Lucas sees the edges of her smile draw in.
Thanks for calling to check up on her, doc – and one more thing. Thanks for examining her stuffed animal during the visit yesterday. She keeps telling everyone, ‘The doctor checked out Winnie the Pooh and said he doesn’t have an ear infection, but I have an ear infection.’
Mother of a 3 year old kid with doctor-phobia – which eased up nicely after I gave poor long-suffering Winnie a full physical.