Update!

Since time is scarce (tomorrow is quiz-day again) and I don't remember everything anyway, I'll just ramble a bit.

Yesterday, ped's ER, was quite uneventful. The huge place (for a "specialized" ER in my opinion anyway) started crawling with residents around 11am, seemed very overstaffed to me in light of the low patient count. Cases were remarkably benign, a few bumps and bruises, asthma, some diarrhea and mild infections. Highlight of the day (for me anyway) was a child with surgically corrected tetralogy of Fallot. Not for the diarrhea he presented with, but because I had never seen an actual Fallot patient before.

I switched with skriehma today, went to ED1 leaving ped's to him. Interesting things today that come to my mind were .. hmm .. the cardiac arrest that was called in but never arrived. We were all assembled, ready to resuscitate, standing there for a few minutes, until people started to trickle off taking care of other stuff. The resident who was supposed to intubate stayed the longest, but eventually gave up as well. I did not find out what happened to that ambulance by the end of my shift.

Interesting as well was a scene that I at first only witnessed from a couple of meters away. An obviously agitated woman was yelling at one of the residents, asking to be let go. She wanted to go home. Said she had to be there at five to take care of her kid. Sounded logical, although yelled a bit loudly. The resident, inside the center desk area, protected by one security guard, another one was circling the patient, told her in a similarly loud voice that "if she was reasonable", she could be let go in three hours. When the patient didn't accept that, he told her that she could either wait calmly for three hours or be physically and chemically (with Lorazepam) restrained and stay for twelve hours. In a country where people can be brought into the same ER totally plastered every night and still have to be let go whenever their alcohol level permits, only a drug or definitely diagnosed psychiatric condition could elicit the resident's behavior. Since psychiatric conditions usually don't go away after three hours of observation, it had to be drugs. And it was. When the resident asked me to provide "some muscle" to pin her down for an IV (which was unnecessary, since she eventually did cooperate), he told me what her story was. She had been found unconscious with a respiratory rate of five, apparently pumped full of heroine. The thing that kept her alive and awake was naloxone. With its short half-life, a three hour observation actually seemed pretty short. And who knows if she actually has a kid. If she does, it is sad that no one down there has the means of getting mom away from opiates and her kid out of that milieu.