We were on intake (aka call) Friday night. Basically 24 hour admissions, and it was a light call with only 16 admission or so. The process goes something like this: Kids with medical problems are seen in POPD (Pedi Outpatient Department-AKA pedi ER) unless they are a trauma, in which case they are seen in the trauma unit (flashbacks to 2003). They docs in POPD do their stuff, and it seems like kids can be there for a while.. initial hydration attempts, maybe x-rays (not usually labs). If it looks like they are going to need admission, they are shipped over to the Admission Ward (Ward 36). This to me is brilliant!
Once we'd finished most of the days chores, the team essentially splits up. Some in our ward, and then the others headed to the admission ward. The ward is half admission, and half "High Care" Like a step down Pedi ICU. Though, that being said kids in high care may be vented, and waiting to get in the combined adult-pedi ICU. Admissions are split up, histories taken, x-rays done, labs done, etc etc etc.
[reflections back home: I've often thought this is how our medicine service should be run. If they obviously looks sick, and are stable, the IM residents should do the bulk of the work up and initial management. ED decisions seem to often function at the brain stem level, not the cortical level. Sick lefts just pick 2 random antibiotics and give them, who cares about cultures before abx etc.. I digress]
Random pts from intake (not mine, but since admissions are a team sport you basically see all the kids).
An 8 month old sent in for question of gastro. The strikingly obvious thing was that his belly was HUGELY distended. You could almost make out the loops of bowel pressing on the skin. Shit, this is not gastro... Someone asks-Ileus? Maybe. We're doing IVs and blood on the kid, and he doesn't even flinch. The red flags are literally dropping from the ceiling that there is something really, really wrong here. I'm having a slight bit of anxiety at this stage cause I'm banking that this kid has intussusception! (Some know my intussusception stories from back home, so I always hesitate to bring up the I-word). This kid is not an ileus, he's gotta be full on obstruction. We get the abd x-ray, sure enough huge fluid levels, totally obstructed. Incidentally, the kid did have a CXR in POPD, which we saw after the abd x-ray, and even on the CXR you could see fluid levels. Pedi Surgeon (super guy from Cuba) comes over, he's pretty sure it's intussusception, and likely bowel necrosis by this point, and is going to get an ultrasound. Now, even during normal business hours, getting an urgent ultrasound is a bit of a challenge... All I know is the kid went to surgery for likely intussusception. No idea how he did.
4 month old comes in with a sat in the 70s.... Blue. Supplemental oxygen and admit to the ward.
11 y/o boy admitted with Bilharzia. (Google or wiki it). Bilharzia! Looked at his urine under the microscope and boom-diagnosis made. That's good stuff.
I like the team sport feel to admissions. Nice to have everybody there, a procedure room-do bloods, lumbar puncture (spinal tap), and IV in one swoop.
When the kids are transferred to the ward. The sisters (nurses) wait until there are 3 or 4 who are ready to go, and regardless of the age they are placed on one of the famous red gurneys and covered with a blanket. A strap is placed across them to keep them from rolling off. I saw 3 infants and an 8 yr old on the same gurney.
