“Most shifts in the emergency department are filled with routine complaints like abdominal pain, minor trauma and nonthreatening pediatric illnesses. Occasionally, however, you treat a patient whose presentation sticks in your mind. It is from these cases that I have gained some of the most important knowledge in my career thus far.
On a particularly hot summer day, I had two similar patients who really got me thinking about a certain topic. It was a typical day in the ED. Patients were beginning to arrive in greater numbers, and we were getting busy. As I dove into the growing stack of charts, I was informed by the charge nurse that paramedics were bringing in a child in cardiopulmonary arrest.
According to the paramedic on the radio, they were transporting a two-year-old female who was not breathing and had no pulse. I was told that the child had choked on a grape, and the mother called for help. We quickly set up the resuscitation suite for a child of this age. The friendly banter that usually precedes the arrival of a critical patient is always absent when that patient is a child, and this was no exception: The blanket of silence in the room was particularly uncomfortable.
The child arrived on a stretcher, intubated but cyanotic. The paramedics who were performing CPR looked grim as one of them told me the story. The child had been eating grapes when she began choking. Not knowing what to do, the mother called 9-1-1 for assistance. Apparently, she simply asked for help, then set the phone down to wait by her daughter, missing the opportunity to receive potentially lifesaving instructions from the operator. The paramedics arrived five minutes later to see a frantic mother holding her blue child. No attempts had been made to remove the obstructing grape, so the child had gone without air for more than five minutes. With obvious dismay, the paramedic told me that with one simple push on the abdomen, he was able to pop the grape out from the airway without any difficulty whatsoever—a maneuver we all now wished the child’s mother had known about.
The little girl was deceased, and we could not bring her back. As I told the mother that her daughter was dead, all I could think about was how easily she could have dislodged that grape had she only known about the Heimlich maneuver.
This lack of knowledge and its devastating results stuck in my mind for the rest of the day. Near the end of my shift on the same day, I took care of another patient of the same age. The difference between the two has left an indelible mark on me as an emergency caregiver and has changed the way I think about knowledge.
The second two-year-old girl was brought in by her mother with a chief complaint of “well check.” As I entered the room, I saw a mother with a perfectly healthy-appearing female child in her lap, playing with a small doll. The mother explained that her daughter had choked on a hard candy and then turned blue and limp. The mother then described a perfectly executed Heimlich maneuver, which dislodged the hard candy and resulted in the child’s quick recovery. The mother wanted me to “check out” her daughter to make sure she was OK. The child was fine.
I exited that patient’s room forever changed. The difference between the results of these two little girls is the difference between life and death. I began to think about my own children and how vulnerable they were. That night, I spent time with my wife going over the Heimlich maneuver and other things I thought she should know. Then I began to think about other ways in which children die and become injured, and how these could be prevented. Over the next few weeks, I researched the topic and learned much about the causes of pediatric death and how to prevent and respond to each one.”
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