triage central

the favorite part of my job at the pediatric office is definitely the triage phone calls.  well, i love working with the kids, too, but i work the after-hours shifts--nights and weekends--with sick kids who don't want to be there getting their throats swabbed or getting a shot or getting stitches.  i love the triage calls because the parents are calling in with questions they need addressed right away.  i love educating people, and what's more, i love seeing the education applied--i know what i recommend to the parents is going to be applied as soon as we hang up the phone.  it feels great to know you are useful.    

i have also had some very interesting calls over the years, which has been very entertaining and some very eyebrow-raising.  let's see...i think this is definitely my number one call:  history: 4 days prior to the call, the family had been vacationing in st. george.  the child fell and hit her head, splitting open a small gash on the top of her head.  the mother-in-law suggested the mom simply braid the child's hair to close the laceration.  the mother complied.  4 days later...the night the mom called our office, she was bathing the girls and was taking the braids out to wash the child's hair and noticed a bad smell.  she was wondering what to do.  .....   ......   ................ok.....i had a million questions running through my head!  first and foremost "doesn't st. george have an instacare or an er they could have gone to?"  anyway, we ended up bringing her in to look at her scalp and check for an infection (too late for staples at this point).   the child was fine, but for future reference, a foul smell coming from an untreated wound is a bad sign.  i also love constipation questions because they always directly correlate with nutrition.  "what's the child's diet like?"  i ask.  "oh, you know, she won't eat anything except for chicken nuggets, french fries and chocolate milk."  the mom replies.  "ok, so no fruits or vegetables, fiber?" i hint.   "well, i just said she gets french fries."  personal soapbox: french fries are not vegetables.  period.  and what do you mean by the child "won't eat anything" except for chicken nuggets, etc.?!  YOU are the parent, YOU are the one in charge!  (all y'all out there with kids are probably laughing at me at this point because naive childless me believes the parents are the ones in charge.  ha!)

last night a very worried dad called in because his 8-month old had swallowed a candy foil wrapper.  i was mortified when he explained he tried to get the wrapper out by inducing vomiting by sticking his finger down the infant's throat.  he couldn't see anything, but he thought he could feel it, so he tried to dig it out with his finger.  ok, don't stick a finger down your throat (bulemia 101), or anyone else's for that matter...especially an 8-month old infant.  cpr/heimlich rule #1: never sweep the throat unless you can actually see the object you're sweeping for, otherwise you may end up lodging the object further.  future reference:   

the concern about swallowing something other than food (well, this could happen with food, as well) is that it would get inhaled rather than swallowed, go down the windpipe and in the worst case scenario, end up in a lung and cause an infection.  it could also get lodged at the windpipe entrance, which would cause wheezing, difficulty breathing, etc.  a friend of mine did have her 12-month old taken in for swallowing a penny, and ended up having it surgically removed from the windpipe.  each case is different.  in this case, the child was in no distress, breathing fine, no wheezing, no gagging (other than when the father's finger was down her throat).  she had literally swallowed the foil.  i spent 10 minutes reassuring the father it had gone down her esophagus, into her stomach, and it would be excreted with the stool in the next 3-4 days.  at the end of our 10 minute conversation he said, "well, i guess i have to believe you."  i said, "this is your first child, isn't it?"  "yes."  "and this is the first time she's swallowed anything other than food, isn't it?"  "yes."  "trust me, this won't be the last.  she is fine.  it will pass with the stool."  "ok.  i guess i have to trust you.  but i'm worried about the foil cutting her intestines now."  it took another 5 minutes to convince him she would not sustain any injuries from the candy foil on its way out of her system.

so this post is dedicated to all you parents out there who may need a triage boost.  i'm here for you!  give me a buzz!  the most important thing you can remember is to take a step back and ask more questions.  as a parent you get scared and alarmed with the first symptom you see.  remember to breathe, step back, and objectively look for more evidence that would make that symptom more concerning.  here is a list of home health books i own, use, and love--may this help you in your triage attempts--and give me a call for an immediate need!

1.  the complete family medical guide, by dr. warwick carter--defines every condition in layman's terms and has pictures.

2.  caring for your baby and young child: birth to age 5, by the american academy of pediatrics (they also have age 5-12, teenager, baby's first year, guide to your child's symptoms, etc. etc.)--i love this because it not only has triage/symptom questions, but they address behavioral and developmental issues, as well.

3.  columbia university children's medical guide, by drs. caddle, mccord, and valman--i love this because it has photos and illustrations of every triage symptom and question known to man.  it also has step-by-step triage charts for you to use!  if your child has symptoms a and b, move to step 2, if not, move to step 3.  very easy to use.

4.  take care of yourself, by drs. vickery and fries--same concept as the book above with the triage charts, but no photos, only drawn illustrations.  but there is a section on infant choking!

and if you're a nerd like me, you'll probably enjoy having illustrated medical dictionaries on hand, too, like dorland's or taber's.