Pediatrics: The Emergency Room
March 13, 1999
Saturday
Hello everyone, and welcome to the journal issue about the Pediatric Emergency Room.
It used to be called the PAS, or Pediatric Admitting Section. But since the Department or Emergency Medical Services (DEMS) changed the whole ER (emergency room) set-up, it’s now called the Pediatric Emergency Room. Not much difference besides the name, except instead of seeing just the usual pediatric cases, we also see non-emergency surgical cases like hernias and foreign bodies in the ear/nose/throat (which eventually are referred to ENT anyway). Most consults here are the diarrhea-vomiting type and the cough-colds type, but sometimes we get kids with seizures, loss of consciousness and other REAL emergencies.
This has got to be the emergency section with the greatest number of non-emergency consults, as there will always be overly-concerned parents who bring their kids to the ER for the slightest complaint. As they say, better safe than sorry. Some overly-concerned parents have children whose sicknesses could be treated at the out-patient department (OPD), but Pediatrics has a chart-all policy (meaning you’re supposed to see the patient even if he is to be sent later to the OPD). There is another type of parent, though, who would bring his/her child to the emergency room because the kid’s illness is already far-advanced. Aside from the usual patient care, this type of parent usually gets reprimanded for delaying seeking medical advice to the point that the child has a disease in the severe stages already.
On a particularly toxic* day, one can have up to 4 or even 5 patients lined up for charting (documenting the history and physical exam) and labs (extracting blood, etc.). Sometimes it can be so benign, as in one patient per 3 hours or 30. Each 24-hour duty is divided into 4 (or 5) shifts, depending on the number of interns present. The shifts frontline 1 and 2 take care of charting and labs. The BE/IV (which stands for blood extraction/intravenous line insertion) intern does all labs which were not done by the frontline interns, as these labs were ordered after the initial labs were done. The monitoring intern takes the vital signs of all patients, at least once every 4 hours (imagine doing this to 35 or so patients – walk, then monitor, walk, then monitor, etc.). A fifth shift (if the group is lucky enough to have a fifth intern) is the “rest” or “floater” – technically does nothing and takes a break. At night a clerk (4th year med student), or two, pitches in, which makes for one more shift (rest again?). And starting this weekend, 3rd year students will be on duty, helping us out by doing the monitoring (yehey!) and charting (double yehey!). The more, the merrier.
A 6-month old girl with very severe pneumonia came in during my last duty. No heartbeat nor breathing was noted, so resuscitative measures were done (this is CPR, or cardio-pulmonary resuscitation). In the process of resuscitating, one of the residents asked me to get water for baptizing the child, so I ran to get tap water and she baptized – I wonder if they do many of these emergency baptisms? The child died, unfortunately, but at least she was baptized by a resident who had the presence of mind to do so.
On a happier note, it is nice to see patients who come in during the early hours of duty (about 7 AM, as our duty lasts 24 hours, from 7 AM to 7 AM the next day), stay overnight for observation and/or treatment, and go home the next day markedly improved. Usually these are the “minor” cases like diarrhea and asthma.
Probably the best part of this ER rotation is the post-duty day, which you can spend in bed, sleeping and over-sleeping).
The last 2 weeks of Pediatrics are spent in the outpatient department. Not much here, just see patients the whole day and go home after… unless on duty as an OPD reinforcer (at the wards) or reliever (at the nursery and Pediatric ICU). Last of the scutwork for internship! After these 2 weeks are done, I’ll be in community medicine for 4 weeks – which is essentially a vacation, then graduation! As of this writing, there are only 49 days to go for internship and 20 days to go for Pediatrics! I can’t wait to take the boards and start my year of rest.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
