Of babies, burns, and charcoal covered exam rooms.
I've just finished two weeks of night float and I'm now on ER rotation. I can't say I really like ER, although each day it's not quite as bad as what I'm expecting. Hopefully, that trend will continue...
Yesterday, I had two little patients that had ingested diet pills each of which contained an unknown quantity of yohimbine. Apparently, mother had left her diet pills lying around the house (perhaps to remind her to ingest them herself, who knows) and the little tykes (aged 2 and 4) discovered, to their delight, some small little candies. As the pill bottle wasn't equiped with a child safety lock, it was easily opened, and when mother found them, the bottle was open and four diet pills missing. So, at most one ingested 4 pills and the other 0, one ingested 3 pills and the other 1, or they each ingested 2 pills. Mother, of course, flew into a panic and called poison control. Somehow the amount and number of pills got greatly exagerated for poison control called our ER with the report that they possible ingested 10 pills each (that MIGHT have been a little more of an emergency). for those of you who don't know. Diet pills contain yohimbine, which basically speeds up your metabolism and gives you a high very similar to caffeine.
Three hours post ingestion, the two little hoolagins arrived at our ER armed with instructions from poison control for 1g charcoal/kg body weight.
I don't know if anyone has had the priviledge of tasting charcoal. I myself downed some last week while suffering immensely with a nasty little stomach bug. Even for me, an old veteran of the natural remedies, charcoal is still a noxious substance coating everything from the mouth down with a layer of gritty, black grime. Now imagine with me, trying to stuff this stuff down two very active little boys?!?
First, we mixed it straight with a little water and presented it as "black juice." Using my sweetest and most sincere voice I crooned "we have a SPECIAL juice for you! only very GOOD children get to drink it. You will like it VERY much and you must be good boys and drink all of it down as fast as you can!" The four year-old took one whiff and of the stuff and pushed it away. The 2 year-old was a little more gullable, he took a huge gulp but then made a violent explosion of the stuff all over the room, me, and his mother. Plan 1 failed. Plan 2 consisted of disguising it in all sorts of juices. That went over about as well as plan 1. Plan 3 consisted in the chocolate experiment. We carefully disguised the charcoal between layers of beautiful brown chocolate. We actually got the 4 year-old to eat part of it (mostly the chocolate part) but the 2 year-old would have none of it. My chasing him around the room offering bites of "charcochocolate" only threw him into a frenzy. Seeing that the door was blocked by mom, he made a dive under the table smearing black charcoal all over the floor, curtains, and table in the process.
I finally gave up after me, the mother, both boys, the nurse, and two exam rooms were coated with a fine layer of that nasty, gritty black stuff. It was only then that the attending walked in and said "it's been >3 hours since ingestion, AND at most one ingested four pills. Therefore charcoal won't do any good anymore and was never necessary in the first place. Their vitals are stable, just send them home!" GRRRRRRRR....
I've just finished two weeks of night float and I'm now on ER rotation. I can't say I really like ER, although each day it's not quite as bad as what I'm expecting. Hopefully, that trend will continue...
Yesterday, I had two little patients that had ingested diet pills each of which contained an unknown quantity of yohimbine. Apparently, mother had left her diet pills lying around the house (perhaps to remind her to ingest them herself, who knows) and the little tykes (aged 2 and 4) discovered, to their delight, some small little candies. As the pill bottle wasn't equiped with a child safety lock, it was easily opened, and when mother found them, the bottle was open and four diet pills missing. So, at most one ingested 4 pills and the other 0, one ingested 3 pills and the other 1, or they each ingested 2 pills. Mother, of course, flew into a panic and called poison control. Somehow the amount and number of pills got greatly exagerated for poison control called our ER with the report that they possible ingested 10 pills each (that MIGHT have been a little more of an emergency). for those of you who don't know. Diet pills contain yohimbine, which basically speeds up your metabolism and gives you a high very similar to caffeine.
Three hours post ingestion, the two little hoolagins arrived at our ER armed with instructions from poison control for 1g charcoal/kg body weight.
I don't know if anyone has had the priviledge of tasting charcoal. I myself downed some last week while suffering immensely with a nasty little stomach bug. Even for me, an old veteran of the natural remedies, charcoal is still a noxious substance coating everything from the mouth down with a layer of gritty, black grime. Now imagine with me, trying to stuff this stuff down two very active little boys?!?
First, we mixed it straight with a little water and presented it as "black juice." Using my sweetest and most sincere voice I crooned "we have a SPECIAL juice for you! only very GOOD children get to drink it. You will like it VERY much and you must be good boys and drink all of it down as fast as you can!" The four year-old took one whiff and of the stuff and pushed it away. The 2 year-old was a little more gullable, he took a huge gulp but then made a violent explosion of the stuff all over the room, me, and his mother. Plan 1 failed. Plan 2 consisted of disguising it in all sorts of juices. That went over about as well as plan 1. Plan 3 consisted in the chocolate experiment. We carefully disguised the charcoal between layers of beautiful brown chocolate. We actually got the 4 year-old to eat part of it (mostly the chocolate part) but the 2 year-old would have none of it. My chasing him around the room offering bites of "charcochocolate" only threw him into a frenzy. Seeing that the door was blocked by mom, he made a dive under the table smearing black charcoal all over the floor, curtains, and table in the process.
I finally gave up after me, the mother, both boys, the nurse, and two exam rooms were coated with a fine layer of that nasty, gritty black stuff. It was only then that the attending walked in and said "it's been >3 hours since ingestion, AND at most one ingested four pills. Therefore charcoal won't do any good anymore and was never necessary in the first place. Their vitals are stable, just send them home!" GRRRRRRRR....
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