Sounds like you were on the spot and did what you thought what was best for
the child. This takes courage and conviction. If there was a subdural or
epidural bleed he would probably have been further delayed at the DGH.
Would they have been able to cope with this?
-----Original Message-----
From: Jel Coward <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 03 September 1999 20:53
Subject: HI child - a little help from my friends
>Hi All
>
>I have had a little 'partner' trouble recently (no not the recurrence of
>that rash ;-)
>
>I had a lad brought in (cottage hospital) - 8 yoa, 12ft (confirmed) fall
>onto concrete - initial LOC - I won't go into detail except to say that
>when I saw him he was inconsolable and not making much sense - then he
>became quiet with GCS 12-13 (E-3 (with repeated and loud voice - then
>would re-close and be difficult to rouse again), V-4, M-5) - this was
>fluctuating somewhat. His Left pupil dilated but responsive to light
>(and local bruising and I think was traumatic aetiology)
>
>He was haemodynamically stable with no signs of other injury except
>slight swelling R wrist.
>
>
>The decision is ?50 minutes to DGH with scanner but no neurosurgery/paed
>surg/paed ITU - and a v long trip from here to further care
>
>or fly - 30 mins airtime but delay in getting aircraft to site etc -
>total time to hosp likely to be doubled c.f. DGH
>
>I spoke to the consultant surgeon at the DGH - long chat - felt probably
>better to go elsewhere - this was my initial feeling and I guess I may
>have pushed him this way a little
>
>My decision was to fly to centre with facilities - and this was in the
>event.....uneventful. I accompanied the child and spent 2.5 hours in a
>taxi coming back (22:00 by this time). Aircraft was large, stable -
>with coffee machine! and full monitoring and extended trained aircrew.
>
>The major bit of this trauma has been my partner's (GP not bed)
>reaction. He was v v displeased (although I managed to get my
>receptionist make the 14 'sick' folk waiting to see me 'disappear' (to
>slots with me starting work early for the next 2 days) - and all my
>partner had to do was to cover the on-call until I returned (with me
>volunteering to do the whole following night (his) in return for the few
>hours cover for me.
>
>He seems to think it was unnecessary to make this trip - and quite
>frankly I am quite upset about it. I disagree with him but am
>infuriated by my unpreparedness to quote the evidence at him. I am now
>on my 3rd night on call and am convinced that someone has switched off
>the light at the end of the tunnel - so can anyone point me towards the
>stuff I need to read and quote.......or does anyone support my partners
>view and can provide me with info to stop me needing to 'create' this
>problem in the future?
>
>
>Many thanks all ;)
>
>Cheers
>
>PS (it is all made worse because our asst GP flew a 2 month old out just
>a few weeks ago - had HI and was unresponsive for 20 mins - partner also
>felt that this was the wrong thing to do)
>--
>Jel Coward
>
>..take a look at the Wilderness Emergency Medicine and Command Physician
courses
>
>http://www.wildmedic.org
>
>[log in to unmask]
>
>'There's no such thing as bad weather - just bad clothing"
> Anon Norwegia
>
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