First Few Days of ER

Today an attending told me about a four-month-old he had seen in the ER. The mother's only concern was tachypnea, and on exam, the kid didn't show any other signs or symptoms. The doctor normally doesn't get lab work on kids that young, but he decided to and just happened to catch a case of DKA, which is very rare in this age group.

Patients I've seen include a drowning victim, a burn victim, a young adult with DKA, a depressed/psychotic patient who can only say three words, and an infected thumb laceration. There have been many others, and I appreciate the diversity of cases in the ER. One pregnant patient was exposed to low levels of carbon monoxide, and though she was fine, she had to stay a while as we figured out what to do about the fetus. Hemoglobin prefers binding CO over oxygen, and fetal hemoglobin binds both gases with higher affinity than adult hemoglobin. My attending had me call poison control, and they didn't have specific recommendations for a pregnant patient. We got in touch with a OB/GYN, and my feeling is they didn't know what exactly to do, either. I looked it up later on UpToDate, and for mild to moderate exposure, there seems to be no adverse affect on the fetus.

I plan on getting my newsletter posted today amongst reading, so I'm cutting this post short.

Scott