# 1 y/o F pt dunked in boiling water



## armymedic007 (Mar 20, 2011)

I feel like i did something wrong...

S: 1 y/o F pt mother states pt was dunked in boiling water

O: Pt presents with partial thickness burns to (circumferential) feet, buttocks, and (circumferential) hands to approx 9% or body. Pt presents with negative cap refill to hands and feet. Pt skin presents with redness and swelling in affected areas. Pt present distant from mother.  R 32 P 168 T 99.1 auxiliary (rectal unavailable).

Aartial thickness burns to (circumferential) feet, buttocks, and (circumferential) hands to approx 9% with child abuse suspected.

P: Immediate transport to burn center, Apply silverdene cream (under doctor's orders), Wrap in gauze and Monitor pt

Kid turned out fine with no scars or evidence of it happening, Mom had munchausen by proxy and used the kid to get husband to come home from work early, and i have horrible guilt and nightmares from it (which is being treated as ptsd and is improving). i think what did it in was the next call which was a 4 y/o F who had common cold s/s w/ vitals stable (over worried mom). But did I screw up? I run thru it over and over. :sad:


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## usalsfyre (Mar 20, 2011)

Sounds like you did fine, now you just have to learn how to deal with seeing the horrible crap people are capable of doing to one another. Sometimes this job really blows the big one.


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## medicRob (Mar 20, 2011)

This is exactly why I hated working the ANGEL Team and the PCCU (Pediatric Critical Care Unit). THIS :censored::censored::censored::censored:, and sorry for the language but Im gonna say it this :censored::censored::censored::censored: is all too common.


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## usafmedic45 (Mar 20, 2011)

> But did I screw up?



You mean other than not having the courtesy to punch the mom in the face or better yet, take her out and save us the cost of a trial?  No, not at all.  You did everything right as far as the medical side of things go from the sounds of it.

I still have a few cases from my career like this that give me nightmares.  If you need to vent, feel free to PM me.


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## Veneficus (Mar 20, 2011)

usalsfyre said:


> Sounds like you did fine, now you just have to learn how to deal with seeing the horrible crap people are capable of doing to one another. Sometimes this job really blows the big one.



Well said.

The worst things I have ever seen are not injuries or illnesses.

The worst is absolutely man's inhumanity towards man.


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## abckidsmom (Mar 20, 2011)

That kind of abuse makes me sick, but at least you can blame it on a person with malice.  I really hate the flat ignorance that leads people to do stupid, stupid things that cause harm.

What is it you think you did wrong on the next call?  I'm not following.


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## Epi-do (Mar 20, 2011)

It sounds like your care was appropriate.  The only other thing that I would have done was fill out the mandatory reporter form our state has for suspected child support.  You may have also done that, but you just didn't mention it.


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## EMSrush (Mar 20, 2011)

I'm not following either. Where do you think you screwed up?


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## Rip Shears (Mar 20, 2011)

Your treatment was appropriate.  You did what you could.  Don't beat yourself up.


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## Epi-do (Mar 21, 2011)

Epi-do said:


> It sounds like your care was appropriate.  The only other thing that I would have done was fill out the mandatory reporter form our state has for suspected child *support*.  You may have also done that, but you just didn't mention it.



Yeah, I meant abuse, not support.


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## mycrofft (Mar 21, 2011)

*Getting back to medical...*

1. Just asking, were there fold marks on the flank where folded skin (from being held by feet and hands while being dunked) was protected from burning? 
2. THey used to caution against large area Silvadine application. Wonder if that applies?

Sound like you got it done right. Don't try to get into someone's head who does that, just treat the kid and let the higher paygrades exercise their due diligence.

We resuscitated a baby smothered by a babysitter for Munchhausen (sitter liked being lauded as a rescuer). Kid did fine, thanks.


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## EMSDude54343 (Mar 21, 2011)

Dont beat yourself up! You did eveything correctly. The child turned out ok in the end, so even if ya did so somehting wrong, it didnt have a negative outcome, did it? NO! 
I work in the communications center and took a call for a 2 yof that was unconc,  not breathing. Followed protocol and did cpr on the phone and got a pulse back just no spontanious resp.
We found out later that it was child abuse and child was beat to death by her adoptive parents. (died 2 days later in a ped trauma facility) I still have nightmares from the call because the caller was the father. 
The best coping mechanism i have found is to just keep reminding myself that I did everything that I was supposed to do and within my protocol. Just keep reminding yourself of the good outcome your pt had! Talk about it with your co-workers and friends, continue with your ptsd treatment.


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## EMSDude54343 (Mar 21, 2011)

BTW; What do you feel you did wrong?


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## MrBrown (Mar 21, 2011)

Nah Brown doesn't think giving mum a very large dose of suxamethonium and leaving the house was wrong


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## boingo (Mar 21, 2011)

Any consideration about pain management?  I didn't see it mentioned, figured I'd throw it out there.


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## bfog99 (Mar 21, 2011)

People keep asking what the OP feels they did wrong. My guess is that it was a rough call and they are looking for reassurance. Not that the treatment choice was poor, but just a way to get it off his chest to a bunch of people that have seen similar things.

To the OP: like others have said, your treament choice was fine. Don't know if this is your first tough call, but there will be others. Knowing you are having a problem with it is the first step to getting the help you need to get through it. For that I give you props.


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## Veneficus (Mar 21, 2011)

bfog99 said:


> People keep asking what the OP feels they did wrong. My guess is that it was a rough call and they are looking for reassurance. Not that the treatment choice was poor, but just a way to get it off his chest to a bunch of people that have seen similar things.
> 
> To the OP: like others have said, your treament choice was fine. Don't know if this is your first tough call, but there will be others. Knowing you are having a problem with it is the first step to getting the help you need to get through it. For that I give you props.



Sometimes focusing on the aspects of a call the provider actually has control over can be theraputic.


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## FrostbiteMedic (Mar 21, 2011)

man, you gotta keep your head up. Several years ago now, I found that time is the only solution to much of the pain we feel. I have already told what happened in a different post, but I will link to it here....it is much easier than having to retype the situation. 
http://emtlife.com/showthread.php?t=22547


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## Mobey (Mar 21, 2011)

I am missing something too...

What do you think you may have missed? The scenario is full of holes as presented, I assume this is not a comprehensive list of the actual assessment and call flow.

Unless you post your scope of practice I cannot determine if anything is missing. 
You called med control, so I am guessing you did all you could.

The question I have is, if you are in councelling why the hell would you risk screwing it up by posting this to the public and allow scrutany?


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## Veneficus (Mar 21, 2011)

Mobey said:


> The question I have is, if you are in councelling why the hell would you risk screwing it up by posting this to the public and allow scrutany?



Peer support?

While healthcare providers and emergency workers can be a rather ruthless bunch that eat their own young, they are rather good at providing peer support.

It is quite obvious from the OP that the thread really doesn't warrent being overly critical of medical procedure or care.

Most of the councilors I know advocate finding or talking to people who have experienced similar situations.


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## medicRob (Mar 21, 2011)

Mobey said:


> The question I have is, if you are in councelling why the hell would you risk screwing it up by posting this to the public and allow scrutany?



Because chances are the counselor has never been in EMS and dealt with one of these situations in our mindset. This is not something you can really discuss with your girlfriend, etc... Sometimes, just being able to talk to another EMS provider can work wonders. When I worked the ANGEL team, I would come home and nights, and I would literally be in tears until time for my next shift. I saw crap like this all the time, my peers were the only people I really felt comfortable talking with about it.


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## abckidsmom (Mar 21, 2011)

And really.  If he drove the kid to the hospital hanging from the ceiling, dropped her on the bed in the ER and gave report and took off, he got something good done.  She's away from the whacked-out mom.

I can't think of a single person who would berate or overly criticize anyone's performance in a thread like this.  If he said, "I did XYZ, do you think that was a good idea?  What could I do differently?" People would appropriately respond, and usually in a pretty gentle manner.

It's the people who arrogantly believe they know it all or who believe they have nothing new to learn who generally get brought down a notch or two.

People with the air of a learner can almost always be taught.  And usually want to be taught.  This person sounds like that to me.


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## Mobey (Mar 21, 2011)

Veneficus said:


> Peer support?
> 
> Most of the councilors I know advocate finding or talking to people who have experienced similar situations.



Totally agree with this point.

I am certain that the internet is not the right place though. IF there were a few people on here ragging on the OP for this call, it could do serious damage.

I highly doubt any councillor worth seeing would suggest hitting the internet forums for "peer support"


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## Mobey (Mar 21, 2011)

abckidsmom said:


> People would appropriately respond, and usually in a pretty gentle manner.




Been on the internet long?

LOL, in good fun!


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## mycrofft (Mar 21, 2011)

*My reply sounded a little critical in it's questions.*

Not intended to be. Just technical questions.
The "zebra sign" burn pattern is used in court to prove child abuse or murder.


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