1 y/o F pt dunked in boiling water

[armymedic007]

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:

 

[usalsfyre]

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.

 

[medicRob]

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.

 

[usafmedic45]

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.

 

[Veneficus]

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.

 

[abckidsmom]

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.

 

[Epi-do]

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.

 

[EMSrush]

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

 

[Rip Shears]

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

 

[Epi-do]

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.

 

[mycrofft]

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.

 

[EMSDude54343]

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.

 

[EMSDude54343]

BTW; What do you feel you did wrong?

 

[MrBrown]

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

 

[boingo]

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

 

[bfog99]

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.

 

[Veneficus]

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.

 

[FrostbiteMedic]

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

 

[Mobey]

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?

 

[Veneficus]

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.