TV fell on 7 month old's head

[paccookie]

This was the start of my day today, my first day working as a medic with an EMT (rather than another medic...just "released" from the FTO). We had a quiet morning up until a little after 11. Then this call came in as an "unknown problem" call with a woman screaming that something was wrong with her baby. We arrived on scene and the woman all but threw the baby at my partner (thankfully, a great EMT with several years of experience). The baby was pale and honestly we both thought she was dead when we first saw her. She had a red abrasion on the right side of her head, covering the temporal and parietal regions of her cranium. No crepitus anywhere on her head or neck. Raccoon eyes already present, dried blood in both nostrils. She didn't respond to much of anything. She did move her arms and legs spontaneously every now and then, and she did make some little noises. No spontaneous eye opening. Manually held c-spine, did an IO in the left proximal tibia (aspirated well, flushed well, baby's movement increased when flushed so gave her 20 mg Lidocaine), monitor, 15 L O2 NRB, towel behind back and shoulders to maintain open airway, immobilized head and spine. Transported emergency to level I trauma center (20 minutes away). I hung saline and got about 75 cc in before the left leg started swelling D/C'd the fluid to reassess the IO. Unable to determine patency of IO, so resecured IO and looked for IV. Unable to find IV. Baby's BP was 118/80, pulse 220, respirations 30, oxygen saturation 100% on 15L. Sinus tach on monitor. Pupils ERRL, approximately 2 mm. Gaze was deviated to left upon arrival to trauma center. Gave my report and baby was moved to CT within 10 minutes of arrival. Haven't been able to get an update yet. She didn't look good from my point of view and the dr agreed. Very sad day. Apparently an older child was trying to put a DVD into the DVD player and climbed up on the tv stand. The tv was one of the old-style, very heavy types. About 32" and sat 3 feet above the floor.

 

[paccookie]

That should say 4 mg Lido...gave the right amount, got the numbers messed up when I was charting.

 

[medic417]

Sadly thats life in EMS. Learn from it and move on. If you dwell on it it will hurt you.

 

[Sasha]

I'm sorry to hear you had a bad call, but take pride that you did all you could and then move on.

 

[VCEMT]

That is horrible. There was one a while back, a 5 or 6 year-old girl was killed when a 42" fell on her. Since then, I get nervous when my nephew runs up to a TV.

 

[rhan101277]

I worry how I will handle this type of stuff when my time comes to do so.

 

[MrBrown]

... and the point of the lidocaine was, what exactly? Was this 1% lido for IV cannulation (I am taught it relieves pain but um, yeah, I don't buy it) or like proper old school lido for anti-arrythmatic properties?

Reason I ask is we use like 1-2ml for pre-IV cannulation pain relief and 20mg for a 7 year old seems very high and more like a loading cardiac does at 1mg/kg.

 

[Pudge40]

... and the point of the lidocaine was, what exactly? Was this 1% lido for IV cannulation (I am taught it relieves pain but um, yeah, I don't buy it) or like proper old school lido for anti-arrythmatic properties?

Reason I ask is we use like 1-2ml for pre-IV cannulation pain relief and 20mg for a 7 year old seems very high and more like a loading cardiac does at 1mg/kg.

Please read the entire thread. They stated in the second post that it was a typo. They only administered 4mg of lido.

 

[medic417]

Anytime you place IO on a responsive patient flushing with lido helps deaden pain so movement will be limited thus helping keep IO in place.

 

[MrBrown]

Anytime you place IO on a responsive patient flushing with lido helps deaden pain so movement will be limited thus helping keep IO in place.

Yeah thats what I thought; guess I should read a bit harder

 

[mct601]

any news on the kid?

 

[paccookie]

any news on the kid?

Yeah, I heard yesterday that she died. :sad: Her funeral is on Saturday, not sure if it's appropriate for me to go. I have some reservations about it because of certain aspects of the call. The dried blood in the nose is a huge issue for me...makes me wonder how long this happened before calling 911. And honestly, I'm just not sure if it's appropriate...would you want to see the medic that picked up your child in this situation??? I didn't expect her to make it, but the news hit me kinda hard. It's bad enough when you hear that one of your adult patients died, but when it's a kid it's another thing entirely.

 

[Chimpie]

I'm sorry the result wasn't what we all were hoping for.

Remember to talk it out if you need to.

 

[paccookie]

I'm sorry the result wasn't what we all were hoping for.

Remember to talk it out if you need to.

Thanks, I have talked to some of my co-workers and it has helped. Thankfully this type of call is few and far between. As someone else said, you talk it out and move on. I will say that it was a learning experience - immobilizing a 7 month old requires some creativity when your equipment is not built for a child of that size.

 

[bunkie]

Can you not go and observe from a distance? I'm sure you could hide out in the back. Going may help you feel better.

 

[el Murpharino]

Did you have a defusing with all the rescuers/providers involved? They tend to help start the process. I had a 9-year old traumatic arrest the other day, and the defusing really helped to get out some of the thoughts I had in my head.

 

[medic417]

While I am sorry for the loss of life I feel as a group EMS work themselves up to the point that they can not cope with death of a child. It should not be that way. Death is death. I am not being calloused but I have seen the way people all gather round and build more into the situation thus some end up leaving EMS. Unless it is your family member really you just have to look at the human body as a machine so you do not take it so personal.

 

[el Murpharino]

While I am sorry for the loss of life I feel as a group EMS work themselves up to the point that they can not cope with death of a child. It should not be that way. Death is death. I am not being calloused but I have seen the way people all gather round and build more into the situation thus some end up leaving EMS. Unless it is your family member really you just have to look at the human body as a machine so you do not take it so personal.

It's true, as evidenced by the many posts I've seen here where people state they'd work a pediatric code longer than they would an adult code, despite time down, previous medical history, etc.

One has to remove themselves enough from the situation to treat the patient appropriately without letting their emotions cloud their judgment. After the call, it becomes easier to grasp the gravity of the situation and get over it. It is natural to be upset after a serious or critical call. Just don't let it consume you and seek professional help if needed.