Site Evaluation Presentation Summary
For my final site evaluation, I presented on a case of a 2-year-old male who came into the pediatric ER with his mother after ingesting rat poisoning one hour prior. My patient did not have any significant past medical history except for some eczema since birth and was not taking any oral medications, vitamins, or supplements.
As for the ROS and PE examinations, everything was within normal limits and was unremarkable. Both the patient and his mother denied any abdominal pain, nausea, vomiting, diarrhea, sudden epistaxis, gingival bleeding, hematuria, easy bruising/bleeding, fever, chest pain, or shortness of breath. The patient was very active in triage, was playful throughout the entire visit, and was in no apparent distress. Even though my attending suspected that patient only ingested one pellet of rat poisoning which was probably benign, he contacted NYC Poison Control for further management recommendations because this was all based on speculation. NYC Poison Control recommended a full work-up due to the many unknowns of this case, ranging from unknown number of pellets ingested to unknown brand or type of rodenticide. My attending thought that a full work-up was unnecessary given the current presentation of the patient but he ultimately transferred to Cohen for 24-hour observation as per the guidelines. However, our job in the ER was to rule out and stabilize more acute and serious issues such as GI bleed or abrupt epistaxis, which fortunately the patient did not have.
At the end of my presentation, Prof. Maida stated that immediately turning to activated charcoal was neither the first line treatment nor the right thing to do. He mentioned that we should have put an NG tube in the child and tried a gastric lavage before using activated charcoal, especially in such a young child who did not tolerated PO activated charcoal well. We then discussed how sometimes hospitals and providers do not do the right things or they order unnecessary tests that ultimately contribute to higher healthcare expenditure and lower patient satisfaction. However, my attending followed the recommendations of NYC Poison Control so there may be a discrepancy between treatment guidelines and what is actually done in practice. In my future patient interactions and H&Ps, I plan on looking up current practice guidelines and compare them to what I see in practice to learn more about what is best for my patients.
This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.
