RobotSquid 
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« on: March 23, 2011, 09:47:51 am » |
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Hi all!
I have a question about an A&E admission - if anyone with the relevant professional background could take the time to answer, it would help me with a scene in a novel I'm working on, and would be hugely appreciated. I'm going to describe a hypothetical admission to A&E, and what I'd like to know is, if you were the receiving physician, what would you do in this case?
Suppose you were working in the A&E at a hospital somewhere close to large expanses of wild, hilly country - hillwalking sort of territory. For the sake of concreteness, let's say Belford Hospital in Fort William, Scotland - the actual place-names given here are irrelevant, but they give you an idea of the sort of place I mean.
One morning, a call to emergency services is received from the reception desk of the Glencoe Hotel at about 6am. A girl, aged about 11, unaccompanied, wearing hillwalking gear and a backpack, staggered into the lobby of the hotel minutes previously. She was filthy, had a fresh cut and noticeable bruises to her face, was visibly shaking and relied heavily on the furniture and fixtures to keep upright. When the receptionist caught sight of her, she looked up, said "I made it ... I made it! ... hehehe ... I feel amazing!", then lay down on the floor and fell fast asleep.
She was taken to A&E by the air ambulance, where she was admitted to your care and did not wake up at any point on the way. There's no sign of concussion or cranial trauma, she's simply utterly exhausted and very soundly asleep. She has a lot of bruises all over her body, and her right leg is in a makeshift splint & cast hacked together from the internal support struts from her backpack and a roll or two of duct tape. You suspect she did it herself, and she's actually made a pretty decent job of it, given the materials she had. She has no ID on her, and doesn't match the description of any recent missing child alert. Her condition is stable, and there's no sign of hypothermia. Other than her recent injuries, she seems to be very fit and healthy, and a very very sound sleeper. If you need to wake her up, you're going to have to do something pretty drastic.
I presume that one of your first priorities is going to be to get an x-ray of her leg - (She in fact has a fractured tibia - it's a clean break, a closed single fracture, and she's done a very good job of splinting it, but she's presumably had to walk on it to get to the hotel from wherever she broke it the previous day) - but, do you let her sleep and do the x-ray when she wakes up, or x-ray her while she sleeps, or try to get her awake before x-raying her? (even if you do manage to get her awake, she'll just keep falling back to sleep)
What would be the most likely course of treatment in this case, and how much (if any) of this treatment would you administer straight away (with or without trying to wake her up), and how much (if any) would you save until she had got some good sleep?
I should mention, this isn't quite the scenario in the novel, which is rather more sci-fi than what I've described here, but knowing what would be the appropriate course of action in this case should tell me what I need to know.
Thank you for your attention!
RS
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