Another Night in the ER.

It was a pretty good night last night.Busy till the mornng but doable. I was team leader again (3 nights in a row!). I think the first night was the worst. However,instead of >200 people a day,our statistics have shown that only about 120 ppl come a day.A marked reduction since the world cup started. Hmm, that means a lot of cases that don't really need to be seen are seen!

Last night itself,within the 10 hours;there were nearly 50 patients in the cubicles (NON ACUTE,and i mean NON ACUTE). A lot came after 10p.m. In the ER,it was okay. However,in the Resuscitation room it was full!. A lot of people come really late at night. When i arrived at 9,the cubicles were empty. Then,at 920,just as the ER was filling up;there were 10 files in the cubicles!. A lot of it were cases that could have been seen in a GP clinic. Not even 15 minutes later,there were 16 files. I sent three doctors to cover it and had to cover the ER and Resusc.

None were urgent enough to be seen immediately. Most cases would not even be seen at a GP clinic in canada. It was complaints like fever for 1 day with obvious causes like coughs and colds. I've been in worse shape and still out and about.

Some silly parents had not even given their children fever medication (which they had at home) and had not sponged nor bathed their child nor pushed fluids. I say silly because in the time they wasted to come,with high temperatues,their children could have fitted if predisposed. A general IQ level before procreation?. There's a distinct lack of sense.

What to do when your child has a fever?

1. a fever is a temperature more than 37-37.5 degrees centigrade.

2. paracetamol is adequate. Please don't be silly and ask for "more power medicine lah". Aspirin is not recommended at all.

3.It will go it's course. It will not go away just after one day. Don't be silly. Don't start saying "doktor bodoh" just because the fever doesn't resolve after one day. Who's bodoh lah?. Have you bothered even reading up?. Do you think there's a magic pill for everything?.

4. Tepid sponging is the best way to cool a child down. Take room temperature water(from the tap),soak a hand towel in it,wipe it all over especially the head,abdomen,armpits and groin. Yes,it's uncomfortable. It does the job and works even better if someone else fans the poor child too. I've done this since i was 9 for all my siblings and cousins. When i was sick,this was done to me. Please don't be stupid. If you care for your child,just do it. Don't show your concern by being abusive to staff who are trying to help you. One lady had time to make up a graph to chart her child's temperature and subsequent fitting.What she didn't chart is that SHE DID NOT DO ANYTHING IN HER OWN POWER to decrease the temperature.What she did do was YELL at my staff nurses. In the pediatric ward,no one wanted to go near her or the child except the consultant who had to. This lady is a typical Malaysian lady who is abusive but incompetent. My nurses had their hands full and had tried to teach her how to do the sponging but she refused.Insisted on Voltaren suppositories.

5.Please do not bundle up the poor kid .How's the heat going to dissipate?.

6.Encourage the child to sip,sip,sip. Of course no one wants to eat or drink.Even adults are like that. However,the body requires more water when there's a fever. Chldren get dehydrated easily as their bodies are composed of more water.

7.A child is adequately hydrated when they pee often,the pee is yellowish or clear (not concentrated), they have tears, their mouth and tongue is moist.

8. If the child has persistent temperature >38.5 despite all these measures,go to a GP first!. Some infections like tonsillitis have very high grade fevers. Most viral fevers are high grade reaching 40 degrees. The key is hydration,cooling down,rest and meds at the right time.

9.if your child vomits everything out or has decreased urine frequency or the pampers are not soaked as usual,come to the ER. please don't overexaggerate,i had one mum last night say her son vomited everything out the whole day. he did look dry and lethargic and since he could not keep anything down (ACCORDING TO THE MUM),we placed an IV cannula to replace the fluids lost. Only after 30 minutes,she said she had given me the wrong idea and he had only vomited once.This was after she spent the 30 minutes whingeing saying it was too painful,must we put this is in.... You daft woman!.DO NOT LIE!.

10.if your child has a heart condition,kidney problems,endocrine conditions,please come immediately.

I keep reading in the newspapers about when to seek the doctor. These articles in the Star's Health section are good because it is done by a group of peers. Some of the articles done by pharmacists are dodgy. In fact,i've had so many horror cases because of "i got the drug from the pharmacistlah,he say good one" that i'm surprised they don't get sued. PHARMACISTS ARE NOT DOCTORS. In Canada, Australia, UK,NZ they DO NOT HAVE THE POWER TO PRESCRIBE. Don't believe me?. Check it out.