Hospital Placement--where would this patient be?

[Ankaboot]

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Hi guys. I'm a pre-med writing a short story about a 12 year old boy who has critical surgery on his leg. Can you tell me where exactly he'd be in the hospital when he is recovering post-op?
Thanks!

Edited:

Hey Guys.
It's no trick question.

I needed a storyline with a 12 yr old boy to be in the hospital for about 2-3 weeks post a leg surgery ("critical" because he's kept that long in the hospital, right?).

If you can tell me under what conditions he would be kept in the hospital for at least two weeks, and where exactly would he be?

I'm asking you because I'm really not familiar with medical conditions and patient placement.

Thank you. I really appreciate this.

 

[deleted87716]

Hi guys. I'm a pre-med writing a short story about a 12 year old boy who has critical surgery on his leg. Can you tell me where exactly he'd be in the hospital when he is recovering post-op?

In bed, of course. Was that a trick question? 😉

 

[BadVB750]

Sicu

 

[USCDiver]

Hi guys. I'm a pre-med writing a short story about a 12 year old boy who has critical surgery on his leg. Can you tell me where exactly he'd be in the hospital when he is recovering post-op?
Thanks!

What critical surgery is he having on his leg? Is it a fracture that needed fixing? If so, he'll probably be in the pediatric floor post-op. Is it a necrotizing fasciitis (flesh eating bacteria) and he's septic (blood poisoning) after surgery? He may be in the PICU.

In general, pediatric patients do not have as many different options for placement in a hospital (aside from a large children's hospital with multiple pediatric subspecialty wards).

 

[USCDiver]

Sicu

A 12 year old in the SICU?

 

[Winged Scapula]

Depending on how ill he is, either PICU (Pediatric ICU), PIMCU (Pediatric Intermediate Care/Step Down Unit) or Peds floor.

 

[GeneralVeers]

If I was on service, he'd be discharged and on his way home. Gotta give the hospital and enema.

 

[EctopicFetus]

Hi guys. I'm a pre-med writing a short story about a 12 year old boy who has critical surgery on his leg. Can you tell me where exactly he'd be in the hospital when he is recovering post-op?
Thanks!

Actually everyone is wrong. He would be in the PACU.

 

[ditch doctor]

Actually everyone is wrong. He would be in the PACU.

Zing! Booyah! Who's buried in Grant's tomb? About how long was the 100 years war? A plane crashes on the border line of USA and Canada; in which country do you bury the survivors?

 

[EctopicFetus]

Zing! Booyah! Who's buried in Grant's tomb? About how long was the 100 years war? A plane crashes on the border line of USA and Canada; in which country do you bury the survivors?

1) Grant
2) 100
3) you dont bury survivors!

😆

 

[deleted109597]

I'm with Veers. He gets to go home after whatever surgery he has on his leg.

 

[BADMD]

I'm with Veers. He gets to go home after whatever surgery he has on his leg.

Depends. If it was a vascular procedure, ORIF, open fx, compartment release (I can come up with more), he'd definitely stay in the hospital at least a day or two.

 

[deleted109597]

Nah, just changes the dispo from home to home with home health, or possibly even rehab facility. Either way, we usually just obs most anything because we don't have the space, and the other facilities do.

 

[Ankaboot]

Hey Guys.
It's no trick question.

I needed a storyline with a 12 yr old boy to be in the hospital for about 2-3 weeks post a leg surgery ("critical" because he's kept that long in the hospital, right?).

If you can tell me under what conditions he would be kept in the hospital for at least two weeks, and where exactly would he be?

I'm asking you because I'm really not familiar with medical conditions and patient placement.

Thank you. I really appreciate this.👍

 

[BlackSails]

Try watching some episodes of House, and taking whatever ails some bone, and moving it to his leg.

Cadmium poisoning?

 

[BADMD]

Cadmium poisoning?

Only if he was shot with a cadmium bullet 😉

 

[docB]

He be boarding in the ED. This is America after all.

 

[Ankaboot]

I'll try asking the surgery section. Sorry to bother you guys. I want to be an EM physician, so that's why I asked you first. I have the notion that EM physicians know everything. heh

 

[Ankaboot]

Dear guys.
I'm a pre-med writing a short story about a 12 year old boy who has surgery on his leg.
I need for him to be able to stay in the hospital 2-3 weeks post operation, recovering.
Can you advise me under what conditions he would be kept in the hospital for at least two-three weeks (bone fracture? post op infection? etc), and where exactly would he be placed (what ward)?

Nothing too complicated, hopefully.

Thank you very much.

 

[ERMudPhud]

I'll try asking the surgery section. Sorry to bother you guys. I want to be an EM physician, so that's why I asked you first. I have the notion that EM physicians know everything. heh

The problem is that there isn't much in the way of isolated single extremity trauma that would keep a kid in the hospital for 2 weeks. Maybe full thickness burns to the entire leg would do it(Burn unit). Maybe a foot reattachment with compromised venous return requiring frequent leech therapy(PICU or some varient of SICU in a peds hospital). Otherwise most other extremity injuries should be home long before your 2 weeks is up. If you can give him extensive multisystem(brain, chest, abd, etc...) injuries thats more likely to keep in for an extended period. Even a bad fracture with surgical repair and subsequent post op infection would probably just go home with a picc line and home iv antibiotics. Thats American health care in the 21st century

 

[Apollyon]

The problem is that there isn't much in the way of isolated single extremity trauma that would keep a kid in the hospital for 2 weeks. Maybe full thickness burns to the entire leg would do it(Burn unit). Maybe a foot reattachment with compromised venous return requiring frequent leech therapy(PICU or some varient of SICU in a peds hospital). Otherwise most other extremity injuries should be home long before your 2 weeks is up. If you can give him extensive multisystem(brain, chest, abd, etc...) injuries thats more likely to keep in for an extended period. Even a bad fracture with surgical repair and subsequent post op infection would probably just go home with a picc line and home iv antibiotics. Thats American health care in the 21st century

Exactly. I mean, people go home 3 days after open heart surgery now.

 

[SLUser11]

Dear guys.
I'm a pre-med writing a short story about a 12 year old boy who has surgery on his leg.
I need for him to be able to stay in the hospital 2-3 weeks post operation, recovering.
Can you advise me under what conditions he would be kept in the hospital for at least two-three weeks (bone fracture? post op infection? etc), and where exactly would he be placed (what ward)?

Nothing too complicated, hopefully.

Thank you very much.

Maybe if his leg was an EVIL leg.....then maybe it would take 3 weeks to cure.

 

[Blade28]

What kind of surgery? What problem did he have with his leg?

Simple things like wound infection, pneumonia, or problems with physical/occupational therapy could delay his discharge.

 

[Flopotomist]

Hmm.. what about a social issue? I mean, kid's parents beat him so badly that he requires some kind of ortho surgery... then he gets a post-op infection, and social services says that there is no foster home that will take him. Might it not take a while to get him dispo'd now?

This is fun.

 

[SocialistMD]

You could give him bone cancer for which the oncologists felt he immediately needed chemotherapy after his surgery, despite the impairment it would have on his healing.
You could also give him a head injury for which he is intubated and in a coma.
You could make it an arm injury with a wrong-site procedure.
You could make it an abuse case where he is kept in the hospital for social reasons.

As far as the ward, anything requiring a 3 week admission would almost always end up (at some point) on the medical service with an ortho/GS consult.

God, being on call at a children's hospital gives you all sorts of nasty ideas.
By the way, SLUser11, I nearly spit out my water when I read EVIL leg.

 

[Sessamoid]

The problem is that there isn't much in the way of isolated single extremity trauma that would keep a kid in the hospital for 2 weeks. Maybe full thickness burns to the entire leg would do it(Burn unit). Maybe a foot reattachment with compromised venous return requiring frequent leech therapy(PICU or some varient of SICU in a peds hospital). Otherwise most other extremity injuries should be home long before your 2 weeks is up. If you can give him extensive multisystem(brain, chest, abd, etc...) injuries thats more likely to keep in for an extended period. Even a bad fracture with surgical repair and subsequent post op infection would probably just go home with a picc line and home iv antibiotics. Thats American health care in the 21st century

I remember keeping little kids in spica casts for femur fractures for a while on the floor.

 

[yaah]

Merged two identical threads in different forums, which is why this thread changed.

FYI.

 

[BlackSails]

Only if he was shot with a cadmium bullet 😉

He could be smoking weed laced with cadmium.

To the OP: You can make it a conspiracy! He feels fine, wants to leave, but his parents secretly hate him and are making a deal with the hospital to sell his organs.

Think Rosemary's Baby, but with a liver instead of the devil.

 

[ditch doctor]

He could be taken advantage of by a hot nurse, who is injecting him with something to keep him in the hospital for their love trysts. A sort of Munchausen by proxy for looooooove. We'd have to give this movie a good title though. Anyone?

 

[Winged Scapula]

As far as the ward, anything requiring a 3 week admission would almost always end up (at some point) on the medical service with an ortho/GS consult.

Not at my hospital. He would have sat on trauma until we could have pawned him off on Ortho....if and only if he didn't have some non-Ortho problem like didn't like red jello or coughed once on POD #3. If ortho wouldn't take him (common problem unless he was "interesting"), then he'd sit on the trauma service (presuming his injuries were trauma related) until rehab took him or he was discharged.

At any rate, we had a kid in house for that length of time. 13 yo boy, motocross accident, hit another racer head on, came into the trauma bay, open femoral fracture, left lower extremity ischemic with signs of a vascular injury. He had severed his superficial femoral art, long gap and injured the vein...we repaired with a panel graft (I was on Vascular, he was admitted to Peds Trauma). Large defect on thigh from femoral fracture...eventually repaired with muscle flap by PRS. POD #2 developed a clot, back to OR for thrombectomy. Anyway, stayed in house for several weeks, waited for toes to demarcate, lost a couple as I recall (I was off service by that time), eventually going to Rehab.

I'm trying to remember more, but what I remember most is that I stayed in the hospital for 3 days from his admission (yes, this WAS post-80 hr workweek suggestions) before the attendings sent me home.

 

[tri]

make him an illegal immigrant with no english skills or insurance and can't afford any rehab after getting a hemicorpectomy. that'll buy you 7-10 days. give him a wound infection on top of that and maybe it'll get ya 2 weeks before he kicks the bucket and his family sues you

now that's a great story to tell

 

[Ankaboot]

Not at my hospital. He would have sat on trauma until we could have pawned him off on Ortho....if and only if he didn't have some non-Ortho problem like didn't like red jello or coughed once on POD #3. If ortho wouldn't take him (common problem unless he was "interesting"), then he'd sit on the trauma service (presuming his injuries were trauma related) until rehab took him or he was discharged.

At any rate, we had a kid in house for that length of time. 13 yo boy, motocross accident, hit another racer head on, came into the trauma bay, open femoral fracture, left lower extremity ischemic with signs of a vascular injury. He had severed his superficial femoral art, long gap and injured the vein...we repaired with a panel graft (I was on Vascular, he was admitted to Peds Trauma). Large defect on thigh from femoral fracture...eventually repaired with muscle flap by PRS. POD #2 developed a clot, back to OR for thrombectomy. Anyway, stayed in house for several weeks, waited for toes to demarcate, lost a couple as I recall (I was off service by that time), eventually going to Rehab.

I'm trying to remember more, but what I remember most is that I stayed in the hospital for 3 days from his admission (yes, this WAS post-80 hr workweek suggestions) before the attendings sent me home.

This is great. Thank you all!

 

[Winged Scapula]

Our program would never duck taking a patient we operated on.

However, immediately after transfer we would look at the monitor and notice that his heart rate & BP seemed to change depending on where he was in the respiratory cycle, or if he was sleeping vs. awake. We would also ask him if he ever drank alcohol, and he would say only at church.

We would then transfer him to Internal Medicine primary with the diagnoses of "Autonomic Instability" and "r/o Delerium Tremens".

And the wise little grasshopper has learned at the knees of the Ortho Gods...

spoken like a true Orthopod!

 

[deleted109597]

We had a trauma patient hit quadruple platinum the other day.
Another reason to not like our immigration policies. If they get head injuries, you CANNOT place them. They have no payor, but they can't go home. For some reason we can't just let the GCS 3T people die off the vent either.

 

[deleted109597]

To the OP. An open fx with osteo would probably hang out for awhile, if he was a kid and they wanted to try and save the leg.
Other than that, I have seen the patient with the attending Dr. Cox and agree with her assessment. They wouldn't stay that long unless they were in a burn unit.