A quick turnaround

I arrived for Thursday's night shift already exhausted from staying up late the night before and then not sleeping during the day. I'd been spending that time usefully, of course - completing my online job application form.

Halfway through the handover, my bleep crackled to life. I waited for it to say "good evening..." - when they say 'good evening' you can relax because it means it's the nightly test call. But instead, it deadpanned: "you have been fast bleeped to A&E". My registrar and I jumped to our feet and ran down the 4 flights of stairs and the long corridor connecting the Mess to the back door of Children's A&E.

In the resuscitation bay was *Brandon, a 2 year old boy, lying stiff and unresponsive with his eyes deviated to one side. The A&E nurse was giving him some oxygen with a facemask. His mother had driven him to hospital after waiting half an hour for an ambulance that had failed to turn up. He was either having a fit, or had just had one. For the moment, he was breathing on his own. He looked pale and was cold round the edges, but had a good heart rate. Someone had already inserted a cannula. His mother sat at the foot of the trolley, looking appropriately anxious.

She said they had been at a motor show, and she'd bought him a hot chocolate. He appeared to choke on it, started coughing and spluttering and then went all stiff. She called an ambulance immediately, but was told they were 'busy'. After 30 minutes, when they hadn't arrived and her son hadn't come round, she decided to take things into her own hands, piling her 6 year old and 2 year old in the back seat and driving as quickly as she could to our hospital, where the boy had been admitted only 2 weeks before with a febrile convulsion.

My registrar thought he might still be fitting, so gave him some lorazepam. Meanwhile I took over at the head of the trolley, anticipating that his breathing might become erratic once the drug kicked in. Meanwhile, the blood gas result came back, showing that he was retaining carbon dioxide. His muscles relaxed a little and he blinked. But at the same time, his breathing slowed, and then stopped. I bagged him, while one of the nurses crash called the anaesthetist. Unfortunately, because I don't usually get to do it, I'm not very good at bagging and ended up giving him quite a lot of air in the stomach as well as the lungs. Luckily he started to come round and fought off the mask. His saturations improved. Then he became sleepy again, though he remained pink.

We decided to get him in the CT scanner while he was subdued, to check for a mass lesion or bleeding in the brain. To cover the possibility of meningitis/encephalitis, he was to be started on ceftriaxone, erythromycin and acyclovir. The scan was normal, and so were the blood test results that had come back so far. The chest x-ray was clear. At this point I was called away to see another patient in A&E - a 1 year-old with bleeding gums. Overnight, Brandon went on to have a lumbar puncture, and then a fluid bolus because he hadn't produced any urine for several hours. He was admitted to the high dependency unit.

The next morning, he looked like a completely different child. When we came to his bed, he greeted us with a smile and excited baby chatter, which turned to frustration as he tried to pick up his toast, but failed because both his hands were in bandages - he had had a cannula inserted into each hand in A&E the night before. He looked so well that the consultant stopped the antibiotics and sent him home with an appointment for an outpatient EEG.