Monday, July 21, 2014

Proximal humerus fracture - part 2

So part 1 ended with us in the waiting area of the ER, slightly dazed and confused. By that point BR had found a reasonably comfortable position in the wheelchair, and she looked more shocked than in pain. A nurse came out to triage us, she poked and prodded BR's arm, concluding that she didn't feel anything broken under the temporary splint. She was also surprised that BR wasn't screaming or yelling and seemed to be too quiet for someone severely injured. Unfortunately when she got to the elbow and started moving it around, BR cried out and started complaining about sharp pain (in the elbow). We didn't realize it at the time, but the nurse simply put in BR's file that her injury was to the elbow - despite the fact that I kept telling her how scarily angled her upper arm looked before it got wrapped up. She also told us to hold off on getting an x-ray until we've been seen by the doctor, to make sure the proper part of the arm gets checked.
Once the nurse left, the elbow pain only got worse. BR was whimpering and complaining about the constant pain, unable to get comfortable and just totally miserable. By that point we'd been at the hospital for a few hours, so we asked for some more pain relief, and she received a dose of acetaminophen. Didn't seem to help at all. 

Seeing her in so much pain and not seeing any progress in our situation, we decided to ask to have the x-ray done as soon as possible, so that we'd have it in hand when the doctor saw us. We got sent to the imaging department pretty much immediately, and the wait there was very short. It was quite nice to be out of the waiting room and feeling like something was finally happening.
The x-ray tech was not happy about BR being protective of her arm. She needed the elbow positioned just right on the table, and was quite curt telling her not to tense up, and that we wouldn't get any useful images if she didn't cooperate right-this-moment. BR was in fact not cooperating, she was quite scared and in pain and did not want to move her arm at all. Luckily for all of us, another technician came in, clearly experienced and with excellent kid bedside manners. She got BR positioned properly and they took the pictures.
At that point, it was back to the waiting room for us. Luckily the positioning of the arm for the x-ray seemed to help with the elbow pain, and BR was back to her calmer self. We managed to take her to the bathroom, and she was in much better spirits.

We were seen by the resident and doctor very quickly afterwards. The elbow x-rays showed nothing, so they got her arm fully unwrapped and the splint removed, at which point the odd angle was quite plainly visible. Unfortunately that part of the arm was not visible in the picture, so we were sent back to the imaging department for more x-rays, this time of the shoulder.
The x-ray techs were not very happy to see us returning. After the giant kerfuffle of our earlier visit, it was quite understandable. Luckily, the shoulder x-ray is a much easier procedure, no positioning required, everything is done just standing in front of a screen.

For some unknown reason, I looked directly at the tech's face the moment she took the picture (this was the same tech who was giving BR such a hard time for being uncooperative earlier). When she saw the picture, her jaw dropped and she had a quick moment of shock. She quickly regained composure, likely realizing I was looking at her. This is when I knew we had a bad break on our hands.
This time, when we came back to the waiting room, we weren't seen right away. In fact, we ended up waiting to be seen for a few more hours. By 8:30, BR was super tired and falling asleep from exhaustion. The wheelchair did not recline, so I had to support her head for it not to topple over. I got a lot of sympathetic looks from the other parents in the room. Neither BR nor I had eaten anything since lunch, and it was getting quite late at this point, but she wasn't allowed to eat or drink "just in case", and I couldn't even think about eating. We just wanted to see the doctor and find out what showed up in the x-ray.
Finally, almost 6 hours after arriving to the ER, we got called back to see the doctor. She was very nice to us, and she was apologetic for the long wait. She told us we had to take a look at the x-ray ourselves. I am glad we got a chance to take a look, but it was definitely not a pleasant experience. I don't have a copy of the image itself, but here's an image that should give you a basic idea of what it looked like:
She fashioned a simple "collar and cuff" sling for BR's arm and sent us on our way. Shell-shocked and bleary-eyed, we headed home.

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