The other day, I saw saw a five-year-old boy
who was transferred to the emergency department with the diagnosis of an incarcerated hernia. They had presented to a peripheral hospital and already received a
comprehensive ultrasound with radiology which confirmed the diagnosis.
Unfortunately it was a particularly busy day in our emergency department and the
child was not in a room until about five or six hours when I saw them.
Because it had been out for so long I was quite concerned and I brought in with me
intranasal midazolam, intranasal fentanyl in anticipation that I would quickly
sedate the child and try to reduce the hernia but when I went into the room and
before I gave the medications, I had a quick look at the site and it really didn’t
appear to be incarcerated hernia at least compared to previous patients I had seen
with the same diagnosis. So I brought the ultrasound machine in and had a quick
look and what I saw were large lymph nodes in fact. No abscess was
found but they were quite inflamed and what I also noted on the skin were several old scab
lesions and they were all over the body and when I spoke to Mom I found out the
child actually just gotten over a bout of chicken pox and had been scratching furiously and if you actually look through the whole clinical picture the area was quite tender, it was slightly red, it was swollen and he barely tolerated the
ultrasound itself. I guess the take home here is that you should always look with
the ultrasound before you perform any procedure whether it’s the reduction of an incarcerated hernia or IND of an abscess especially when you didn’t make the diagnosis yourself
previously and this can save you a lots of hassle and discomfort, or unnecessary
stations for your patient.