Point-and-cluck

The pager buzzed, and we were off to pick up a pre-adolescent “vomiting blood”. As usual, DTs and his rising-medic preceptee were bouncing ideas back and forth.

“Okay, gimme some reasons why a kid would be vomiting blood.”

“Ingestion of something?”

“Yep – could be. In which case we have to definitively ID the substance and contact poison control, right? What else?”

“Maybe the blood’s from someplace else?”

“Very possible – say from a posterior nosebleed, gets swallowed, irritates the stomach and gets chucked back up. History of nosebleeds, maybe something got jammed up in there depending on the kid’s age, or perhaps chemically irritated. Next?”

“Maybe the kid’s just been vomiting for a long time?”

“Also a possibility. Irritation of the esophagus or the cardiac sphincter. More of a vomit-with-blood-in-it rather than vomiting blood, though. Mallory-Weiss, but probably not esophageal varices, yes? Possibly brighter, redder blood.

“So: Loss of blood. We’re ready for anemia, right? We’re going to need to get O’s into the kid without him filling up a face mask with vomit. And possibly a low BP/high HR, depending on his volume? Let’s go ahead and convert the weight and pre-calculate fluid bolus amounts and drip rates…”

So we get there, and the kid is just fine – two rounds of vomiting, parents deny any frank blood. I’m slightly annoyed at our paging system, and contact our dispatchers when we’re done with the call.

“Say, did anyone there feel the need to embellish our call? To add, perhaps, some drama and tension to an otherwise unexciting situation?”

No – it turns out our paging software lists complaints in alphabetic order. “Vomiting Blood” was simply the next item in the drop-down list below “Vomiting”. Of all the calls we’ve been dispatched to, a misplaced click has happened maybe twice. A very rare occurrence, and it could have been worse – “Anemia” when they meant “Aneurism”, for instance.

But, really, we’re all EMS folk – shouldn’t it have been listed as “Hematemesis”?