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2 year old vs 6 month old


Will_Son

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I ran across this question while preparing for my interview and wasn't really sure how to answer the question other than first come, first served. If they both arrived at the same time, I'm thinking maybe the 2 year old because there might be a better chance of survival? They were also promised a bed first. Not sure, though.

 

Any comments? Thanks in advance. :)

 

You are an emergency doctor. You receive a call from an ambulance indicating that there is a 2-year-old child on the way in critical condition. You hang up the phone. Thirty seconds later, you receive another call from a different ambulance telling you that there is a 6-month-old child on the way, who is also in critical condition. There is only one free bed in the ER. You are unable to get another bed. What would you do? Which child would you admit?

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I ran across this question while preparing for my interview and wasn't really sure how to answer the question other than first come, first served. If they both arrived at the same time, I'm thinking maybe the 2 year old because there might be a better chance of survival? They were also promised a bed first. Not sure, though.

 

Any comments? Thanks in advance. :)

 

They're both small. Put 'em in one bed.

 

;)

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I actually said the same thing. Like.. how hard can it be to find somewhere to put a 6 month old. They're tiny. :)

 

Is there any significant difference between a two year old and a 6 month old that would influence your decision? It's hard for me to come up with one.

 

they can both be critical, but maybe one is in 'critical stable condition' ...therefore, maybe one needs a bed URGENTLY while another can be okay in teh ambulance, they can go to another hospital.

 

maybe one doesn't need a bed? i dont know..

 

is this a terminal condition? acute? maybe teh 2 year old has had leukemia over some time...maybe the 6 month old was drowning in the bath tub! therefore, the prognosis for the terminal patient may not be as good, and i'd be more inclined to help the patient who is more likely to have a better quality of life post-treatment.

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Patients are not normally triaged by age but by severity of illness. These scenarios seem a little ridiculous to me, especially at a premed level. How are you supposed to know who is "sickest" and needs to be seen first?

"I would tell the triage nurse to make that decision."

 

**** move, but that's probably what you'd actually be doing anyway.

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A friend just had a similar question in an interview. She asked the interviewer which patient needed the liver/heart/kidney(?) more/who was in more critical condition. They told her which. so that's the one she picked. Remember, you can always ask questions.

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  • 2 weeks later...

I would compare the severity of the condition of each baby. If there is a significant difference, I would have the baby in a less critical condition taken to another hospital and wait for the more critical one. If there is no significant difference, I would admit the one that arrives first!

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So when I see a choice and limited resources, i think back to basic economics class.

Now a 30 year old may be older, and that 2 month old may PROBABLY have more time to live, but what if that 30 yar old is a father of many? what if the father's death will cause more grief than that of the 2 month old? How would you decide?

I doubt that there is a right answer, and from what ive been told interviewers dont look for the right answer, but rather look at your thought process and HOW you came up with ur answer.

Jotch i like ur anwer btw, too bad im not ur interviewer :(

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Agree - this is a stupid scenario!!! Usually wouldn't be an ER doc making these decisions - it would be a specialist on call for a particular service.

 

In real life, there are bed coordinators who help out with this sort of thing - usually they are apprised of the bed situation in the entire province/district... so they know that even if beds aren't available at your hospital, they might be at a different hospital close by.

 

If one of the kids has a condition that REQUIRES the services of your hospital (ie. maybe you're the only hospital that has peds neurosurg or peds cardio), well, you'd preferentially take that kid if the other one could receive equal treatment somewhere else. Also, maybe you could provide advice over the phone that would temporize matters and stabilize one/both kids until a bed could be found somewhere.

 

Unfortunately with bed/staff shortages, I deal with this crap every time I am on call... get called about a post cardiac arrest patient AND an aortic dissection AND an acute MI who has failed thrombolytics. CCU nurses say, "CCU is full!!!" Get on the phone with bed coordinator... some of the patients who are currently iin our CCU might get transferred to another hospital in the city to make room for one of the new acute ones..A ward patient might get transferred elsewhere to make room for a less sick patient who is occupying a CCU bed... ICU might agree to take one of those patients... Worst case scenario, one of the patients goes somewhere else (Regina, Edmonton, Winnipeg).

 

it's an unfair question to ask someone who has never actually worked in the medical system, and I think all they are looking for is a well-thought out answer.

 

Or... could just suggest bunk beds :D

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  • 2 weeks later...

Hey,

 

Meh, just kick out the drug-seekers. They're the ones that keep saying that they accidentally knocked their open pill bottle into the sink and all of their Percocets went down the drain (and are also allergic to Tylenol, Ibuprofen and Codeine). They're going to go to the next ER after you tell them that you're not giving them narcs anyway, so you'd just be saving them some time and trouble! :D

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  • 6 months later...

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