Foot laceration complications

The pain in Namine’s foot from her fall was so out of control that we ended going back to the ER.

Our recent visit to the ER saw us coming back home that very same night. The laceration was closed with stitches, but she didn’t receive anything for the pain, save for over-the-counter medication. The following day, this did little to help her manage the pain. We ended up calling the Complex Care line at Children’s Hospital to ask what they recommended; they prescribed a heavier medication which seemed to help Namine sleep that night.

The following day — two days after the initial ER visit — Namine’s pain was still more than she could bear, despite the heavier medication. There was also increased redness and swelling on her foot, leading Complex Care (after we put in another call to them) to recommend coming back in to the ER.

The previous time in the ER, we had arrived at about midday and were home by the evening. But this time, we didn’t arrive until after dinnertime. The ER was also already full by the time we arrived, so we waited for a room for quite some time as well. We did (of course) eventually get into a room.

Among the list of concerns was the possibility that there was a fracture in Namine’s foot, and it had just been missed the first time. (There is the very real scenario where the initial trauma can hide a fracture, while some time can allow it to be seen.) So they took Namine back for another set of X-rays, this time focusing solely on her foot. The answer was the same: there were no fractures in Namine’s foot.

Having ruled out a break, there were still two issues: the swelling and the uncontrolled pain. The doctors believed that Namine had an infection in her foot. They were confident it was cellulitis (skin infection), but it might be deeper still. Since even the heavy medication didn’t touch her pain, they wanted to put her on an IV pain medication. This led to the obvious conclusion: she would be admitted to the hospital.

The plan was primarily to keep Namine on IV medication — for the pain and to fight infection — and, if the need arose, to order up more imaging on her foot. Broken bones had been ruled out, so that meant no more X-rays, but the spread of redness and swelling in her foot could mean something else was brewing in there. One possibility was infection; another was fluid buildup. Consequently, an ultrasound was ordered. Its results were negative all around. The swelling was just that: swelling in response to the trauma of the fall and its resulting laceration.

In spite of the swelling “just” being swelling, that term is insufficient to describe how much pain Namine was still dealing with. Complicating matters, the IV line blew — meaning it had to be removed. The nurse tried to amend it, but to no avail. This led to Namine not receiving her medication — for pain or infection — for the better part of the day.

Namine did eventually get a new IV line placed, though later in the day than we would have liked. In the meantime, her pain remained pretty steady, though you wouldn’t have known it by looking at her. (Ever since she was little, she has always had an incredibly high pain threshold.) Once she got the new IV line and the medication resumed, the pain seemed to lessen for her. The swelling and redness in her foot never seemed to decrease, however — perhaps even increased. It was obvious we were not going home yet.

Apropos of nothing: on one of my walks to the cafeteria, I saw TUG, the robotic train that delivers supplies.

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