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Teaching3bears

Dr. Hive: smashed hand UPDATE

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We think my son with special needs might have swallowed a pencil last night.  It would probably be a short colored pencil.  Anyways, he was screaming and frantic all night long and his self-injurious behaviour returned and we had a rough morning too though he is better or else exhausted right now but the top of his hand is red and a bit swollen but not deformed and his knuckle makes a noise or  feels like it makes a noise when I move it.  There is a big chance that he fractured his knuckle in some way.  The only option I see is to bring him to the ER but what can they do really?  If they gave him a cast he would hit himself harder with a cast and I can't imagine him sleeping or living with a cast.  He has severe sensory issues and they absolutely rule his life.  He would try to take it off in any way he could.  He has never even allowed a bandaid.  

He is an adult now so he could not go to a children's hospital.  This time of year the ER is full of people with flu (and maybe coronavirus) and the wait times can be 3-7 hours.  We don't need more problems.  We have enough.  I don't even think they can do anything and I am feeling exhausted over last night.  Will the red go away on its own?   Will it heal itself because he is young. I am scared he will hit his hand again.  

I am feeling overwhelmed.  He has been doing a bit better these days but not with swallowing stuff and then it hurts him.  I feel so scared and sad and worried.

Edited by Teaching3bears
update
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Call his primary care doctor and work out a plan.

Swallowing a pencil is not something you wait out.

We have done things in the past like get X-rays at the primary doctor or at an orthopedist’s to avoid the ER.

 

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And, gently, with Level 3 autism (or whatever his issues are, as you haven’t named them, only the severity of them), I think you would benefit from having a more proactive management plan. 

Like, WHEN xyz happens, then we will abc. I, for example, would have no problems giving Ativan to a kid who is self-injurious while we sort out why the child may be acting that way.

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If you have to go to the ER, then have the primary dr call ahead and put you in queue. We have often waited in a vehicle with our medically fragile kids and gone straight into triage or been admitted straight up to floor.  

I cannot emphasize enough the importance of having close contact with the primary care doctor. Like, should be on your BFF list forever.

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Due to his issues, some children’s hospitals will take a special needs up to age 26 ( found this out a couple of weeks ago).  Perhaps, you might call and ask.

He needs an X-ray for the pencil. Call his primary and get him in for an appointment or a script for an X-ray if they don’t need to see him.  

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I would  be more worried about the pencil than the finger at this point.  That could cause severe internal damage, if it hasn't already.  Contact PCP or drive to the ER and get him seen. The broken finger is distressing, but aside from deformity, it shouldn't kill him.  A pencil on the other hand could get lodged or perforate his intestines....This could end in a traumatic, horrible situation. I assume it was tiny, like a mini pencil? Did it have a metal ferrule on it? Depending on the metal, that itself could cause trouble. 

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I am not sure he swallowed a pencil.  I am more concerned about his hand.  The paediatrician is not there.  If I call tomorrow they will tell me to go to the hospital if I am concerned.   

You are right.  I need a medical emergency plan and more support.

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Our children's hospital takes young people with ASD much longer. You could at least call them and talk with a nurse. And frankly, you should because GOING IN is the way to get help. Your county board of disabilities needs to see that he's in DANGER and is having this level of situations so they'll actually step in and bring in funding and do something. Is there a reason you're not taking him in?

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He has gotten very upset in the past and then we found things he had swallowed like rocks, sticks, marbles.  

The other day, we had someone care for him and she left a bunch of color pencils everywhere.  We cleaned up, even under the couches but what if we missed one.  I don't think he could swallow a pencil unless it was short.

Our children's hospital will not accept kids 18+ at all.

 

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Gently, the pencil could lead to perforated bowels, sepsis, and death.

A broken joint could lead to a malformed joint with a loss of range of motion.

Very different risks and outcomes.

Look for an urgent care with X-ray capabilities, if you don’t want to go the ER route. It takes some doing but is possible.

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I really don't know if he swallowed anything.  I am just guessing.  DH doesn't want to go to the hospital.  We will have to bring the whole family to a germ-infested place and wait for hours and him and my other DS touch everything.  

I am worried about his hand.

 

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2 minutes ago, Teaching3bears said:

He has gotten very upset in the past and then we found things he had swallowed like rocks, sticks, marbles.  

The other day, we had someone care for him and she left a bunch of color pencils everywhere.  We cleaned up, even under the couches but what if we missed one.  I don't think he could swallow a pencil unless it was short.

Our children's hospital will not accept kids 18+ at all.

 

Oh dear. Can you try a different city? And have you talked with your county board of developmental disabilities? 

Yes, one of the things our behaviorist said was to train ds on the idea that when he's not calm and he's handed a medication he takes it. And that sounds horrible, but it's a safety thing. With my ds, I haven't used many prescriptions yet. We've used chamomile (tinctures and capsules), niacin, and prescription hydroxyzine. Ativan, some scrip that you can give in emergencies, sounds like a tool you need. Just out of curiousity, was he always at this level or has the issue increased? My ds is 11 and everyone is telling us it will ramp up, sigh. I've seen parents locally saying 14+ was even worse, so I can see how things would be working and then not. Sigh.

I think the main thing is to keep reaching out for help. County level, another children's hospital, a state org, your senator or state rep. 

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Just now, Teaching3bears said:

DH doesn't want to go to the hospital.  We will have to bring the whole family

This is absurd. You go with your ds.

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Or you are unable to go? Someone has to take him. Obviously the whole family isn't going. If Urgent Care is open, take him to an UC.

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1 minute ago, Teaching3bears said:

What will they do for his hand?

I'm going to say this again. Unless you go in and GET THIS ON RECORD, the county cannot help you. You have to have paper trail showing the lack of funding by the county and lack of supports is resulting in danger and harm to him. You cannot hide this and get help. It doesn't matter what they actually find but that you're getting it documented that this happens at this level of danger.

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I would also be additionally concerned that failure to get medical attention for something like a possible fracture could lead to CPS issues (how old is he? I'm don't remember the equivalent agency for people with disabilities who are no longer minors--I assume due to his disability, you could be held responsible for neglecting to get proper care). If you have no real reason to suspect he swallowed a pencil other than there having been pencils around and him having swallowed thing in the past, I'm not sure that's sufficient reason to take him in for that issue. Can you call the babysitter and have her check if she has all her pencils?

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I'm not entirely following all of this. For his hand, there are things they can do that will help with the pain and such whether it's broken or not. Well, and they can determine yes it's broken, or no it's not. My husband injured his thumb a while back, and while it required MRIs and XRays and all kinds of things they were able to give him a steroid shot to reduce the inflammation in the joint. There's a possibility that your son's knuckle is not broken, but just inflamed or something, and a shot or similar may help. 

I understand your thoughts on "he won't take a cast anyway" but I'd get it checked just in case there are other options. If nothing else, they would have the ability to give prescriptions for stronger pain medications that may help calm him and if he's calmed/less agitated (due to the pain being reduced) he would less likely further harm himself. 

I'm not clear on why you think he maybe swallowed a pencil, but then are back-pedaling on that so much....if you feel there's *any* possibility at all, I think I'd get that checked for sure, just in case. Unless you are suddenly very confident he did not swallow a pencil, for sure I'd get that checked just in case. 

Any risk to your family of "maybe" getting sick from being in the ER (why can't one of you take your DS and the other stay with the rest of the kids??) is minor compared to the definite risks if your son did swallow a pencil, and I'd say maybe roughly equal in weight to the benefits to your son if the ER is able to calm the pain in his hand (and possibly offer a healing option as well). Given that......I'd err on the side of seeking help for your son, at the risk of potential flu for whoever goes with him. 

I hope you're able to work out something for the future, too, so this doesn't become such a production next time. 

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1 hour ago, Teaching3bears said:

I am not sure he swallowed a pencil.  I am more concerned about his hand.  The paediatrician is not there.  If I call tomorrow they will tell me to go to the hospital if I am concerned.   

You are right.  I need a medical emergency plan and more support.

 

I know nothing about special needs kids but I did notice you said in that first post that you are overwhelmed.  I think I remember you saying in another thread you were not getting much sleep either.  So you are going to struggle through this. You are scared.  It's okay.  Just take the next step. 

When you say the pediatrician is not there, did you try the emergency line? Because this is an emergency if he swallowed the pencil. At this point, you need to just assume the worst and hope for the best. It is a possibility that he swallowed a pencil. You need to investigate that. I would call the emergency line of your pediatrician, have them call the ER of the local hospital and let them know you are coming in, and then line up your sitter for any children you don't want exposed at the ER and go to the ER.   If the pediatrician does not have an emergency line, do everything else but call him/her.  However, if that is the case, make a note that tomorrow you start looking for a pediatrician you can reach after hours for emergencies.

Praying that you can just do the next thing.  Write down your steps. Do them one at a time. Just keep doing things until you are done.  You are overwhelmed but you can do this.  You need to do this.  We are cheering you on.

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I agree you need a major plan.

When my daughter tripped and fell and hurt her head on the edge of the kitchen cabinets I grabbed a clean rag, pressed it to her head and in the same fluid motion reached into the med cabinet, got out 2 Ativan and popped them into her.   I knew we would need that medication support for whatever was coming.  I rarely (like 2-3 pills a year) use it but when it is needed, it is needed.

By the time we got to ER for stitches (as urgent care wouldn't use versed and I knew we needed that) the Ativan was well on board and that along with the versed got us through stitches......along with getting a different ER doc to do them and numbing it super well.

Please at least call your doctor but I really think a trip to ER is in order.

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2 hours ago, Teaching3bears said:

Oh, and the pencil is still in him.

 

If he possibly has a pencil inside him he needs to go to get medical care for that.  

If no UC then ER.

If it is too much for you, an ambulance would presumably have restraints or calming medicines that might be needed.  

A broken finger might not heal perfectly, but it isn’t the same level of urgency as a swallowed pencil.  

I hope you all get good help!!!

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So there is no reason for you suspect he swallowed a pencil? Or there is? Other than he had a chance? There are a myriad of things he could swallow every day, what makes you think he swallowed a pencil...enough that you thought to post about it?  I am guessing there is something that makes you suspect it?????

If it was just that he was acting off....was it because his hand hurt? Have you given him pain meds to see if it helps?

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5 hours ago, Teaching3bears said:

There are no urgent cares near me right now.  

What will they do for his hand?

Pain medication for starters.

And a fiberglass cast isn't going to break if he hits it on something. And they can prescribe a sedative if need be while he gets used to it. 

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9 minutes ago, Ktgrok said:

Pain medication for starters.

And a fiberglass cast isn't going to break if he hits it on something. And they can prescribe a sedative if need be while he gets used to it. 

 

I think maybe op is afraid he will hit himself in head with cast, or something like that. Or be destructive in trying to get it off.  

 

But I would still put number 1 concern to swallowed object.  Marbles or smooth rock has better chance of passing through GI system than a pencil does.  Even a small pencil.

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I might be remembering wrong but I thought that despite his severe special needs that this son is verbal?  Do I have that correct?  Have you asked him if he swallowed the pencil? 

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I am praying for you and my heart goes out to you.

If there is a risk he swallowed something, please take him in.  Please.  Even if you cannot go yourself and have to release him to the care of paramedics in an ambulance.  As traumatizing as that would be for everyone, it is not life-threatening like a punctured intestine.   The sooner you know for sure about the pencil, the easier it may be to remove it if necessary.  

No one on this message board can give you specific medical advice about his hand or the pros or cons of possible treatment.  Get a medical opinion, then you can either accept or deny that treatment if you think more harm than good could come of it.  

 

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13 hours ago, Jean in Newcastle said:

I might be remembering wrong but I thought that despite his severe special needs that this son is verbal?  Do I have that correct?  Have you asked him if he swallowed the pencil? 

 

I may also be remembering wrong, but think both op’s older sons are nonverbal  (it has been confused because of their reading list seeming advanced, but it has seemed they can not communicate or answer questions when this was asked in past threads iirc). 

As much as the situation is about current immediate pencil and hand crisis, I expect there’s also a huge parental emotional crisis in terms of the bigger picture of the problem of caring for the two young men with severe special needs.  

I hope that OP will have emotional and other support beyond this immediate hand and pencil situation. 🙏 

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1 hour ago, Monica_in_Switzerland said:

OP, I hope you can give us an update!  How is your ds doing?  

 

 

@Teaching3bears And also, how are You doing? 

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On 2/17/2020 at 4:20 PM, Teaching3bears said:

 Our children's hospital will not accept kids 18+ at all.

Have you verified this for sure? Because our children's hospital says 'up to 18' on their website and stuff, but they actually will take older patients in various circumstances. Just make sure you are not taking the website or something one employee told you as gospel; dig in and talk to more people and make sure (because that would really help you out!). 

I hope all is well. 

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huge hugs teaching3bears

 I really feel for you 

wish there was something I could do to help.

 

I would be more concerned about the pencil as well.

 

 

Edited by Melissa in Australia
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Thanks everyone!  He is very calm now but so tired.  He spent 2 nights awake and now he looks so tired.  We got his hand looked at and there was nothing on the x-ray (I'm so thankful) and the bruising has gone down.  It was bad.  I was paranoid about getting sick from the other people in the waiting room.  The whole x-ray process took a long time but it gave me peace of mind.  There is so much going on right now with my other son in a bad mood, DH with medical stuff coming up and lots of appointments, my youngest with lots of activities to organize and homework that he needs help with and then just the regular cooking, cleaning and homeschooling that really takes up all the time.  I feel like I need to catch up on the lost sleep from the other nights myself.

I love the idea of a plan.  I contacted someone and made an appointment to talk about that and spent about 4 hours on the phone today calling about services.  I still have more calls to make and a bunch of forms to fill out.

The whole pencil thing is a non-issue now.  I don't think it ever happened and we were confused.  I'm sorry to have worried everyone.  Anyways, from now on there will be only crayons in his presence.  They are more edible.

I really hope my oldest gets his mojo back.  He is so tired-looking right now.

 

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3 hours ago, Teaching3bears said:

I was paranoid about getting sick from the other people in the waiting room.

I'm very glad you were able to get care and that you're getting connected with local resources! I'll make a suggestion here. You might look for a GP, a family practice doctor, to switch him to. We have a GP we use who is family practice in an office where all the docs are family practice. In the one place they can do xrays, bloodwork, everything. So if you could find a family practice doctor in a practice large enough to have these resources but close enough that they weren't a pain, they might help you stay out of the emergency room. And you'd get continuity of care for your ds as he's aging. And the practice we use is large enough that they have Saturday hours too. 

Anyways, just another thing to add to your list of consideration. I know some people are like no, I want an autism specific doctor, and fine. But me, I just wanted someone to help me keep my ds well, deal with injuries, give referrals. And a sharp family doc can do that if he/she is someone who listens well. 

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