I got paged in around 23:00 the other night to reduce a kid's pinky finger. I would have been less annoyed, except it was the second time in a week that I've gotten paged in around 23:00 to reduce a kid's pinky finger. It's times like this I really wish the ER knew how to do stuff like reduce fingers. (they tried once earlier this year and then I got paged to redo it when they messed it up. So I guess they're scared of trying and honestly, redoing their crappy work was harder than if I had done it myself in the first place so I probably shouldn't complain, but seriously guys, it's a freaking pinky.)
Me: So when did this happen?
Mother: Around 19:00. So we went to (outside hospital) and they told us to come right here.
Mother: Well, first we went home and [patient] took a shower and then she had dinner and then we came over here.
One could make the argument that if you feel like showering and eating dinner, you probably don't have an emergency going on, you could also make the argument that doing a reduction sometimes requires sedation and if you've just eaten it makes it that much harder to do that. But I was telling this story to my sister and she brought up the time that she fell off her bike and needed stitches in her chin and mom convinced her to shower first under the pretense that she would feel better. She claimed that she did not, in fact, feel better, but this is the same sister who continued ice skating after she broke her elbow and continued skiing after she separated her shoulder. And the same mother who told me I was too old to have an earache (I was 13 or so), at which point my eardrums ruptured and leaked pus into my hair for the next week and I wound up on 2 courses of antibiotics.
Anyway, reducing kids' fingers is annoying. I'm a big fan of sedation for pediatric reductions. One of my coresidents never does it and things seem to go fine for him, but i'm of the opinion that you can only get away with that if you're convinced you can get it on the first try. And I'm not. So usually I sedate kids because it's a lot easier for me to do a reduction if they're relaxed, I can do it as many times as I need to to get it perfect, and I think the parents probably prefer not hearing screaming followed by the crack of a bone. (and sometimes it really does make a loud crack.) but if it's just a finger, it's kind of overkill to sedate the kid and the risks outweigh the benefits, so the ER won't do it for you. But you don't really have great options. I could do a hematoma block, but that involves sticking a needle in the sore area and injecting numbing medication, which burns. I could do a wrist block, but that's three needle sticks and burning. I could just do nothing, but then parents get mad. If it was my finger, I'd probably go for nothing since that numbing medication stuff seems to burn like hell and it's over quick anyway, (and I am sure my parents would be fine with that since over the course of my childhood I remember getting tylenol once and it was because I had a fever of 104 so really, mom and dad were not quick with the analgesics here) but not everyone's parents are so OK with hearing their kid yell.
So I gave the kid (and her mother) the option of hematoma block or nothing, they picked the hematoma block, and the kid screamed like hell while I did it and for a good few minutes after. This was after the 20 minutes of crying leading up to the hematoma block once i explained what it was. So once we did the stupid hematoma block we actually did the reduction (seriously, I pulled on the finger and got it straight. I would say this took under 10 seconds at a conservative estimate. We could have done this a couple hundred times in the time it took the kid to calm down from the stupid hematoma block)
At least the kid was super cute. She was actually the second super-cute girl under age 10 with a pinky fracture who I've seen in the past week, so either kids are getting cuter these days, pinky fractures only happen to cute kids, or I'm starting to get mushy in my old age.