12 February 2020

What's the ICD-10 code for fall from mango tree? I guess it would have to be W14.XXXA. Fall from tree, initial encounter. But the lack of a specific code to blame the fall on a mango tree only reflects the lack of mango trees in the U.S.

This poor kid managed to land in all sorts of wrong ways in his fall from a mango tree. Both surgeons were occupied in both "operating rooms," including "salle B," which is our improvised operating room, ideally used only for smaller cases. It was currently occupied with a hernia repair. The family carried the mango tree's victim into the hospital and into our pre-op area. He had apparently bled profusely along the way. The dad's shirt was covered with blood. But now everything seemed to have calmed down. Dried blood under the nose, no active bleeding. Gaping tongue laceration, but also not bleeding now. A tiny 0.5 cm laceration in the forehead, trickling a trail of now-mostly-dried blood. Hemoglobin 12. No signs of skull fracture. No abnormal movement or crunching on palpating the bones in the face. Just some soft tissue swelling on the right side of the head and face. For other orthopedic injuries--deformation of the right wrist. I handed the patient's father a prescription for an x-ray. We could get that done while waiting for a room to open up to fix the tongue laceration.

I was not eager to repair a tongue laceration without ketamine, the "baby shark" incident still fresh in my mind (for that story see "Chomped"). On the other hand, the boy seemed really concussed, and in the first few hours after head injury we would rather avoid sedation. Danae tried reasoning and negotiating and convincing the 7-year old to acquiesce to having a syringe advanced toward his open mouth, the needle safely hidden out of sight. She dabbed his tongue with the blunt tip of the syringe. See? Not so bad? Then she stealthily slipped the needle onto the tip to finally inject the lidocaine. But he caught sight of the needle. Negotiating and discussing resumed, but with a much less reasonable patient. Finally, with many hands holding him down and many tears, the tongue was anesthetized with local anesthetic, and she was able to put a few sutures in his tongue laceration.

Now for the arm. A Colles fracture, Olen predicted. We confirmed on x-ray. We tried once to reduce the fracture but couldn't quite get the distal end of the radius far enough reduced to stay in place. Olen talked me through a hematoma block. To the trepidation of the fatigued patient, I advanced a needle into the fracture site, aspirated a little blood from the fracture, and injected lidocaine into the fragment. Soon the boy was moving his wrist in all directions, studying the injured joint as if wondering where the pain had gone. Now we could pull on it with all of our force to reduce it. We repeated the x-ray and noted improvement, then took him back to the OR pre-op area to place the cast.

PSA: Never trust a mango tree.