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Not All Fun & Games: Read Suraj's Story
One wrong turn changes child’s play into a trip to the emergency department
“A lung puncture causes air to fill the cavity surrounding the lung. Left untreated, this can be very dangerous.”
Date: 11/21/2012

When you meet eight-year-old Suraj Bhardwaj and his sister Shalu, it’s obvious from the start the two have a dynamic built of mutual encouragement, competitive spirit and a good helping of fun. But on one quiet afternoon, that fun quickly turned into a scary situation for the pair.

An Injury Beneath the Surface
Taking opposite paths while riding bicycles around the neighborhood, Suraj and Shalu were heading straight toward each other. In a moment, the two chose the same direction to swerve, causing a head-on crash. Suraj was thrown over his bike, with the handlebars pressing into his chest. It was immediately apparent something was wrong.

“I felt weird in my stomach and it was hard to breathe,” Suraj recalls.

Their mother, was in the family’s home in Princeton when Suraj came in hunched over in pain. “I couldn’t see any injury, but it was obvious he was unable to stand up all the way,” Suman Bhardwaj explains. “So I knew I needed to get him to the emergency room.”

When Suraj arrived at the hospital, his emergency care team went to work to determine the extent of his injury.

“Suraj had sustained a broken rib, which punctured his lung. A lung puncture can cause air to fill the space surrounding the lung, as was the case for Suraj” explains Michael Omoh, MD.

“As more air fills the pleural cavity (space around lung), it causes the lung to collapse completely and can cause air pressure to build on surrounding organs, like the heart. Left untreated, this can be very dangerous.”

Once the cause of his pain was clear, the emergency physician called the thoracic surgeon on-call to place a chest tube in Suraj to release the trapped air in his chest. The chest tube provided relief for Suraj and he was stabilized, but required further care in a children’s hospital.

Specialized Care for Children
As part of the Robert Wood Johnson Health System, RWJ Hamilton physicians interact daily with colleagues at the system’s children’s hospital. This provides its youngest patients a seamless transfer of care to Bristol-Myers Squibb Children’s Hospital at RWJUH, one of the country’s top hospital’s for pediatric care.

“It’s easy to think of a child as a small adult, but their anatomy is unique, as are their needs. It’s essential to have individuals trained in pediatric medicine providing care,” explains Dr. Omoh. “So for patients like Suraj, we contact the pediatric transport team in New Brunswick to ensure the best care.”

When the transport team arrived to pick up Suraj, his parents had a full understanding of their son’s condition and what to expect. Dr. Omoh and the care team communicated with the attending physician in the pediatric intensive care unit to ensure they had a clear picture of Suraj’s situation.

“Sometimes when parents find out about the transfer, it can cause increased anxiety. They may think the condition is more serious. But it’s typically about getting the most appropriate care for the child,” says Sonnie Kekulah, MSN, CPNP-PC, pediatric critical care transport team advanced practice nurse at the children’s hospital.

Comfort in Communication
Although Rajesh, his father, was hesitant to transfer Suraj at first, he was comforted by the communication that took place between the two hospitals, and with him and Suman.

“Communication is the key to a smooth transfer,” says Kekulah. “Both hospitals try to provide anticipatory guidance for the parents. We let them
know on both ends of the transfer what’s going on, what to expect and the reason for transport. It helps to put them at ease during a stressful time.”

And that communication continues after the child arrives at the Children’s Hospital. “Part of the transport team’s job is to follow up within 24 to 48 hours to communicate the child’s disposition and treatment plan. We usually call and speak to the referring physician within that time frame to keep them informed,” Kekulah explains.

Suraj spent four days recovering from the accident. When he arrived home, he was told to take it easy for a while to heal — a tough prescription for a child as active as Suraj.

These days, Suraj says he is “back to 100 percent,” as is his activity calendar. Suraj has gotten back on a bicycle, plus he plays soccer and attends tae kwon do classes five days a week.

“I really like tae kwon do,” says Suraj. And it’s no surprise that Suraj especially enjoys practicing his moves on his sister.

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