Abuse cases in the ED. How....?

  1. I'm new to the ED, have been working the floor for a little less than a month, still in orientation. I do have prior nursing exp, 3yrs on an acute cardiac medsurg floor, different hospital.
    Anyway, this morning, last case of the day for me, was a 2.5yr old darlin little girl that weighed 8kg. No other obvious signs of abuse, just [EVIL]gross neglect.[/EVIL] HOW do you deal with it? I was having the hardest time not punching mom's lights out. I'm still angry about it. Yes, CPS was contacted, and the child was sent out to a Children's Center.
    I knew that these cases would be the roughest for me to handle, but I need some help on how to deal with this. Any advice would be appreciated. Thanks
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  2. 20 Comments

  3. by   jill48
    You are stronger than I could ever be. I don't think I would be able to control myself. And that is a bad thing for me. I couldn't do it. Somehow you made it through today. Maybe you have the ability to think ahead of a situation and realize that you could do more good for that child by keeping a cool head. I was born without that gene. I don't think first. Thank you for doing what you do.
  4. by   Batman24
    I hate reading this like this as I know it happens all too often. How can anyone be so cruel?!

    Be keeping a cool head you were able to keep the situation at hand on what was most important...the health and well being of a little baby doll. She is lucky she had someone so compassionate looking out for her. You contacted the right people and hopefully she was now be safe.

    I still think there should be a test before people can have children. :angryfire
  5. by   nancykday
    I work for the PA DOC. We have a woman on death row who staved one of here children to death, while feeding the other children. Here 8 y/o was 11 pounds whwn she died. Unfortunatly there is evil in this world. The demon mother has no remorse, and was shocked when she lost custody of here other children. She couldn't understand why, she was a 'GOOD MOTHER".
    You deal by compartmentalizing your workk from your life, or you'll go insane.
  6. by   RNtigerEMT
    Thanks all.
    Batman, I agree 100%. UNfortunately, they don't require intelligence testing or even sanity testing before conception is allowed.
    I talked it over with my DH this morning when I got home. He basically said what you all are saying, don't dwell on it. And I know better than to, but I just keep seeing that little angel, plus the other 4 children involved. All I wanted to do this AM was come home and hug my kids, but they were already inschool by the time I got home. I almost stopped by the school, but didn't want to disrupt their day. Also didn't want to explain why their mommy suddenly went crazy hugging them at school. So they "suffered" when they got home. Should have seen them squirm
  7. by   TazziRN
    You can only do what you did......report to the authorities and hope the child does not fall through the cracks.

    It's hard. The first abuse case I saw ended in the child's death, and I was furious. He came in with a head injury and the CT scan showed a bleed. When we shaved his head in prep for the OR and saw old bruises, you could have heard a pin drop in the ER. It wasn't until that moment we realized we were dealing with abuse. If looks could kill the dad would have been impaled within seconds by the staff.

    It's not easy to find a way to deal with it so that you are not sucked dry. You talk about it and debrief, and you go home and hug your own kids. And sometimes you cry.
  8. by   RNtigerEMT
    I cried all the way home, and then afterwards talking to my DH. Bless him, cause he sure deserves it after listening to me rant and rave sometimes about my job issues. He's prior Marine Corp(Semper Fi) medic, and current First Responder, so he's aware of the medical aspects.
  9. by   Jabramac
    Just out of curiosity, other then wieght what else lead you to believe it was neglect? I ask because my 2 year old is tiny, about 8.5kg, but not for lack of us trying to feed her. We have had so many work ups already with our primary MD, an endocrinologist, nutritionist, psycologist, OT, PT, speech therapy and the school districts special ed department (to see if she/we needed community assistance).

    It is a nagging fear and feeling that people are judging our ability to feed our child.
  10. by   RNtigerEMT
    Quote from Jabramac
    Just out of curiosity, other then wieght what else lead you to believe it was neglect? I ask because my 2 year old is tiny, about 8.5kg, but not for lack of us trying to feed her. We have had so many work ups already with our primary MD, an endocrinologist, nutritionist, psycologist, OT, PT, speech therapy and the school districts special ed department (to see if she/we needed community assistance).

    It is a nagging fear and feeling that people are judging our ability to feed our child.
    The child was filthy, arms and legs cyanotic, unable to obtain a pulse ox reading, temp 102.6, could not hold head up, was told by mom that child had had n/v/d for about 24hrs, and thats why she was so thin. Diarrhea episode in room, was sandlike it was so dry. This child is skeletal, eyes sunk in , dark circles, one eye red and swollen, red "bump" on side of head("from the child wrestling with parent while trying to throw up") The other 4 children were all on the smaller size, but wnl. I understand about financial reasons, not enough food, etc (specially in this area) but everyone else was well fed, and moms largest concern was how long was it going to take. Older child in room (approx 13yo girl) was more concerned about child than mom was. Told mom 4 times that child needed diaper change, then did it herself, as if used to doing it. Mom threatened to walk out when told that oldest daughter could not ride in squad during transfer. "well what do i do with her" CALL YOUR HUSBAND, while we call security to keep her there.
    Gut feeling.
    I won't call it if there are reasonable/believable explanations for the presenting problem, and no other evidence other than "gut"
  11. by   morte
    is it possible that the baby is actually the grand child?
  12. by   DDRN4me
    Quote from Jabramac
    Just out of curiosity, other then wieght what else lead you to believe it was neglect? I ask because my 2 year old is tiny, about 8.5kg, but not for lack of us trying to feed her. We have had so many work ups already with our primary MD, an endocrinologist, nutritionist, psycologist, OT, PT, speech therapy and the school districts special ed department (to see if she/we needed community assistance).

    It is a nagging fear and feeling that people are judging our ability to feed our child.

    jabramac, there are many reasons for a child to be small; not all are neglect, and you are obviously persuing all avenues to investigate. This other child is obviously in dire need of parenting like yours.

    To the OP: you did what is best for that child!! and her siblings, that is how you deal. Had you ignored the obvious and sent her home it would be different. take care! mary
  13. by   sanctuary
    Quote from morte
    is it possible that the baby is actually the grand child?

    Possible, check genes for father being both gf and f?
  14. by   traumaRUs
    How sad! The ten years I worked in the ER were both the most rewarding as well as heartbreaking. You never get used to it. However, you do learn to separate things (as one poster said, to compartmentalize). You have to, to survive.

    Talking it over afterwards and defusing the situation for you is very important. Does your ER offer a Critical Incident Stress Debriefing? I have found them very helpful.

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