Re: Phenergan Supp given to toddler; child dies
Um, it doesn't sound to me like the triage nurse had anything to do with it. Our standing protocol for vomitting states that for peds vomitting, IV may be started and labs sent, but any boluses or meds are up to provider discretion. In my ER when we triage, with children or any patient, we can talk to the doc and tell them what we see and ask to start boluses, but that order is still up to the doc. The triage nurse may have recognized the bad signs and talked to the doc or nurse assigned to the patient but if no order was given we can't just start medicating at our own will (scope of practice and all). I only know of one doc that I work with that might not have started the bolus until he had seen the patient, but without looking at the chart and seeing the presenting symptoms, orders, and nurses' notes I can't really say for sure who would be to blame if anyone would be at all. Usually for little guys we give ODT Zofran to kids for vomitting. They don't have to chew it, less sedating side effects, and generally kids seem to respond to it better. However, at my hospital, the admin has restricted phenergan use IV because of some incidences where someone didn't push the drug correctly or didn't dilute it or didin't verify that a site hadn't infiltrated and one or tow pts' ended up with tissue damage from the phenergan. Our max dose is 12.5mg IV diluted in 5-10 cc NS given over 5 minutes. I'd rather give ZOfran any day.
But any time a child dies, we all want to know why. It seems so senseless to lose a child. Older people, well, they've lived and had families, memories, that sort of thing, but with any child death I think it is human nature to want to rationalize, understand, even blame our way through it. My heart goes out to that family.
Also of course every ER should have at least one PALS certified caregiver avaiable on each shift, more than one would be better though!
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