[RNin92]

Originally Posted by Gompers

Yep, yep, yep. When learning the emergency care of children, that is one of the things they drill into your head. Kid's vital signs can be completely normal for a very long time as their bodies compensate for things like hypovolemia. Then they get to a point where they can't compensate anymore...and they just crash. So I agree, any child that has been vomiting that much (to the point of vomiting blood) and had a heplock already in place should have gotten some IV fluids. A bolus, a running line, something, anything. Dehydration is deadly in children, and the smaller they are, the harder it can hit them. This stands out to me much more than the phenergan suppository.

I agree. By the time kids crash...it is far too late for intervention.

I am so sorry for our friends loss.
I cannot even make myself go there.

[thanatos]

Originally Posted by TraumaInTheSlot

regarding the cutting of the supp, the supp is supposed to be cut lengthwise, from the point of "the bullet" down. if you cut them in half, the medicine isnt even. i hope this makes sense.

My point is that suppositories are not designed to be cut. There is no 'score' to delineate equate amounts of med and to facilitate breakage into two equal pieces. I have found it very difficult to cut a cold suppository lengthwise (the correct way, I agree) and end up with two perfect halves. Probably that not big a deal, but it is not best practice.

[hotrodrn]

Originally Posted by TraumaInTheSlot

Children tend to show signs of decompensating hypovolemic shock later than adults, when they go "off the deep end". Pals teaches you to prevent the arrest. it doesnt hurt to give the child a bolus or even two.

any child with vomiting should be given IV fluids, or a PO challenge with pedialyte. it sounds to me like this child got lost in the shuffle. either that, or they gave the kid the wrong sized supp, maybe a 50.

my sincerest condolences to you and your friend.

Kids actually show improvement before they decompensate and crump.
The kid probabley couldnt have holded the pedialyte down if you gave him/her a challenge with it anyway.

Our protocol for my hospital is As Follows:

IV/500ML/NS or/LR maybe D5 depending on the doc.

Check labs for electrolyte defiecensies.

Abd. Work up/x-rays/ct/ultrasound to rule out a hot appy.

We use one of the follwing for an Anti-Emetic and generally give it IV push,
we use to give IV phenegran tell we found out it necrosis veins and causes phlebitis. And an IM of it stings like crazy.

These are the anti-emetics we usually give-

Composine/Reglan/Vistaril/Anzemet/ and sometimes Benedryl works as a good one.

Comfort measures.

Try to get them to suck on Ice Chips.

If they are vomiting blood one of our physicians usually has us drop an NG and Lavage with cool saline just to make sure that they arent bleeding internally.

[needsmore$]

Agree with the other posters-if child was dehydrated and no intervention was given w/ IVF boluses, that would lead to shock, then eventually cardiopulmonary failure and death. This is why any ED nurse who cares for pediatric patients be certified in AT LEAST Pediatric Advanced Life Support, maybe APLS and/or ENPC. Someone did not provide the standard of care with this patiet in that regards. Also, suppositories should not be cut in half- again because the medicine is put into a gel and you have no way of knowing how it is distributed in the suppository.
Anne

[jannecdote]

My 10 month old grandson went in to the ER with N&V, and was diagnosed with gastroenteritis. Got very lethargic after we finally got him back to a room. After reading these posts, it makes me realize how lucky we were that they started fluids on him right away and gave him a Phenergan supp. about an hour later with no ill affects.

This is such a devastating situation for your friend. My heart goes out to her. The loss of a child is overwhelming, to say the least.

[tridil2000]

even if there was an error in the dosage of phenergan, whether it was the order itself, or the nurse's error, i truly believe this child's demise was a result of lack of fluids. dehydration kills children. they simply can not handle a lot of volume loss bc of their size. the child should have received iv fluids promptly and before any other intervention.

it is the pals standard of care.

my sympathy to you, your friend and her family.

trish
pals cert

[cadillac05]

This thread is an example of how much I appreciate the information/expertise shared that enhances my knowledge base in areas not readily familiar to me as an OR nurse.

[OriginalWmn]

In all of the facilities where I've worked we never give phenergan with suspected gastroenteritis. We don't give anything to stop diarrhea if they have that either. We make the childe NPO, start an IV to give a bolus and then start maintanence fluids. Then maybe we start attempting po with pedialyte, if they continue to vomit then we make them NPO again and maybe try later. I'm talking with the toddler age set. I work peds floor so maybe in ER with kids that are not as dehydrated as the ones that get admitted to the floor they try this so they can send them home.
I've understood that with Gastroenteritis we just do supportive care until the virus (most likely cause) runs its course and the body's way of getting rid of it is vomiting and pooping it out. If stool cultures come back with something like salmonella or if it is suspected antibx are started too.

[imagin916]

I am so sorry about your loss, my heart breaks for your friend.

A comment to all other posters: What great info you all have given! I rarely float to Peds ER, and when I am over there I am scared as hell! I always double and triple check any meds that I am giving to any child because I am not a peds nurse, and I am not familiar. I will check the order against my drug book, and confirm with the attending that this is what he/she wants given.

[poor.er.doc]

I was taught in residency never to give phenergan to a child less than 3.


I believe there are valid reasons:

1. It makes the child too dorwsy to orally rehydrate/maintain hydration...

2. How can you tell if the child is lethargic if they are drugged from phenergan?

This is why I order so much fluids on vomiting children despite the eeevil glares I occasionally get from our nursing staff

I agree that dehydration killed this child, not the phenergan. I am terribly sorry for your friend's loss.