I work in an ER department and we had a three year old female carried in by mom in a postical state. She had a temp of 104 and had vomited on the way to the hospital. Blood tests showed an increase white count and her urinalysis was clear. We got her fever down but during our assessments we noticed she began to be unable to use her body strenght to sit up or stand. When mom went to pick her up the little girl began screaming in pain and shaking uncontrollably. The child was just not acting like a typical febrile seizure. A pediatrician was called in and he decided to do a lumbar puncture. He requested sedation for the child. He gave her 2mg of midazolam (versed) IV push. This in my opinin did not sedate the child enough for the procedure. She was still talking and looking around and crying because she was scared. She was alert enough to tell her mom at that point that she was scared and wanted to go home. He then asked the parents to leave the room which upset the child right away. A nurse and I were told to hold her in place for the lumbar puncture and not to let her move. He then proceeded to do the puncture but didn't not freeze the area. As he stuck the spinal needle into her back the child screamed out in pain and moved to try and grab what was poking her in the back. He then got mad and said he needed someone stronger to hold the child in place. He preceeded to do the lumbar puncture without any further sedation or freezing to the area. I left the room and was very upset to the point of tears. Another nurse told me that sometimes it is just better to get the procedure done than mess around with freezing and have to poke the child with the freezing and the spinal needle. My thoughts are that we give adults local freezing when we do a lumbar puncture...is it not cruel to not give the same to a child? I just need a little feedback about this because I was made to feel as though I was over emotional and too sensitive.
my choice would have been to sedate the child better. don't forget that zylocaine stings like the dickens and takes a little while before it's fully effective, so it hurts possibly as much as the lp. on the other hand, they'll squirm and cry for that and maybe, maybe hold still for the lp. or not.
while you're waiting for the local and sedation to take effect, you can spend a little time getting the child calmed down---soft voices, mom rocking, etc.
i don't the think the doc is "barbaric", just not empathetic, patient and possibly a little dumb. jmo.
Last edit by prmenrs on Jan 21, '06