Broken Collarbone?!

[LACA, BSN, LPN, RN]

3rd grade kiddo came into the clinic yesterday afternoon @ 3:10 (first bell rings at 3:15). he had been outside playing football and another child landed on his shoulder. he was crying at the time. i looked at his shoulder, it was red on the backside, there was no swelling or bruising. i gave him an ice pack and told him to go back to class to get his stuff together. as soon as he left my office, i called his mom. told her what had happened, explained how his shoulder looked, etc. she mentioned that he had had a broken collarbone in the past, i told her it looked okay to me. she asked if she should come get him, i told her that was completely up to her, but i thought he would be fine on the bus. (my thinking on this was, he would be home from the bus before she got to school to get him, only 5 minutes left in the day).

fast forward to this morning--mom comes to the school to talk to the principal and teacher--kiddo has a broken collarbone! said that when he got off the bus it looked horrible so they took him to the er. my principal called me into his office, i told him i had called her etc. he said she was upset because she didn't come get him.

i spoke with his teacher this morning, she wasn't concerned at all. she said he didn't even tell the teachers when it happened, then asked a few minutes later to go to the clinic.

i thought i had covered my bases with calling, i had no way of knowing that his collarbone was broken. it looked fine when he left my office.

what do you guys think?!

[missfixit]

Did you check mobility? Didn't mention if you did or not , just curious. I don't think you did anything wrong. How an injury looks can change quickly, how it looked 5 minutes after it happened can be a totally different ballgame 15-30 minutes later. If assessment checked out ok and he was not in pain, then I don't think you were wrong. No one has x-ray vision.

[LACA, BSN, LPN, RN]

Yeah, he had pretty good ROM. I originally thought maybe his shoulder had popped or something- never thought it would be a collarbone injury.

[Purple_Scrubs, BSN, RN]

You know, that close to the end of the day I probably would have done the same thing. Get him on the bus rather than hold him and risk not being able to contact a parent or have the parents say they can't come get him and then you are stuck after hours with a kid who has no ride home.

Hindsight is 20/20, I think you did the right thing given the situation and the assessment at that time. Like Missfixit said, until we develop x-ray vision we just have to muddle along on these things!

[bergren]

Jessica

Look back over your assessment and ask yourself if you missed something?

HOP:History/ verbal expression of pain, observation, palpation,

The clavicle is the most common broken bone in the body.

ROM? extreme pain while moving the arm on that side

Did you palpate the bone? ususally the break can be felt through the skin - it is a shallow bone.

Was the child's posture symetrical? shoulders even?

Pain localized at one point as opposed to an area? "where does it hurt?" They point to ONE spot.

shocky symptoms? facial expression? pallor? nausea? dizzy? I can usually tell a kid broke something by their color - very shocky looking.

Guarding? favoring other arm/ shoulder?

Did child want to talk to mom or want mom to pick them up?

[LACA, BSN, LPN, RN]

He was red faced, but he had been outside playing. He was crying, but he was pointing to the back part of his shoulder. His posture was fine, he was completely symmetrical. The only abnormal thing was the redness on the back side of his shoulder. I asked him what hurt and he said his shoulder, but pointed to the back part. I've thought and thought about it and I really don't think I missed anything...I never had any inkling that anything was broken. The only thing I can think of is that he got to moving and stuff and that made it worse??

[NurseLoveJoy88, ASN, RN]

Based on your assessment I think you did the right thing. When I worked in school health I would always tell the parents if you think your child should be taken to the ER or clinic then do so. I tell them we do not have x-ray vision thus it is better to be safe then sorry.

But there is no way you could of known.