Okay, I have just been wondering here who else is confused with this. First a little background I am a mommy, wife and have 4 kids ranging from 19(on Thursday) to 21 Months with 2 in the middle.
Okay, when I go out, I make sure the kids have what they need for my little one an ample supply of diapers, wipes, a change of clothes, snackies, drinks, diaper cream, and whatever else I need. If we're going somewhere boring the older 3 take books, gameboys, Ipods etc to keep them occupied. My oldest (the 19 year old) has Autism. WE went t hrough some BAD times, but my work is paying off. (his official dx is Autism, Bipolar, they recently dropped ADHD)
Okay, I'm a little more tolerant because of this. I understand that one day you pack 2 changes and the baby gets diarrhea and bam your out of clothes and can't get home quick enough. I understand things happen.
Why do you come to the ED with a 6 month old with NO formula, NO diapers, No extra clothes etc? Really Why? We stock size 3 and 5 diapers sometimes, if we're lucky we get newborn. We carry 1 type of formula. That might NOT be the formula your baby is on, we don't stock soy.
Than you get in the room and you want a cup of ice, 9 packs of graham crackers, peanut butter and Cranberry juice/Gingerale with SEPARATE cups of ice for those.
It's not the marriott folks! Than the warm blanket request for the patient, the parent, the parent's best friend, and grandma who is on way oh and they want drinks and ice too.
While all this is going on the 3 year old decides it's okay to try and pull the SHARPS box off the wall and grind the graham crackers in the floor. The parent is wrapped up in the blanket on the bed trying to sleep (by now the friends/family have left) and starts to SCREAM at the 3 year old.
Okay, I will be the FIRST to say I'm So not perfect, I dont' yell for 1 reason, it overstimulates my Autistic one so I rarely scream, yell raise my voice. I'm not saying i'm perfect because I am so not. but, really if you act like that in ER I'm scared as to what goes on at home.
Than you stick your head in the room and say "is everything okay?" and the mom says "oh yeah he just got add"
Well I understand ADD, some of those kids are off the wall but there is a DEFINANT difference between ADD and bad.
Am I the only one this bothers? (I had this happen yesterday with 2 crit patients) I was just wondering if i'm the only one
I have approached the "I'm diabetic, I need to eat now" pretty much like this. "When did you take your insulin/pills" oh your not on anything? Oh your diet controlled? When did you check your bs? Oh you only check it one time per week. Well lets see how bad it is, if it's too bad we'll just give you something to bring it up.
usually it's 180-260
Than I go your okay. I'll get you water or diet ginger ale but your running high, so carbs are contraindicated. Sorry
HA-HA This is a little off topic but unless the person is cought off gard I do not know may diabetics that would not plan ahead and bring snacks and drinks with them . Witch brings me to a question is there anything that will not melt ,crush , go bad , that you can pack in a bag . even grola bars crush up .
Wow. I would have died of embarrassment, had it been my family. I have a 15 month old, and we do not leave the house without the "diaper bag of doom" which contains diapers, wipes, desitin, yogurt, bibs, snacks, juice, water, baby acetaminophen, at least one change of clothes, a couple toys and a teething ring, among random other stuff. This was all because of one incident in which the diaper bag was left at home by accident when my girl was 3 months old, and she had a diaper explosion at a restaurant which culminated in us leaving with a screaming, unhappy baby wearing nothing but a burp rag under the condemning glares of the other patrons. I felt like the worst. parent. ever. Why someone would go to the ED without being prepared...I just don't get. I'm unemployed at the moment, and my fiance doesn't make that much, but damn...our daughter does not go without. Ever. The hospital is there for your medical emergencies....and if you are asking about a sandwich, you must not be that sick. Sheesh.
Specializes in Emergency Dept. Trauma. Pediatrics.
Usually the docs back me up. They say if they are expressing the c/o hypoglycemia, we need to have a bs in the chart. and my charting is as follows:
pt c/o feeling "shakey" states has not evaluated home fsbs in >72 hrs. FSBS evaluated and result of 180. Reported to MD. pt informed not having hypoglycemic episode.
Oh yeah, I also pull the "narcotics are contraindicated in migraines"
My other is "I'm so sorry the physician is not prescribing antibiotics for your child, however excessive use of abx is linked to resistant infectiosn. I would rather NOT give your child abx today than to not be able to treat an infection in the future"
but my personal favorite (foot/ankle pain who can't ambulate to restroom but walked into the door) "I will not lift you, we are an ambulatory ED, that means you came in on your own. I will gladly provide a bedpan for your use. (if the patient refuses and states they want to go the restroom) I state I can also speak with the physician and see if they will authorize a cath for the duration of your visit"
If they came in unable to bear weight, I have no issue helping, if they have a fracture I have no issue, it's the foot pain x 3 years I have this issue with.
(I like to thank my previous time in banks for coming up with customer service talk)
You tell a patient that they can't have a narcotic if they have a migraine???
As for the rest, here is an article y'all probably can appreciate.
I started reading this thread and wanted to contribute. One of my jobs is a pedi office...trust me we see it all! Parents trying to reason with a 2 year old that needs a shot why they need it. 18 yo girls with piercings/tattoos everyone who pitch a fit because they need a vaccine. Finally had one 13 year old talking so disrespectfully to her mom that I told her to please stop speaking to her mom like that in front of me.
On the other topic of ADD/ADHD in kids. Do I think it is over diagnosed? Probably. HOWEVER there are varying s/sxs of ADD/ADHD. My oldest (a girl) struggled all through school. We even moved so she would have a better school system/greater variety of teaching styles. All through elementary/middle school they told me she was just too social, needed to stay after more for more help, etc. Some of her teachers would come to me and say they just didn't understand because if they asked her one on one the questions, she would answer they all. Give her a written test-she'd fail. Didn't think she would ever graduate. Moved for her high school years. He pediatrician asked her how she was doing in her new school. They started talking, he advised we go to neuro to make sure there wasnt anything going on. They tested her and before any of the other results they told me she had BLARING ADD. Looking back through the years the signs were there but she was a girl, very well behaved, etc. Her problem is focus. She can't focus when other stuff is going on in the room. Started her on meds and her grades jumped like you wouldn't' believe. Prior to med a teacher told me to pull her out of a language-she doesn't need to go to a 4 yr college. She started her meds, got a tutor to help and went from an F to a A in one quarter. Took another year of the language and got straight A's. She graduated from College on Deans list and will make an incredible teacher! I am sorry for the length of this but wanted you to know it isn't just the kids that have behavioral issues that have ADD and it isn't all hogwash.
My son is also dx with ADHD. He definitely has a behavior issue. His teacher once called to tell me he hadn't had his med in the morning. I insisted he did. Finally found the pill on the kitchen counter. I asked her how she knew. She said she could tell by the Pledge of Allegiance. He was all over the place. Not just active, etc. He is loud, obnoxious, in your face. Will walk past his brother and hit him for no reason. Can definitely tell when he has/hasn't had his meds.
Have I even used his ADHD as an excuse for him not behaving-ABSOLUTELY NOT! BTW, I was the parent that was AGAINST any type of meds for my kids. Had a nice talk with pediatrician because I didn't want to put my child on meds and he asked me a simple quesiton-"IF he was a diabetic, would you give him insulin?" Of course I would! He told me this is no different, the meds help the signals in his brain connect. Enough said! I am a convert for kids that really need it.
Again, sorry for the length. Between the pedi office and my home life, I see so much. I get a little defensive when people who have never dealt with it say that it isn't really an issue it is just bad parenting. Also saying that teachers want the kids on meds so they will behave. If a child doesn't have ADD/ADHD meds will NOT do anything for them to help them behave. When I started my son on meds I did not tell the teachers. I went in for a conference about 3 weeks later. I asked how he was doing etc. She told me that in the past 2-3 weeks she had seen such an improvement in his work, etc. Showed me his journals and you could see just in his thoughts/writing/penmanship. She said she felt like he was ready to move to the next grade where 1-2 months before she wasn't sure. I then told her that I had started him on meds.
Also, just because you have ADD doesn't not give you a special ed diagnosis. Kids with ADD are typically very intelligent and there needs to be another reason for the special ed dx. ie, learning disability of some type. My son didn't' qualify for an IEP until many years later because of an executive functioning disability. His counselor told me he was "organized like a train wreck". Only then he got services but not before.
Wow. I would have died of embarrassment, had it been my family. I have a 15 month old, and we do not leave the house without the "diaper bag of doom" which contains diapers, wipes, desitin, yogurt, bibs, snacks, juice, water, baby acetaminophen, at least one change of clothes, a couple toys and a teething ring, among random other stuff. This was all because of one incident in which the diaper bag was left at home by accident when my girl was 3 months old, and she had a diaper explosion at a restaurant which culminated in us leaving with a screaming, unhappy baby wearing nothing but a burp rag under the condemning glares of the other patrons. I felt like the worst. parent. ever. Why someone would go to the ED without being prepared...I just don't get. I'm unemployed at the moment, and my fiance doesn't make that much, but damn...our daughter does not go without. Ever. The hospital is there for your medical emergencies....and if you are asking about a sandwich, you must not be that sick. Sheesh.
That or you're too poor to eat and you're truly hungry and you don't know where else to turn.
You tell a patient that they can't have a narcotic if they have a migraine??
I know this is not directed at me, but overuse of analgesics for headaches leads to rebound headaches, and can even lead to chronic daily headaches. Also, evidence demonstrates that 1L NS bolus and Compazine IV are the most effective in relieving migraine symptoms.
If a patient presents to the ED with new onset headache, or with symptoms that are more severe or different in nature from their normal headaches, there are a host of neurological conditions that they could be experiencing. A full neurological exam is indicated for these people.
I frequently find myself having to explain that I cannot give them anything for their pain until after the doctor has seen them, because the effects of medication can interfere with a sound neurological exam. This means waiting for medication until after a doctor has been in the room, which on a good night is within an hour, and on a bad night, can take up to two hours or longer.
The best I can do for them prior to being examined by the physician is to start a line and give them a fluid bolus, dim the lights, give them a cool compress and maybe some O2.
Once the physician has completed the neurological exam and orders the Compazine/Benadryl cocktail, I can give it. If the patient requests a narcotic and the doctor has not ordered one, I then explain to them that narcotics can actually worsen migraines, or that the narcotic might temporarily make them feel better, but that they will most likely experience a rebound headache after discharge, and that the Compazine/Benadryl cocktail is the most effective remedy we have in the ED.
I started reading this thread and wanted to contribute. One of my jobs is a pedi office...trust me we see it all! Parents trying to reason with a 2 year old that needs a shot why they need it. 18 yo girls with piercings/tattoos everyone who pitch a fit because they need a vaccine. Finally had one 13 year old talking so disrespectfully to her mom that I told her to please stop speaking to her mom like that in front of me.
On the other topic of ADD/ADHD in kids. Do I think it is over diagnosed? Probably. HOWEVER there are varying s/sxs of ADD/ADHD. My oldest (a girl) struggled all through school. We even moved so she would have a better school system/greater variety of teaching styles. All through elementary/middle school they told me she was just too social, needed to stay after more for more help, etc. Some of her teachers would come to me and say they just didn't understand because if they asked her one on one the questions, she would answer they all. Give her a written test-she'd fail. Didn't think she would ever graduate. Moved for her high school years. He pediatrician asked her how she was doing in her new school. They started talking, he advised we go to neuro to make sure there wasnt anything going on. They tested her and before any of the other results they told me she had BLARING ADD. Looking back through the years the signs were there but she was a girl, very well behaved, etc. Her problem is focus. She can't focus when other stuff is going on in the room. Started her on meds and her grades jumped like you wouldn't' believe. Prior to med a teacher told me to pull her out of a language-she doesn't need to go to a 4 yr college. She started her meds, got a tutor to help and went from an F to a A in one quarter. Took another year of the language and got straight A's. She graduated from College on Deans list and will make an incredible teacher! I am sorry for the length of this but wanted you to know it isn't just the kids that have behavioral issues that have ADD and it isn't all hogwash.
My son is also dx with ADHD. He definitely has a behavior issue. His teacher once called to tell me he hadn't had his med in the morning. I insisted he did. Finally found the pill on the kitchen counter. I asked her how she knew. She said she could tell by the Pledge of Allegiance. He was all over the place. Not just active, etc. He is loud, obnoxious, in your face. Will walk past his brother and hit him for no reason. Can definitely tell when he has/hasn't had his meds.
Have I even used his ADHD as an excuse for him not behaving-ABSOLUTELY NOT! BTW, I was the parent that was AGAINST any type of meds for my kids. Had a nice talk with pediatrician because I didn't want to put my child on meds and he asked me a simple quesiton-"IF he was a diabetic, would you give him insulin?" Of course I would! He told me this is no different, the meds help the signals in his brain connect. Enough said! I am a convert for kids that really need it.
Again, sorry for the length. Between the pedi office and my home life, I see so much. I get a little defensive when people who have never dealt with it say that it isn't really an issue it is just bad parenting. Also saying that teachers want the kids on meds so they will behave. If a child doesn't have ADD/ADHD meds will NOT do anything for them to help them behave. When I started my son on meds I did not tell the teachers. I went in for a conference about 3 weeks later. I asked how he was doing etc. She told me that in the past 2-3 weeks she had seen such an improvement in his work, etc. Showed me his journals and you could see just in his thoughts/writing/penmanship. She said she felt like he was ready to move to the next grade where 1-2 months before she wasn't sure. I then told her that I had started him on meds.
Also, just because you have ADD doesn't not give you a special ed diagnosis. Kids with ADD are typically very intelligent and there needs to be another reason for the special ed dx. ie, learning disability of some type. My son didn't' qualify for an IEP until many years later because of an executive functioning disability. His counselor told me he was "organized like a train wreck". Only then he got services but not before.
My problem is when the diagnosis is overused and abused. I know there are school systems (and other people) that do this. I have had it comfirmed by people who work in school systems. I can't say it happens in every school system, but it does happen.
I even know of a situation where the teacher and principal of a little boy wanted him on meds for his behavior. The principal was trying to tell the mother of this child ( a friend of mine) of a doctor who would give her the prescription without a medical exam. I think that is dangerous.
Why do you come to the ED with a 6 month old with NO formula, NO diapers, No extra clothes etc? Really Why? We stock size 3 and 5 diapers sometimes, if we're lucky we get newborn. We carry 1 type of formula. That might NOT be the formula your baby is on, we don't stock soy.
Because they panick that the baby has a fever of [insert a usually non-scary number] and leave without your normal supplies. And maybe do not have a realistic sense of how long you could be waiting. Or just expect to be taken care of at the spa/hospital.
Than you get in the room and you want a cup of ice, 9 packs of graham crackers, peanut butter and Cranberry juice/Gingerale with SEPARATE cups of ice for those.
I hate patients like that. These are often the ones who ask why the wait is so long when this is supposed to be a children's hospital (um....because there are a lot of other children here? duh?) or ____ other annoying behavior that makes you wonder how they manage to navigate adult life at all.
I actually had to tell a parent the other day "please do not let your child play with the electrical outlets." PARENT your child, FFS!
what fun are they :) I use them as my veary last resort
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Trekfan
466 Posts
HA-HA
This is a little off topic but unless the person is cought off gard I do not know may diabetics that would not plan ahead and bring snacks and drinks with them . Witch brings me to a question is there anything that will not melt ,crush , go bad , that you can pack in a bag . even grola bars crush up . 