Emergency Room vs. Motorcycle Accident Patient

suzanne4, RN · May 21, 2008

You have every reason to be upset and not just because it was your son. It could be anyone else's son as well.

I would report what you told us here to Risk Management at the hospital as well as talk to the manager of the ER.

There is much that could have been done to clean those wounds initially in the ER as well, telling someone to try to do it when they get home is not an acceptable answer that I would have tolerated.

Sorry, but shame on the staff that cared for your son that night.

Best of luck to you and him.

Spritenurse1210, BSN, RN · May 21, 2008

*hugs* I'm so sorry that they took such poor care of your son. I hope everything will be ok

bollweevil · May 21, 2008

I work in the operating room. Have previous ICU experience. Never floated to ER, so here's what I need to know:
Saturday afternoon a 24 yr. old male transported to ER by ambulance, involved in motorcycle crash (approx. 50mph), wearing helmet,no other riding gear. Patient flipped 6-8 times after having ridden motorcycle through sideways slide. No loss of consciousness. Spine stabilization in place. Alert and oriented x 3. NP evaluates patient, RN gives 10mg Morphine. X-rays are ordered (flat plate, no CT scan). Patient given another 10 mg Morphine (approx 30 min. later, before radiology visit and because of no pain relief). Patient comes back from radiology, still no pain relief, minus C Collar, radiology cleared spine.
ER MD comes in states no broken bones. Road rash 2nd and 3rd degree burns. Dress the wounds and will be allowed home. ER RN starts dry wiping debris from back (rocks, gravel, sand, dirt). Patient screams, begs her to stop, request made for additional pain medication. She stops, shrugs her shoulders and states she'll just have to apply the dressing over the wounds and patient will just have to clean it off when he takes a shower, the doctor didn't order any more medicine. (Wounds on both shoulders (most severe), full back, bilateral kidney areas around to sides (most severe). Both knees with less severe wounds, both arms, hands with scrapes, cuts. Left ankle sprained, no skin wound. Open wounds covered with tubes of Bacitrain ointment, adaptic sheets applied, wrapped in kerlex rolls. Discharged with Rx Tylenol IV, orders to see primary care physician in 2-3 days (patient has no primary care physician).
This patient is my son. I'm ashamed to say I was not an RN or advocate for him in the ER. I was just a mom, thankful her son was alive. My nursing knowledge was not a benefit for him or me at this time. :bluecry1::bluecry1:
Later Saturday night my nursing knowledge kind of kicked in enough to make me realize I needed to be monitoring him for internal injuries, etc.
Monday, unable to find a doctor to see my son, no one accepting new patients. My charge nurse at work contacts a surgeon who indicates he will see my son in his office the next morning (he is in operating room all this day).
Tuesday, the surgeon's first response was to take my son to O.R. to debride and clean out the wounds (I could not get it all out, pain too severe). (My son refused, not understanding that he would be put to sleep for this procedure, and I did not know that he didn't realize that. The doctor decided we would continue with wound treatment with Silvadene, abdominal pads and kerlex wrap, and appropriate pain medicine an hour before dressing changes. Concern with possibly needing skin grafts later. Come back in one week.
I am thankful to say the dressing changes have been going much better.
At least now I am not skinning my son with every dressing change.
I guess I am just venting, now that I feel my son will be getting better.
I am disappointed in my hospital's care delivered to my son. I feel that he should have been CT scanned, I feel he should have had a trip to the OR, I feel that he should have been admitted at least overnight, or transferred somewhere else, I feel that the dressing was inappropriate (no silvadene applied or prescribed, adaptic dressing stuck and pulled skin off when being removed), no dressing supplies were supplied or suggested where they could be purchased in bulk.
Do you all think this was appropriate standard of care? Am I just being an upset Mom? As a RN myself, I am horrified at how things were handled and ashamed of myself!

His care sounds second rate, for the reasons you state. But it's not too late to get the CT, is it, and also to let the ER NM and Med Director know what you have related here?

Can't a referral service get you to an appropriate doctor? How can ER just discharge him without a solid referral in place? Where was the social worker?

It's hard to be a mom and a nurse sometimes, like when our kids have had a serious health problem. But let the RN juice kick in now and go to bat for your son, who I pray is recovering well, and for future patients. :nurse:

ebear, BSN, RN · May 21, 2008

I am appalled at the care your son received (or failed to receive). I agree with the others---write this up and speak with risk management, the director of emergency medicine, and the NM.

Your son should have been taken to the O.R. for debridement and dressing application. Not to do so was barbaric. The nurse used poor judgment, but the ER doc should have been more thorough also.

I'd raise one heck of a stink!!! :angryfire

ebear

rjflyn, ASN, RN · May 21, 2008

His care sounds second rate, for the reasons you state. But it's not too late to get the CT, is it, and also to let the ER NM and Med Director know what you have related here?
Can't a referral service get you to an appropriate doctor? How can ER just discharge him without a solid referral in place? Where was the social worker?
It's hard to be a mom and a nurse sometimes, like when our kids have had a serious health problem. But let the RN juice kick in now and go to bat for your son, who I pray is recovering well, and for future patients.

Yeah its not too late for a CT but why. The purpose would be to rule out serious internal injury, of which its Wed now and the injury occurred on Sat. More than likely he would have shown outward signs of it by now, so only spending needless $$.

Definitely second rate care. What social worker, some ER's may not have one, as far as referrals its common to refer pts to their PCP. Also some facilities may not have referral services either.

Now from the sounds of it this pt should have never even been transported to the facility he ended up at. He as a trauma pt and should have went to a trauma center. You need to be talking with EMS as well. Sounds like they were over their head and just were winging it.

Rj

CarVsTree · May 22, 2008

Wow!!! I'm sorry your son was treated so badly.

Is your hospital a Level 1 or 2 trauma center?

Standard of care for MCA at 50mph would be Primary survey, plain films, CT scans Head, C,T,L spines, Chest, Abd, Pelvis.

How did radiology clear your son's C-spine? He needs a physician exam to clear C-spine. Also many fx's don't show up on plain films, CT is standard for spine.

Wounds should have been debrided in OR and dressed. Bacitracin not nec. wrong, some burn docs prefer bacitracin, some prefer silvadene. And there's about a billion others. However, as you know, you can't just slap bacitracin on a dirty wound that needs to be debrided. If he had 2nd & 3rd degree burns, he should have been referred to a burn center (I think, but not sure if it is standard or not, since my hospital is a burn center, but I'm not a burn nurse).

I would definitely report this to Risk management, Director of ED, ED director's boss, etc. That care isn't just a little off, it is apalling and extremely dangerous. What if he'd had a splenic lac or even worse a big liver lac. He could have died. Very scary, as I'm sure you're aware. Don't leave this unreported.

I hope your son is feeling better. How are his wounds? Is a burn or plastic surgeon following him? He should not be followed by a general surgeon. He needs burn/plastics.

Good luck.

Sue Z

loricatus · May 22, 2008

First, as a mother, my heart goes out to you & what you must be going through.

Second, it sure sounds lke the place had never heard of trauma protocol. Like others have said--report them for the inadequate care given to your Son. They should not be accepting trauma pts if they cannot handle them. The Joint Commission should hear about this because if it happened to your Son, it probably is happening to others who aren't as fortunate to know better. I hate to think of the complications from this possibility.

suzanne4, RN · May 22, 2008

Please let us know what happens, we are all interested in this case. No one should have to suffer like this.

And not sure where you are located, but you can notify the state about the care that he received and they will be out rather quickly to investigate.

They should not be permitted to continue like this and you can also call the Board of Medicine for your state as well.

andhow5, BSN, RN · May 22, 2008

Bad, BAD care.

He was a trauma patient, and treated like a fast-track patient. Considering his MOI, he needed much more ADVANCED care than he received. I'm glad he's OK, and I hope he heals quickly.

mwboswell · May 22, 2008

How did radiology clear your son's C-spine? He needs a physician exam to clear C-spine. Also many fx's don't show up on plain films, CT is standard for spine.

Careful here when you say "standard" then that means that all places that either don't do it or don't have the capacity aren't providing "standard" care.... CT is NOT the standard of care for spines at this time. It is an adjunctive diagnostic tool. The history and clinical exam are the standard (meaning everyone gets this), the plain films or CT are based upon your findings or further investigation. I refer you to research the Canadian C-Spine rules or the NEXUS criteria for imaging of the spine in trauma. These tools have been validated and thoroughly researched over the years, and Mechanism of Injury alone is not criteria for imaging the spine.....

Do we xray and CT more than we should - definitely.

Do some clinicians use xrays and CTs in lieu of poor assessment and inadequate clinical decision making -YES (I am guilty of this sometimes also I admit)....

But does that make it acceptable to connotate xrays and CT's of the spine as "standard" - NO

All I'm saying is just be careful to not get in the trap of thinking what is "standard" versus not.

In my level I, university/teaching, trauma center, 115 bed ER with 180,000 ER visits/year - this definitely is not standard care.

Hope this helps!

-MB

mwboswell · May 22, 2008

Bad, BAD care.
He was a trauma patient, and treated like a fast-track patient. Considering his MOI, he needed much more ADVANCED care than he received. I'm glad he's OK, and I hope he heals quickly.

...see my other post: MOI in and of itself does not dictate the level of care