Eye injury

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Specializes in MS, ICU, Peds, L&D, Camp, HH.

A parent is suing.

I'm not an ER nurse but I'm asking this here as ER nurses are likely to have seen some eye injuries, if not many.

I worked at a busy camp for part of the summer. There were frequent fights and rough housing between middle boys (ages 11 - 13) and not surprisingly, a few injuries occured including 2 fractures, a deep shoulder contusion (from a punch) and then there was an eye injury.

A boy was swung at and hit in the eye in his cabin. He had a blood spot (not just redness but pure red like a blood blister but on the sclera) on the outer aspect of his L eye, with no pupillary or visual changes. I cleaned up a couple of minor cuts on the eyebrow and lid area then gave him an ice pack, the soft gel kind, with a sheath covering it, and telling him to apply it only gently. I had also given him acetaminophen to cover discomfort, though he did not appear to be in much pain. Looking back, I think this is a sign of no abrasion, though I'm not sure. I then observed him while waiting for the driver and other accompaniment to bring him to the local ER.

He came back from the ER later that night, where they dx'd it as a contusion which should diminish over time, possibly taking a couple of months. No abx drops or patches or anything were given or prescribed.

On the report it was stated that there was no permanent injury to the eye structures.

So he was back at camp, and I told him to check in with me on a daily basis. At first I didn't see much of a receding of the blood spot area, but by the end of the week began to see a little. There were no further complaints or changes. It happened on a Sunday and he left camp the following Friday.

When I first spoke to his mother over the phone, she was very irate and threatened to call the police. I explained what was going on, then referred her to the camp director.

Well, I just heard from the camp that the mother is suing. The camp is not sure yet whether she is suing mainly because the injury happened there, or because of his eye. We are in the dark about how his eye is now... if the condition of the eye worsened or didn't improve or what. It's also not known whether the hospital will be involved or not. My gut tells me that this is somone who first of all, is emotionally volatile and second, wants to get $omething out of the situation too... but if his eye is indeed damaged...this will be a problem.

So for any of you who are familiar with eye injuries... what could have gone wrong? What could I have done better to avoid this lawsuit?

Of course if this is primarily going to be about the injury happening there at camp, an injury that they might say should not have happened in the first place, that will be the camps responsibility in terms of safety issues - supervision, etc.

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Specializes in MS, ICU, Peds, L&D, Camp, HH.

I just wanted to add that the mother could have come and picked him up, or asked the camp to bring him home, in her great concern, but she didn't. This camp is free for the children who attend as its funded from various charity sources and offered for underprivileged children from the city. Over 800 kids over four sessions through the summer.

One of the kids who broke his arm from another boy falling on him during wrestling around - his mother didn't even want him to come home when he had to for follow up care w/ Ortho. She was angry that we couldn't get follow up care for him where we were, which is out of state from where they are and not really practical as f/u should be consistent after initial care.

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Specializes in Trauma ICU,ER,ACLS/BLS instructor.
I just wanted to add that the mother could have come and picked him up, or asked the camp to bring him home, in her great concern, but she didn't. This camp is free for the children who attend as its funded from various charity sources and offered for underprivileged children from the city. Over 800 kids over four sessions through the summer.

One of the kids who broke his arm from another boy falling on him during wrestling around - his mother didn't even want him to come home when he had to for follow up care w/ Ortho. She was angry that we couldn't get follow up care for him where we were, which is out of state from where they are and not really practical as f/u should be consistent after initial care.

Some people will sue no matter what. And some people send their kids to overnight camp because they do not want them around. Sad.

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Sounds like $ to me since you have stated that this is a free camp for kids that are considered underprivileged. Did you have a chart and document on what you did, what you saw, and did you document EACH and EVERY time you checked on this patient? You will need to find out more about the suit. Who are the defendants? What is the complaint? If these are the poor people I think they are, they have gotten an ambulance chaser that only makes the client pay if they win the suit, then the attorney takes 50-80% of the "winnings". He/she obviously feels that there is a case of some kind that is winnable, either by trial or settlement, or they would not have accepted the case since it is unlikely that the family can pay an attorney without winning the case. You also need to know if you are named and if the camp will be assisting you with representation. Of course they will sell you out to cover themselves. If you are being named you really need your own attorney. If you are not named, then you can make the decision to hire your own. But you will go to deposition with the camp's attorney by your side if the camp is a defendant. Don't freak out yet. Get all the facts first. Right now you don't have enough info. Be sure to gather up all your licenses, certificates from CE, etc. They will want to see these things, even if you are only being deposed as a witness and not as a defendant. It would help if you have taken first aid/emergency classes and are not just a hospital nurse. If you have insurance, now is the time to let them know that something is going on. They may be able to help you figure out the whole story.

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It is sad but true - some parents sue for whatever reason. I am not saying much since this is on a public board. FYI, if he had a corneal abrasion there would have been a foreign body sensation & scratchy sensation. The only way to check this would have been fluroscein dye illuminated by a blue light. Just FYI

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Specializes in Emergency & Trauma/Adult ICU.

I'm wondering if the central issue that emerges as this case proceeds will be not the appropriateness of medical treatment but whether or not there was adequate adult supervision. I understand that kids will be kids ... and in particular boys will be boys ... but 2 fx's, this eye injury and other bumps and bruises specifically from fighting/roughhousing seems like it might raise a red flag with me.

As long as the OP's documentation is good and the camp's written policies were followed I think things are probably covered in terms of the camp nurse: the camper was referred to the ER for eval, parent was informed, etc.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

If you have your own insurance, call them now!! If the case progresses, you will need someone who has your best interests at heart.

As far as your actions are concerned, I honestly don't think you could have done anything more. As another poster said, checking for a corneal abrasion is not something you would be prepared to do. You got him to the ER and followed him the rest of his time there. If there was an undiagnosed abrasion, then it was the ER that missed it, not you. There may not have been an actual serious injury, however.

That being said, I don't think that the suit being filed necessarily means the case has merit. The lawyer, who almost certainly is doing this on a contingency basis, may think that he can manipulate things in this case enough to win. Some are very good at twisting things around!

Good luck to you. Keep us posted!

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Perhaps the injury caused a post traumatic cataract. When that happens the lens would need replaced in the future when it worsens, and vision becomes impaired. Just a guess. Or it could be a way for the parent to sue for pain and suffering due to poor supervision. Your just going to have to wait until you receive more info. Best of luck.

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Specializes in MS, ICU, Peds, L&D, Camp, HH.

Thanks for all of the valuable information and advice here. I do carry my own insurance, NSO, and will be calling them, and also plan to call the camp and set up a time to come down and discuss it. I'll look over my documentation (log book entries and summary notes) also. Hopefully I'll know more soon. It is alarming to hear about a suit coming up when you were the nurse involved, but on the other hand I was not surprised when I heard who was bringing the suit. Also, MLOS summarized well the other issue involved in this case.

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First, I agree with others that the parent seems to be grasping at money and that the issue will probably be about supervision and how things were allowed to get to the point that punches were thrown. As far as the legal issues here, I have no experience so can not comment. As far as the injury itself I can add a little something.

What the boy had is called a subconjuntivial hemorrhage (or more simply a subconj heme). This is a result of broken blood vessels that bleed into the space between the scelera and the conjuntiva. Classic presentation is a bloody-red eye (either half or whole). There does not have to be a corneal abrasion, this was from a blunt trauma. Essentially a "black and blue" directly on the eye itself. Typically, the eye socket is too small for fist to fit in completely. (Although, a racquetball -or anything smaller- is just about the right size.) That's part of the eye's first line of defense, along with the lids and lashes. The second is orbital fat that surrounds the eye in the socket, and the last line of defense is the inferior orbital floor (maxilla? -I'd have to look that one up). It's very thin and with enough force you could get a "blowout" fracture. This would have been assessed at the E.R. either by E.R. doc or with a consult from ophthalmology.

When we saw this (in my old department- ophthalmology) after making sure the globe was intact, secondary concerns would be hypehma, anterior/ posterior synechia, lens subluxation (but not in your case where he had no vision change) and/ or iritis. If by some chance he did have a corneal abrasion, he could have symptoms ranging from very mild foreign body sensation to excruciating pain typically along with profuse tearing.

To do this kind of exam/ assessment requires special equipment including a slit lamp (aka biomicroscope) something. That's all I have off the top of my head... but it's the most common out comes for the situation you described.

Best wishes

~Wave

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Specializes in MS, ICU, Peds, L&D, Camp, HH.

Wave - subconjunctival hemorrhage is exactly what I had been thinking also, in fact still am, yet he came back w/ a different diagnosis -- not that a contusion excludes a 'subconj heme' but could include both perhaps (?).

On average I was logging in between 40 and 60 kids and counselors daily coming in to the health center for one thing or another and don't remember every detail about this case... it was a crazily busy weekend and only my second full day at this camp. I shared the summer there with another RN (where she did 2 sessions and I did 2) who's been there for 7 summers, this was my first. I vaguely remember that he did have a foreign body sensation in the beginning which lessened over time. Since there were no further complaints after that first day, I thought it was that sensation (of a foreign body) that sometimes lingers even when it is gone, because of the initial impact of (some part of) the other boy's hand in his eye.

But as there were no further complaints of pain or discomfort, I felt there probably was no abrasion... but now I'm uncertain. I also remember telling him "no pool" and never cleared him to go back in. Hopefully that directive didn't get lost through the week.

Camp nursing anyone? Come and try a new experience next summer at a camp near you. :nurse:

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Specializes in Emergency.

Wave,

Very nice explanation.

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