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.
Please keep us updated but I honestly would not worry about it. I know it is hard not to but I dont see how you are at fault for anything. First things first, you did not cause the injury, and were not responsible for preventing this. As a nurse you are responsible for your actions which in a court of law will be compared to what another nurse would have done. You assessed the eye, sent the child in for treatment then followed the doctor's orders on care. Nurses are not able to diagnose, if he did have some type of injury that was not caught then that will be on the ER.
I find it hard to believe that the child has some serious type of injury. Even if the ER missed it, I really would have expected the child's sx to worsen. But from your post I think you have done everything appropriately.
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
Don't forget EYE PAIN and tearing that accompanies a corneal abrasion.
Specializes in Peds ED, Peds Stem Cell Transplant, Peds.
I wouldn't worry too much about it. Mainly because when people start suing, they throw in every name possible to get as much money as possible. If you documented well, and you took the kid to the ED, then you did your job. Whatever the ED did from there is out of your control.
Don't forget EYE PAIN and tearing that accompanies a corneal abrasion.
Yes, and he wasn't in pain. Discomfort and foreign body sensation immediately following the injury yes.. but not pain or ongoing pain. So I don't think there was a corneal abrasion unless he somehow re-injured the same eye causing an abrasion sometime after going home. But again, we've not even been told how his eye is at this point. It may be fully healed for all we know.
I spoke to the associate director of the camp again. After looking over the documentation and log entries, he feels I don't have anything to worry about. And as far as the camp - it turns out the boys were supervised when this happened - they were in the playground in the presence of counselors (not the cabin as I originally thought). They went behind a structure (out of sight) when the altercation took place.
I wonder how often this type of thing happens at schools... though there are consequences such as suspensions and such that limit this kind of activity on the grounds. My son used to tell me everything happened behind the teacher's back or when she stepped out. Middle School age, especially for boys, seems like a notorious time for fighting. Not that camps and schools shouldn't place extra efforts on avoiding fights from taking place in the first place, they should, but it's a bad age.
Anyway, after talking to him again, it doesn't sound so bad - I'm not named, the camp is, which is being sued for negligence, and she might not have a good case even there. The camp staff there are a very dedicated and caring bunch... but oft overwhelmed. They took in many more kids this summer than they've previously taken in. Not sure why, but would have been an upper management decision.
I liked the way one of the ophthalmologists used to explain about corneal abrasions: the outer layer of cells fills in the abrasion quickly -like quicksand, but it takes a little while longer for everything to set up (as in cement). Good mental imagery for the patients to latch onto (even if they have never been stuck in real quicksand!)
Noryn
648 Posts
Please keep us updated but I honestly would not worry about it. I know it is hard not to but I dont see how you are at fault for anything. First things first, you did not cause the injury, and were not responsible for preventing this. As a nurse you are responsible for your actions which in a court of law will be compared to what another nurse would have done. You assessed the eye, sent the child in for treatment then followed the doctor's orders on care. Nurses are not able to diagnose, if he did have some type of injury that was not caught then that will be on the ER.
I find it hard to believe that the child has some serious type of injury. Even if the ER missed it, I really would have expected the child's sx to worsen. But from your post I think you have done everything appropriately.