I rarely answer medical questions or give advice online... - page 2
But...I sort of felt I had to tonight. On another board I post on, there is a lady wanting advice about treating her child's fever of 105°. Most people are advising alternating Tylenol with Motrin,... Read More
Mar 2, '07that child absolutely needs to be back at the er, though perhaps not the same one that discharged her. temps that high are a problem for so very many reasons. i can't imagine how dehydrated that kid is with a fever that high...or how bad the infection she may have is....so many unanswered questions. that's just scary.
Mar 2, '07that child needed to be in the ER hours ago. I pray she did OK. Sounds a lot like a case we had in our ER a few weeks ago. young girl in from out of town for an event, in on Friday for high fever, dx FUO (fever unknown origin), sent home. Back in on Saturday with continued high fever with the onset of mental status changes much like you describe. She was transferred to a local pedi facility where she was quickly given spinal tap and diagnosed with bacterial meningitis. (yes, we all had to get prophylaxis).
she was critical for several days but I have not been able to learn an eventual outcome.
That would be one instance where I would say, go directly to ER!
Mar 2, '07Altered mental status? Holly cow crud, I would be calling 9-11! Even if it is a case of dehydration, at least the paramedics can get an IV started and start pushing fluids! Also, once in hospital they can continue IV hydration and medicate the fever and monitor till it passes and make sure she doesn't go comotose or something! Holly cow!
Now I know there are lots of hospitals that don't specialize in peds, mine is one of them...but we sure as heck will have them transported when able to a childrens hospital in these cases! Also calling 9-11 will get ambulance service there and they can take the child to an appropriate hospital while being monitored and cared for!
Sometimes I wonder about folks...how basic is it to seek out appropriate help? I learned to call 9-11 as a child for cases like this...not hop on the internet! I also knew that you can call your PCP and speak to the MD on call for urgent cases. But if my child had a fever of 105...darn straight I would be on my way to a childrens hospital if not calling 9-11, and if they had mental changes....9-11!!!!!!!!!!!
Mar 2, '07Triage, many non-medical people don't know what to do when they've already been told by a doc that there's nothing wrong.
Think about how many people with medical backgrounds come here looking for advice!
I went to the site and checked that post out......the OP said that the child had started slurring her speech after discharge from the ER. Since the mom had been told that her child was okay, to just give antipyretics, she didn't know what to do next. And actually it wasn't the mom who posted, it was a friend of the mom's.
Update on that: she posted this morning that the child has sinusitis and OM. Apparently the first doc never checked the girl's ears.Last edit by TazziRN on Mar 2, '07
Mar 2, '07Thanks for the update there Tazzi! I still wonder about folks though...have heard many a story like this and how people just hit the online for help instead of calling their MD's or going to the ER. I can see some folks may not have insurance and freak out...or just simply don't know to call their MD (white coat syndrome and the whole..."I don't want to bother the MD" bit).
Before I was an RN, I didn't trust MD's much...and if they didn't tell me what I needed to know about things, I typically stuck to my guns and said "nope, that is not good enough". Guess I learned that from years of seeing my mother go through so many medical probelms and just getting another pill to the list and still having probelms! I think I also have the theory "if you would return your expensive steak dinner because it wasn't cooked to your satisfaction...then expecting satisfaction from an MD should really be no different...and you pay them a heck of a lot more than a steak!". I just have the personality to question and stand up...and I will return that steak! LOL!
But all in all I question some people now a days, not as a tisk tisk deal, but as a way to improve things for people in these circumstances! Definately education is still so very needed on how to know when something is urgent vs emergent...who to call...when to call...and some old fashioned lessons on trusting your internal red flags when you feel that things are just not right!
I remember a case not to long ago my hubby had to go to (paramedic) where a child spiked a high fever and the mother really didn't know what to do. She had no insurance and her 4 year old child was not breathing well, sore throat, and feverish. She went online and got the advice of tylenol/motrin, fluids, and open the window for fresh air, as well as a humidifier. SHe did just that and the child worsened. She finally called 9-11 but it was basically too late. The child had epiglotitis and when she gave fluids and pills, he aspirated. The child died on route...
That one killed both hubby and I...sad sad sad. So I guess I am a little shell shocked when people don't call 9-11 for children who are having serious signs of probelms....
Mar 2, '07It frustrates me too, Triage, but I can understand more when Mom has already been told "Your child is okay." Then she sees other symptoms and thinks, "Now what do I do? The doctor said she's okay so if I take her back there he's going to tell me the same thing."
A lot of that comes from lack of discharge teaching. I always discharge my pts with the instruction "Take her to her own doctor if she's not any better in 2-3 days. If she gets worse, bring her back here immediately." I am one of the few who do that. I've even had pts come back all freaked out because of a new symptom, only to find out it's a side effect of the med we prescribed. Nobody told them to expect it.
Mar 2, '07Me too tazzi! I do a lot of teaching before discharge...yeah, will audience too when all they want to do is go home..LOL! I have really great resources at my hospital and I can print just about anything medical needed! I do this...great resource and why not! Even if I spoke till I was blue in the face...things will be forgoten, especialy when someone gets anxious or confused! Printed material or even a handwritten reminder on discharge papers helps! I have, myself, relied on those to remind me too as a patient!
I am so not into a MD saying that a child with a fever is just fine...no they are not or they wouldn't have a high fever! I give lots of advice to parents in this...if they stop eating for over 12 hours, if the fever doesn't break in 6 hours, if they do not urinate in 3 hours, or they get worsening symptoms like not responding well or odd behavior, come back or at least call! If there are breathing difficulties of any kind call 9-11...not something to take lightly in children. Try to keep them comfy and well loved and hydrated as much as possible, I like to see clear yellow urine every hour or half hour if you are doing it wonderfully! And always listen to your internal warnings and red flags...if you just FEEL something isn't right, call!
Good reminder to all of us to really educate people on aftercare...this is typically when things go wrong..when they are outside the hospital and feel they are okay! Nope, not out of the woods yet....
Mar 2, '07Something I have noticed: I get a lot of people in the ER after having seen the PMD in the office for the same complaint. I ask "What did the doctor say was wrong?" and I get "Nothing, he said I (my child, etc) was fine."
Nooooooo, what they said was "I can't find a reason for the fever." Or the doc did give a diagnosis and the pt didn't understand what it meant and didn't ask for clarification. Big difference.
Mar 2, '07Quote from cotjockeyOh dear God......and she's posting on the 'net asking for advice?Exactly...she's already been to the ER and was sent home, but now the child has slurred speech and is lethargic and "acting like she is drunk." Yeah...a good time to go back to ER...this is one I wouldn't even fault for calling 911.
Mar 2, '07Quote from TazziRNUpdate on that: she posted this morning that the child has sinusitis and OM. Apparently the first doc never checked the girl's ears.
I wonder about that. If it's true, it's more than scary. I can't imagine that the little girl's ear wouldn't be the first stop for a kid with a fever.