"Hypothetical" Situation

[BrisketRN]

If you had a student with an apparent dislocated elbow/broken arm with mild swelling, full movement in fingers, good cap refill, low pain would you agree with the following treatment?

• Finger movement and cap refill checks q 5 min
• Immobilize arm by placing in lap
• Waiting 30 min for parent to arrive as long as vitals stable/normal cap refill/no swelling of lower arm/arm remains in immobilized position

Should the arm be immobilized in a sling or should it be kept straight if that causes the least pain for the child?

Would you have done anything differently?

At what point would you call 9-1-1 for this type of injury?

[CanIcallmymom, BSN, RN]

1 hour ago, nursej22 said:

This same er probably let the patient sit in the waiting room for an hour, like they did for my son with a dislocated shoulder and another son with 3 rib fractures and a small pneumo.

Yes, I almost even used the same logic in my reply but erased it. As an ER nurse (former) would I feel comfortable letting them wait for a (hopefully) short while until an appropriate room was available? If so, then why would they need an ambulance to rush them to the waiting room? Would this be material for a hall bed? Idk.

[UrbanHealthRN, BSN, RN]

When a person breaks a bone, basic instinct (usually) kicks in and that person will try to keep the broken limb still, because moving it = pain.

If the fracture is on a part of the body where it would be difficult to keep still (like trying to ambulate to the car with a patellar fracture), sure, splint it or find some other way to safely move the student. If the student has very poor body awareness and can't keep still, then sure, splint it for safety.

Sounds like none of those special situations applied to this kiddo. In which case, good job!

P.s some folks always want to be the ones to heap on the bandages, ointments, splints, and other medical equipment. I think we forget that if any of these items are used incorrectly, including splinting a fracture, more damage can be done that just leaving the injury be.

[Cas1in72]

22 minutes ago, UrbanHealthRN said:

When a person breaks a bone, basic instinct (usually) kicks in and that person will try to keep the broken limb still, because moving it = pain.

If the fracture is on a part of the body where it would be difficult to keep still (like trying to ambulate to the car with a patellar fracture), sure, splint it or find some other way to safely move the student. If the student has very poor body awareness and can't keep still, then sure, splint it for safety.

Sounds like none of those special situations applied to this kiddo. In which case, good job!

P.s some folks always want to be the ones to heap on the bandages, ointments, splints, and other medical equipment. I think we forget that if any of these items are used incorrectly, including splinting a fracture, more damage can be done that just leaving the injury be. 

THIS 1000%. Sometimes doing nothing is DOING something. Honestly, splinting can be a scary thing, especially when you dont actually know what the dx is.

[Flare, ASN, BSN]

i had a student with a dislocated elbow earlier this year. I ended up calling 911 for emergency transport, but here's why:

Student's pain was level was severe.

Parent gave no indication of WHEN someone was coming

I wasn't sure that we'd get compliance in taking the child for appropriate treatment due to lack of insurance.

I waited about 20-25 minutes after the initial call to the parent who stated they'd "call right back after finding someone to get him" to call again. When there was still no definite plan, I called the audible to rely on EMS.

From the OPs description, it sounds like that particular case was handled appropriately.

[bluebonnetrn, BSN, RN]

I was once asked by a parent to call EMS for a fractured finger. After I explained that the ambulance would bill the family and not the school it was agreed that it wasn't necessary.

I did have to call for EMS assistance once for a dislocated patella. This child was in a lot of pain and between, mom, dad and I we could not get her into the private vehicle for transport. When I called 911 and explained the situation they asked "how old is this child" and I replied 12 and was scoffed at. ummm... sorry but this 12 year old is bigger than I am and 3 adults weren't able to get her into the car. Anyway, the EMS guys came, understood the situation and eventually were able to get her into Dad's car. So it took 3 firefighters to get her in the vehicle! They were very helpful and totally understood why I made the call.

[OyWithThePoodles, RN]

On 2/14/2020 at 12:37 PM, BiscuitRN said:

Non-medical professional guardian claiming to quote ER staff.

I had this this year. A parent telling me that the ER staff said I should call EMS for a SPRAIN. I let him know that I do not call EMS unless there is an open fracture, loss of consciousness, or a parent cannot be reached in a timely manner. I got a hold of mom immediately and she picked him up within 15 minutes. OY WITH THE POODLES! I mean, I wish I could demand an ambulance instead of calculating in my head how much the trip is going to cost me.

[Csn2016, BSN]

I agree with all the input from the other nurses...

Wanted to point out from the parents side maybe they should thank you for avoiding the ambulance fee....I had to call an ambulance when my 1 year old had full blown grand mal seizure that lasted well over a minute. Scariest moment of my life even with years of ER experience long story short she spiked a sudden fever (no indication of illness prior to)...BUT we had an 1800$ ambulance bill! We have great insurance too....So yeah maybe you should bring that to everyone's attention because the parents could dispute that they did not want the ambulance and could have refused to pay the bill and pin it on the school.

I think you handled it perfectly

[ihavealltheice]

On 2/14/2020 at 11:43 AM, Cas1in72 said:

No way that needed a 911 call. Who knows, the "ER staff" might have been housekeeping ( not a slap to housekeeping staff) but I would let that roll off my back.

This! Once you get to the hospital, ALL people wearing scrubs are considered nurses. I remember getting dinged so many times on surveys by the "nurse who brought me my lunch" or the "nurse who cleaned my room" or the "nurse who took my xray"

@BiscuitRN, you did everything right!!

[BrisketRN, BSN, RN]

Thank you everyone for all of the responses. I'm the only medical professional over here, so being able to debrief with some more experienced nurses helps so much.