Missed a fracture.

Published

7th grade girl came in, banged her hand in gym. She had no swelling, good movement, good hand grasps and low pain level. I gave her ice since hands tend to bruise and sent her on her way. She came back later in the day holding her hand like a wounded baby bird.

I called her parents immediately, but ugh. They are not easy parents.

I feel like an idiot.

Specializes in School nursing.
I just love it, truly do love it when the staff comes in with that smirk on their faces and tells me "they knew all along". Well, pin a rose on your nose! If you happen to know tonight's lotto numbers - fill us all in!

Exactly! I suppose if you know how to do my job, you don't need me. Cool. Then I have a line of 5 kiddos right outside my office door waiting for you...:mad:

Up Vote Up Vote ×
I'd love to know how they knew it was broken. Give me a break!

I see what you did there.

Up Vote Up Vote ×
Specializes in Telemetry, Gastroenterology, School Nrs.

I don't think you did anything wrong. Unless there is some physical abnormality with appearance, there is no way for you to know that there is a fracture. I will sometimes give the student ice and ask them to come to see me in 30-45 minutes, so that I can take another look at the site. You called home after a second assessment, they shouldn't have a problem with that. I also generally call home to let them know an injury has happened and what I am seeing at the time, that way they are aware of what is going on and can monitor and make a decision later, if the child is still complaining.

Up Vote Up Vote ×
Reading this thread has defintely helped me feel better. I had a preschooler come into my office Friday who had fallen on her left wrist. No bruising or swelling, and let me palpate the area with no signs of pain at all when she was distracted by reading a book. She would also say it hurt when I touched other parts of her body such as her right knee, etc. so it seemed to me that she was just reacting that way because she was upset. I sent the student home regardless after 20 minutes and she ended up getting an x-ray but now I have staff coming in telling me they knew it was broken all along and I should have sent her home right away. Ughhh not the way I wanted to start my week

OHHHHHHH REAAALLLLLLYYYY? They knew it was broken because they are a radiologist trained to perform and read x-rays????????????????? The problem with staff is they don't know what they don't know!!!!!

Up Vote Up Vote ×
Specializes in School nurse.

Tranquillight, how fortunate all your teachers are licensed medical professionals!

Up Vote Up Vote ×
Specializes in School Nurse.

I always document - "No swelling or bruising seen at this time." Some injuries look different in a couple of hours, I tell student to return/tell parents for swelling or worsening symptoms (document that as well). I do ask if they know what swelling is (little ones do not), and then describe it as a balloon that fills with air.

Calling the parent as well.

Up Vote Up Vote ×
I always document - "No swelling or bruising seen at this time."

I chart it the same way-- "No bruising, swelling, or open skin noted at this time. Advise student to return for reassessment in an hour."

Up Vote Up Vote ×

A similar thing just happened at my school. A 3 1/2 yr old Pre-K fell on the playground. Staff carried her in to the office. She was crying and couldn't point to where it hurt. We reassured her, and I started assessing. When I got to the left ankle she winced when I touched it but no redness swelling or unusual presentation. I continued to calm her and iced the ankle for 10 min. She played with toys while resting on cot with ice. After 10 min I asked her to stand on. She refused to put wt on it. I called parents and they were there in 10 min. When student saw mom she started crying. I told mom what had happened and said she may need an x-ray since she refused to try to stand on that foot. I told her I thought the problem was her ankle. Mom said she would take her for an x-ray. Next day my Principal received an e-mail from the mom saying I was uncaring and cruel to try and make her daughter stand on a broken ankle (x-ray confirmed it was broken). How was I uncaring? She later apologized to the teacher and principal for her e-mail but said nothing to me about it. I get to see mom 2 x dly when she drops student off and when she picks her up. It is impossible to please everyone. And I cannot tell if bones are broken.

Up Vote Up Vote ×
Specializes in School nursing.
I chart it the same way-- "No bruising, swelling, or open skin noted at this time. Advise student to return for reassessment in an hour."

I write something similar to this all this time. I also hang a copy of the Ottawa Ankle Rules for Ankle Injury Radiography on the wall above my desk for reference - has helped me a few times.

I remember when I was in college and home on break, my brother fell off the swing set. He was 8 at the time. Landed on both wrists. Dusted himself off, no complaints. Wrists appeared fine. Next day, wrists a swollen mess; he had fractured both of them. He still shrugged, stating it didn't hurt much. Some kids...

Up Vote Up Vote ×
Specializes in school nursing, ortho, trauma.

Love it! now the Ottawa rules for ankle radiography are above my desk too! I love having my on-line colleagues show me cool things

Up Vote Up Vote ×
Love it! now the Ottawa rules for ankle radiography are above my desk too! I love having my on-line colleagues show me cool things

You all have taught me so much!! Just added this to my resource board too!!

Up Vote Up Vote ×

I love how we all share useful resources! It's amazing the helpful information out there!

Up Vote Up Vote ×
+ Join the Discussion