NOT gas!

JenTheSchoolRN, BSN, RN · Sep 17, 2015

This is something that isn't taught in nursing school.."going with your gut." - That feeling that something isn't right even though it may appear so. Many years ago in the ER, I was triage, and a mom brought her 13 year old in, about midnight, because he got up to use the restroom and felt dizzy/unsteady on his feet that evening. The only history of activity was he and another kid were playing earlier in the school day and fell into a chain link fence....no pain, no marks, alert, all vitals were WNL...but something started ringing a bell in my mind that I couldn't explain...they registered and sat in the waiting room but I kept an eye on him (amongst the chaff and ER abuse, at our expense, that fills the waiting room)...anyway, later I looked over at the kid and noticed a faint sheen of perspiration had formed on his forehead/he was leaning over on his mom - and then the siren went off in my head. I yanked him up and dragged him to the only room we had open...in the back of the "fast track." A lot of stuff happened at that point but within one hour the kid was in ICU with a ruptured splenic artery. Prior to that, there he was...sitting there in our ER waiting room bleeding to death. After they were able to tamponade the bleed with about a zillion units of blood he was able to go to surgery for repair and ultimately walked out alive. So....you can't predict the future....but as others have shared - listen to that little voice and "go with your gut."

Great catch, OldDude! Little/growing bodies can compensate for a lot of things - that was one thing that stuck with me after getting through peds in nursing school. One second they can be fine, the next... :scrying:

Get instinct is so important in school nursing. I am still learning that I need to trust it and that it only gets sharper with more experience.

Farawyn · Sep 17, 2015

I'm impressed, OldDude.

mercurysmom · Sep 17, 2015

I am a true believer in gut instinct. My gut saved my hide (and probably a camper, too) when I was working at a fancy-schmancy summer camp, maybe 2 or 3 years after I became an RN.

10 year-old girl came into the infirmary to refill two water bottles (I had a bottled water dispenser in the Infirmary) and asked to take a nap. She told me that she was exhausted from climbing all of the "mountains" leading up to her cabin. She had only been at camp for about eight hours, mind you. Physical exam and vitals were all okay, but something just felt "off." I called Mom, who said that "Susie was a drama queen and needed to get lots of exercise, not nap all afternoon." Susie was 10, on the chubby side but not obese. I checked her health form and there were some lines left blank, and the MD sig was indecipherable and didn't seem to be close to any of the names of MD's at her Pedi practice. I called the pedi's office, and they had not seen her for nearly a year. She had weekly MH visits with a LICSW, but no medical visits, and no one at the practice saw her on the date that her camp physical was signed.

As it turned out, Dad was an adult orthopedic surgeon. He signed the form. No UA done, no BP, pulse, or Hct recorded. Dad and Mom were on their way to the airport and were going on a cruise. Mom made a comment about the way I was letting a 10 year old manipulate me, and if Suzy was coming down with something, it could be handled at camp. I kept Suzy in the infirmary overnight so that I could keep an eye on her.

Suzy went from the water dispenser to the bathroom and back to her cot at least every half hour. (You see where this is going...). At around 4am, she started screaming and crying, telling me that she's having a panic attack and begged me for a "sleeping pill" (no meds ordered.). She was frantic, had blurry vision, and My gut said enough is enough, and I brought Suzy to the tiny local ER for evaluation.

Yup. Big problem. Undiagnosed type 2 DM with non-ketotic hyperglycemia. Blood sugar over 900. She was airlifted to Boston Children's. Kid recovered. Now the butt-saving part: first, Mom was LIVID that I took Suzy to the ER for a "panic attack." Then, after the ER doc called her, she called me back and screamed at me some more because "You didn't tell me she was REALLY sick!"

Parents ended up complaining that they deserved a refund for camp tuition AND the price of the cruise that they missed because of the inconvenience of their daughter's illness. I documented the crap out of this kid from the first time she came to the infirmary and the first time I called home.

SchoolNurseTXstyle · Sep 17, 2015

I am a true believer in gut instinct. My gut saved my hide (and probably a camper, too) when I was working at a fancy-schmancy summer camp, maybe 2 or 3 years after I became an RN.
10 year-old girl came into the infirmary to refill two water bottles (I had a bottled water dispenser in the Infirmary) and asked to take a nap. She told me that she was exhausted from climbing all of the "mountains" leading up to her cabin. She had only been at camp for about eight hours, mind you. Physical exam and vitals were all okay, but something just felt "off." I called Mom, who said that "Susie was a drama queen and needed to get lots of exercise, not nap all afternoon." Susie was 10, on the chubby side but not obese. I checked her health form and there were some lines left blank, and the MD sig was indecipherable and didn't seem to be close to any of the names of MD's at her Pedi practice. I called the pedi's office, and they had not seen her for nearly a year. She had weekly MH visits with a LICSW, but no medical visits, and no one at the practice saw her on the date that her camp physical was signed.
As it turned out, Dad was an adult orthopedic surgeon. He signed the form. No UA done, no BP, pulse, or Hct recorded. Dad and Mom were on their way to the airport and were going on a cruise. Mom made a comment about the way I was letting a 10 year old manipulate me, and if Suzy was coming down with something, it could be handled at camp. I kept Suzy in the infirmary overnight so that I could keep an eye on her.
Suzy went from the water dispenser to the bathroom and back to her cot at least every half hour. (You see where this is going...). At around 4am, she started screaming and crying, telling me that she's having a panic attack and begged me for a "sleeping pill" (no meds ordered.). She was frantic, had blurry vision, and My gut said enough is enough, and I brought Suzy to the tiny local ER for evaluation.
Yup. Big problem. Undiagnosed type 2 DM with non-ketotic hyperglycemia. Blood sugar over 900. She was airlifted to Boston Children's. Kid recovered. Now the butt-saving part: first, Mom was LIVID that I took Suzy to the ER for a "panic attack." Then, after the ER doc called her, she called me back and screamed at me some more because "You didn't tell me she was REALLY sick!"
Parents ended up complaining that they deserved a refund for camp tuition AND the price of the cruise that they missed because of the inconvenience of their daughter's illness. I documented the crap out of this kid from the first time she came to the infirmary and the first time I called home.

Just wow!!! Poor girl to have 2 such idiots for parents. Thank goodness she got sick at camp and you followed up or the poor thing may very well have died if left to the devices of her parents. And dad is a physican???? Give me a break!!!! One of those sepecialists that can't see past their specialty.

SchoolNurseTXstyle · Sep 17, 2015

I find sometimes the "go with your gut" works in many different ways. I will have a kid with something so minor and silly that I usually don't even call a parent on but something about the kid's behavior just gives me a feeling. Sure enough, it is a parent that makes a mountain out of a molehill. Better to head those off instead of getting the angry call the next day.

nursmimi, BSN, RN · Sep 21, 2015

Update on the little tummy dude...it ended up not being intussusception, it was a mass and they removed it. Have not gotten path report on that yet. He is doing great and eating pizza as of this morning.

Farawyn · Sep 21, 2015

Update on the little tummy dude...it ended up not being intussusception, it was a mass and they removed it. Have not gotten path report on that yet. He is doing great and eating pizza as of this morning.

Thanks for the update. I hope he's okay.

Are you okay?

nursmimi, BSN, RN · Sep 21, 2015

Yes, thank you!