I WAS an RN in NICU (taking some time off to raise a family). I am unfamiliar with Phenergan. Obviously we did not use it in my area.
I have a very tragic situation....A very good friend of mine brought her toddler to our local ER for vomitting and dehydration from viral Gastroenteritis. The child was under two and small for her age (9.5 kg). After waiting more than two hours with symptoms worsening (vomitting blood), her child was given a Phenergan suppository 12.5. No IV was given. No exam was performed. My friend think it was actually the 50 dose based on the color of the packaging and size of the supp. Later, when her daughter coded, the child was given Epinephrine (excessive dose). I have been able to find out that Epi contraindicates with the Phenergan (Lippincott). Her child died. She had me look over the records and the Phenergan stuck out.
What has been your experience with Phenergan supp in pediatric patients? Thanks for your input.....Mom23
Specializes in CCU/CVICU, Hemodialysis, ER, PALS Inst..
I just read this thread and I am shocked that a little one under 2 was given phenergan at all. I am trying to remember in my 10 years if I have seen it given to a child under that age and I am almost confident I haven't. I gave 6.25 mg to a child that was about 4 not long ago and that's the last time I really remember giving it to a kid in a long time.
I am terribly sorry for your friend's loss. I definately think it warrants looking into but I also think that all things should be considered (dehydration, etc.)
I love Zofran too. It seems to work really well and many providers I work with are giving it first line instead of even trying anything else.
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
No way would this have happened in my er uh huh.
This child should have had at least a 500 bolus of saline or LR if not a liter or 2. We give compazine and benadryl togather in our er. And seriousely the others are right why go to the trouble of actually putting a line in if your not going to use it. I also agree with hotrod this child should have also had an Ng dropped and lavaged to check for bleeding, at my er we probabley also would have put a foley in to check output and kidney fuction and ua would have been sent a whole slew of labwork, and probabley an abd. ct to rule out an appy. Tell ur friend were all so sorry for her loss.:angryfire
rgroyer- In your ER a child under two would have drowned, and the outcome would be the same. Of course they would be well sedated with the Compazine and Benadryl, so breathing wouldn't be an issue.
Specializes in ER/SICU/Med-Surg/Ortho/Trauma/Flight.
Lol, thanks alot canoehead I was angry when I wrote that I meant though the child should have gotten at least 250 if not 500 of Lr or d5w, and I gues the reason the docs in my er give benadryl with the compazine is to reduce eps symptoms I dont know but all of them order that on everyone lol, If this was an adult a liter or 2 would have been good lol good day!
Just coming in at the tail end of this and have not read all of the posts. But I wanted to say I gave my 52 lb 6 year old 12.5 mg Phenergan (supp) after vomiting all day. I stayed right beside her because she had never had Phenergan before and I wanted to see how she would react. She was SO sedated that she barely even roused from her sleep to vomit. SCARY ! If I had not been right there to log roll her on to her side I have no doubt she would have aspirated many many times. Despite the meds she threw up about 3-4 more times. I will never allow a Phenergan Rx for her again.
More recently we were in the ER for r/o appendicitis and they used Zofran = NO problems at all.
Can someone tell me why Zofran is so expensive? I think they finally came out with a generic but that was still very expensive. I had a doc who refused to prescribe it because of the expense and insisted I try phenegran when I knew Zofran was the only thing that has previously worked.
I am so very sorry for the loss. When children die the world stops for the parent.
I have worked in a pediatric ER for 15 years and phenergan supp. were used many years ago, when that was all there was to give. Now we only give zofran.
I am currently working in a adult ER but we see many peds patients, and with my experience and when I am there I get all the peds patients.
Many caregivers are uncomfortable with handling pediatric patients and I believe that there should be a PALS certified caregiver available at any given time.
I would venture to say that this child was in hypovolemic shock, and had PALS guidelines been followed the outcome could have been different.
Specializes in Peds ED, Peds Stem Cell Transplant, Peds.
Well I work in a peds ED, I have actually worked in two separte ones in two different cities. The drug of choice is Zofran for vomiting. The only time I ever gave phenergan was to a teen with Migraines. Zofran is sooooo much safer, and has less side effects the phenergan.
Specializes in ub-Acute/LTC, Home Health, L&D, Peds.
I am so very sorry for the loss. When children die the world stops for the parent.
I have worked in a pediatric ER for 15 years and phenergan supp. were used many years ago, when that was all there was to give. Now we only give zofran.
I am currently working in a adult ER but we see many peds patients, and with my experience and when I am there I get all the peds patients.
Many caregivers are uncomfortable with handling pediatric patients and I believe that there should be a PALS certified caregiver available at any given time.
I would venture to say that this child was in hypovolemic shock, and had PALS guidelines been followed the outcome could have been different.
Again I am so very sorry for the loss.
I agree that there should always be a PALS certified caregiver on any unit that admits Peds. When my son was hospitalized he was on a med/surg unit in a small hospital and I really don't know if any of the nurses were PAL certified. I doubt it though. I think they did a fine job and I never left his side except very rarely to go to the bathroom. But that is what I was thinking is that if they are going to accept peds patients and it is not a peds unit they really are obligated to have someone who is certified available to take those patients. In my opinion. Also of course every ER should have at least one PALS certified caregiver avaiable on each shift, more than one would be better though!
even if there was an error in the dosage of phenergan, whether it was the order itself, or the nurse's error, i truly believe this child's demise was a result of lack of fluids. dehydration kills children. they simply can not handle a lot of volume loss bc of their size. the child should have received iv fluids promptly and before any other intervention.
it is the pals standard of care.
my sympathy to you, your friend and her family.
trish
pals cert
So it sounds like the Triage nurse is at fault for not recognizing that the child should have been bolused quickly and been evaluated more quickly. Very sad, very scary. I'm so sorry for the pain and sadness and I hope they will take legal action because this was a preventable death and calling attention to it will help prevent similar events in the future, I hope.
mamalle
114 Posts
I love zofran. we use in the outpatient center I work in. I have noticied some of my er docs ordering it more often than phenergan now adays..