questions to PICU nurses

[feebebe23]

OK I know this is a wierd question....

Long story short a friend of mine and her 2 children were in a terrible MVA in Arkansas about 2 months ago. The youngest child 4yo boy is now a quad....

He was care flighted to Ark pedi hospital where they kept him for about 3-4 weeks and never did any surgeries. They also said that he could not be transported back to Dallas (where he is from) LOW AND BEHOLD when his 1 million lifetime ran out they PAID for his transport to Dallas. Once in dallas he had his first surgery with in days resulting in him being able to sit up in a wheel chair, he is no longer vent dependent, can eat liquids, and has had his trach uncapped to he can talk....

Does it sould like he had a delay in treatment because the Ark. hospital would not transfer him until his lifetime max ran out or am I being perinoid??

[NotReady4PrimeTime, RN]

Sounds suspicious to me. What do the docs in Dallas say? Has he been harmed by the delay in treatment, or would he be how he is regardless? You're probably not paranoid. They should be asking questions, lots of them.

[CarpeDiemRN]

I agree- ask some questions, but be careful about assuming that appropriate care was delayed during his time in Arkansas.

We get alot of MVA victims, and they can require intensive therapy lasting weeks to get them to the point that they can go to rehab.

For instance, he could have had brain swelling- in which case they might insert a bolt or IVC into the brain right at the bedside.. no trip to the OR needed. They could have been doing hypothermia therapy, and using medication to manage ICP spikes. He could have been on vasopressor support, had lung injury or diaphragm paralysis requiring extensive vent support and lengthy weaning process, developed infection/sepsis, or developed storming. Many of these patients lose some of their ability to autoregulate their body functions and it takes some time to convert them to medication that they can take once they leave the PICU, to manage this.. not to mention establishing motility, priming the gut- getting a bowel/bladder regimen established. A patient will typically fail extubation once or twice before they decide to put in a trach, and in our facility nobody goes anywhere until the first trach change so the stoma heals- our standard is 5 days to do this. (although, putting in a trach would be a trip to the OR- so i'm not clear if this happened in arkansas or dallas from your posting). Before a child would be allowed to take anything by mouth they'd probably do a swallow study.

Getting out of bed, initiating PT/OT, fitting a child with a passy-muir valve are all rehab type interventions... unfortunately, many patients endure some delay getting into rehab d/t insurance processes... and in the instance you speak of, they had to coordinate medical transport too. If a child is out of town, they will usually try to set up rehab where they live... and that can take some effort to coordinate. I'm not sure what the surgery is that he got in Dallas- maybe an orthopedic procedure? This might fall to the bottom of the list, behind neuro function, airway management and cardiac function.

Again- find out what they did do for him in Arkansas... it's possible that they were busy saving his life... not necessarily "delaying" needed treatment.