Wednesday at 1:20 I had a 3rd grade student come in bawling and holding his arm after a fall on the playground. Initially he was able to move it and squeeze my fingers, but after about 20 minutes he said it hurt too much and refused. He was crying and yelling the whole time he was in my clinic, about 40 minutes, saying it hurt too much. No swelling, no blood, no bruising, no obvious breaks, full cap refill, etc. Instant ice pack applied, after about 15 minutes it was warm to the touch and his skin felt warm too, so I gave another one.
I called parents after about 10 minutes (when it became obvious he wasn't calming down), but they didn't get there until 30 minutes after I called. He'd calm down a little while walking (to get his bag) and when I told him he couldn't have water while crying due to risk of choking, but as soon as another person appeared the screaming would start up again. His dad said "he's a little sensitive," but he hadn't come to my clinic before now, so I had no idea what he was "normally" like.
Well long story short, he's got a fracture just above the elbow, still not back at school because the children's hospital has done two temporary casts and is doing a permanent one today. I feel horrible, like I should have told dad "take him to the doctor RIGHT AWAY," or at least "give him some ibuprofen RIGHT AWAY," but I didn't. I just keep thinking over it, wondering if there was something I was missing that would have told me he definitely had a break, something I should have assessed but didn't.
On the other hand, this is my first year as a school nurse, and my first fracture at school, so maybe I'm just being too hard on myself and need to take it as a lesson for the future? I don't know. Any advice would be much appreciated.
I tend to call a lot on MS injuries. In middle school, every injury is the worst, i have yet had a kid (for anything) give me pain level of less than 8. I let the parents make a decision if they continue to complain. No xray eyes here.
SchoolNurseTXstyle
566 Posts
I tend to call a lot on MS injuries. In middle school, every injury is the worst, i have yet had a kid (for anything) give me pain level of less than 8. I let the parents make a decision if they continue to complain. No xray eyes here.