Stethescope for peds..

[rn29306]

Today I worked in the pre-admission testing for the outpatient peds OR today and somehow let a child slip by that had crackles in one lung. Not that it is someone else's position to catch my mistake, but the RN didn't hear it either. CRNA about to do the case supposedly heard it and case canceled. I honestly never heard it. Parents upset and MDA even more so. I know what lung sounds are heard as, I don't think my brain or ears are the problem. He was a little underdeveloped preemie when he was born and didn't appear to grow much since then.

My question to you guys is "What stethescope do you use for your PEDS patients?" My littmann master cardiology has a fairly large head on it, I know they make an adapter that goes to a smaller size supposedly for bones and joints, but I think this is what reached up and bit me today as he was really tiny. I kind of need to avoid this repeat episode that happened today, I was wondering if any of you bought specialty peds stethescopes, esp for the really little ones.

Thanks guys,

now 1/2 posterior rn29306

[TennRN2004]

Something to consider...maybe the child was clear when you listened, then had rales in the OR. How much time passed between when you assessed and when the child hit the OR? As we all know, assessments can change minute to minute.

Obviously, that's the reason CRNA did their own assessment. Don't let them (and yourself) automatically assume it's because you missed something.

I worked on a healthy mother/baby unit for a while, and the little ones are harder to pick up on things. We did have pedi stethoscopes that made it a little easier, but honestly I don't think there was that much difference. JMO. Don't beat yourself up about it. Just be confident in your skills as a nurse, and don't make this one situation cause you to doubt yourself.

[suzanne4, RN]

Lung sounds can change quite rapidly on these little ones. You could have heard clear when you listened, and when it was time for the case, things changed.....what was the lag in time, how many hours?

If you are talking pre-admission then chances are you are talking of a couple of days..........anything can happen in that time, and it is nothing to feel bad about. You did nothing wrong.

[rn29306]

this instance was show up at children's outpatient surgery, nursing assessment, anesthesia assessment (yours truly), preop PO versed, atropine, t3 by my order, then off to OR after 15-20 minutes. i really don't think that he changed that much in 20 minutes unless he aspirated the entire cocktail, which i doubt, but then again not only did i miss the junky lungs, the assessment RN didn't hear it either. who knows.

thanks for the concern, peds isn't really my favorite population to work with anyway.

rn29306

[air]

"What stethescope do you use for your PEDS patients?" My littmann master cardiology has a fairly large head on it, I know they make an adapter that goes to a smaller size supposedly for bones and joints, but I think this is what reached up and bit me today as he was really tiny. I kind of need to avoid this repeat episode that happened today, I was wondering if any of you bought specialty peds stethescopes, esp for the really little ones.

Thanks guys,

now 1/2 posterior rn29306

That master cardiology should do the trick, you should just vary the pressure on the diaphragm/bell of the stethescope during ascultation.

If you want to you can get one of those attachments or buy one for peds.

[DelightRN]

How big of a kid was he? In my experience, I've used both the master cardio and neonatal scopes, depending on the size of the child.