Hey guys, I'm not sure if this is the right place for this topic, sorry if it's not! I wanted to ask your opinion of something I saw happen in a hospital this past week. I really feel like this Doctor made a huge mistake but wanted to see if this seems okay to you guys.
I went on a missions trip in the eastern US and worked with very underprivalged children this past week. At the begening of the week a five year old girl was playing in a gym when she ran into another little boy and fell face forward. I didn't see the little girl run into the boy but I saw her while she was falling. I watched the little girl at first because children fall a lot and get back up fairly easily most of the time so I didn't think she was that hurt. Well the little girl didn't get up, she didn't move at all. So I ran over to the little girl and turned her over. Her eyes were open but they were glazed over, she was breathing, but she wasn't crying or screaming or talking or anything. I said her name several times and she didn't respond. It was then that I noticed a large amount of blood quickly filling up her mouth, enough so that she would choke on it. I turned the little girl over so she wouldn't choke on the blood and it poured out of her mouth. Then I pulled her back onto her back and called her name several times. By this time there was a lot of people around us including a NP and a LPN, after maybe 10 or 15 seconds of the little girl being out she came back to consciousness and started cyring and screaming in a lot of pain. We got an ice pack and applied compresions to her lip which had been torn in the fall and was the cause of her bleeding. The little girl complained of nausea, her eyes staying cross eyed, and pain to her lip of course. The mother of the child was present and we decided to take the girl to the ED. The mother drove and I sat in the back with the little girl on the way to the ED. The car ride is kind of a blur because there was so much stress and panic. The little girl kept clossing her eyes and trying to go to sleep in between screams and lost consciousness at least 2 more times for about 3 seconds each time. The hospital was 25 minutes away and I was concerned that she could loose consciousness and stay that way so I called 911 to tell them everything that was going on and ask them if we were ok. They said we needed an ambulance right away so we pulled over and the ambulance met us and took us to the ED. When we got to the ED the girls pulse was 161 and she was still screaming inbetween trying to go to sleep. The nurse put her in the hospital bed and tried to sit her up. The little girl couldn't sit up and her entire body flopped over as soon as the nurse let go of her. Her resperations were somewhere in the 30's but her sats were like 98 so I was thinking that was ok. She didn't have a temp and I don't remember her BP. The DR came in looked at her and said she would be monitered for an hour. No IV was started, no labs were drawn, no blood sugar was checked, NOTHING at all was done for this hour. After an hour the child has stoped bleeding mostly, she was sleeping/crying and her pulse was 150. The DR gave her motrion and then wanted to send her home. The child was still complaning of all the same symptoms. At this point I was like wait a second, your not going to do a CT? The DR claimed that he didnt want to expose her to the radiation and that she was fine. To me it seemed like the DR had no idea what he was doing. I asked the DR what kind of things would be a cause for concern as we monitered her at home and do you know what he said? "Well if she looses consciousness" NO?!!!?? REALLY?!??!! Lossing consciousness is a bad thing???!!! Thats all he said!!! If the child was mine I would have demanded a CT and a Pediatrician. The girl went home and ended up being okay but I think the DR was just lucky. Would this happen at your hospital? Wasn't the DR putting the girl at a huge risk? Also is there anything else that I should have done for the child at the time she hit her head? Your input would be great, thanks!
It's not about the cost of a procedure (I hope!) it's about preventing a child being exposed to a frightening experience plus a dose of irradiation unless it is deemed clinically necessary.
Criteria have to be met in order to justify the use of CT and the assessing nurse and doctor will look at a whole range of indicators including methodology of injury and Glasgow Coma Score to name but two.
In my experience doctors tend to err on the over cautious and on occasions scan when a wait and see approach could be justified. I have to say given the improving observations (I would expect a pulse rate of 160 in a crying distressed child) and the normal GCS I would have supported the doctors proposed course of action.
That said I wasn't there and assessing on paper rather than in reality is always very different.
OP, I just recently took TNCC, I'll admit I'm no expert, so I will probably be flamed too.
My take on the situation-that's a time to call 911 immediately. Support c-spine, with possible head injuries you should always assume spine injuries as well. Good job clearing her airway. Judging by the age of the child and that she was clearly upset, those vitals wouldn't have been too terrible. The falling asleep between screams and nausea would have concerned me also. As nurses though, we do have to collaberate with the doctors and do as they say. There are ways of asking Doctors to do more test, ect. It involves playing the nurse/doctor game. "Doctor, this patient was unconscious after falling and now she is falling asleep between screams and complaining of nausea, gosh, do you think we should see if she has a head injury?" "No" "I guess I still have alot to learn could you please help me understand this?" Always protect their egos, you get more that way.
The child was okay, so...maybe the doc didn't have time to explain everything to you, but possibly what he saw from his ER years might explain why he didn't do all the tests he could have done. You could have maybe asked the nurse to explain. Now, they did observe the child for an hour, so possibly with no changes, there were no interventions needed.
Keep asking questions, good luck with nursing school.
I am thrifty, by all means. But if I had to "rack up a hefty ER bill" to be sure my child was safe, then so be it.
As far as the bolded statement, it means nothing to me. I have met some of the stupidest, most incompetent MDs in my lifetime.
I could say the same thing for a few nurses I know. Every profession has some idiot that is flying by the seat of his pants. Generally speaking though, doctors know what they're doing.
If you had to pay for it out of your own pocket opposed to having it billed to your insurance would you feel the same? A lot of people don't care about racking up hefty medical bills because it's one thing to have an insurance company pay $2,000 for an ER bill than it is to have to pull $2,000 out of a bank account or charge it on your personal CC. Now lets imagine if the doc said the child is fine but if you want a CAT scan then go to the cashier and pay her in advance for this unnecessary test.
This is the problem with health care today...people feel that money is no object as long as the bill is going to the insurance company or the govt.
Just my:twocents: and I humbly apologize if you meant that you would have no problem spending your hard earned money to pay for a test that has been deemed unnecessary.
I am thrifty, by all means. But if I had to "rack up a hefty ER bill" to be sure my child was safe, then so be it.
As far as the bolded statement, it means nothing to me. I have met some of the stupidest, most incompetent MDs in my lifetime.
if it was my child losing consciousness, a ct scan would've definitely been done especially since they're going to charge you a ton of money anyway. furthermore, doctors may be taught assessment skills. however, many doctors don't even use them and instead ask the nurse about the physical assessment of the patient. there are incompetent doctors just like there are incompetent nurses.
I don't believe in overtesting or putting all my eggs in the lab basket, but clearly the staff didn't do so hot on communication. A couple of minutes might have aleviated a lot of concerns/fear. I firmly believe teaching is always part of the job even if you only have 30 seconds.
Thank you for your replies. I can see both sides better now.
LTC RN JC: Thank you for your post. Its true that when questioning anybody, especially a Doctor the way you phrase your question means a lot. I wish the ED Dr. had explained like you had! That would have helped a lot!
For my child yes I would spend tons of money on a test that might not be necessary. If it means the childs life or quality of life. There are already going to charge you a few hundred just for saying hello to you, might as well cover all your bases. Besides assuming that there is inusrance your not paying it anyways. I don't see a problem with sending large bills to insurance companys. Thats what their there for, paying the bills. And if there is no insurance well that sucks but the kids life is more important.
Well, as far as communication, the doc didn't explain things to the OP who is apparently of no relation to this child, just a random person doing missionary work, so why would he?
The doc did an assessment. The doc made a diagnosis. The kid is fine. If the kid wasn't fine, you'd take them back to the ER. But the kid was fine.
The doc also didn't do a full skeletal survey. The doc didn't do a VCUG. Why not a liver biopsy and a full septic workup with 3 days in the hospital on IV antibiotics until the cultures all come back negative? There's a lot of things the doc didn't do because they didn't need to be done. The kid was FINE.
To the OP, when you're in these impoverished countries in the future, you won't have a CT machine available. You're going to have to trust the assessment skills of the people around you.
It's not about money. It's about unneccesary radiation. What is a CT's radiation? Something like 2 years worth of radiation? Not to mention, unless she was showing severe signs of mental status change, a CT in most cases isn't even going to show something.
Just because a test is available, doesn't mean it needs to be done. Procedures are limited to bare minimum for kids. If they don't need an IV, they don't start an IV. BECAUSE IT MAKES THE KID MORE AGITATED. Agitation leads to increased heart rate/respiratory rate, if the kid DID have a brain bleed going on, that would make things worse. Stick a kid in a giant piece of metal on an uncomfortable metal table. WILL MAKE THINGS WORSE and like I said, a CT isn't going to show things at that point anyway unless they were bad enough to be creating more extreme mental status changes.
Geez o peezo. Can't a student ask some experienced nurses some questions without being critiqued on paragraph and sentence structure? This is the mentality of some nurses that I wish would just go away. I am a new nurse of one yr myself and remember being hypervigilant about certain pt's I was assigned to as a student; just seemed to come with the clinical territory and "by the book" thing going on. Why is it important to respond to OP's with condesending remarks, dissing them for help with a homework question, or feel certain that the OP is troll. To the OP, you had some decent skills going on in that circumstance, and now simply questioned if enough was done for the little girl. I've seen youngsters topple off their bicycle, split their lip and see stars and a few other symptoms similar to the OP's scenario. Parent takes them into ED and a stitch or two and they're good to go. Two days later they are back in with a subdural hematoma. Give these baby nurses a break. Just sayin.
You're more likely to be given a break if you don't come in looking for verification that the big bad ER doc was wrong and doesn't even know as much as a nursing student. If you want to learn, you don't come on and say, "I saved her life and then the doc didn't even run enough tests! And I've known lots of stupid docs!" You say, "This happened, and I would think they'd have done a CT, why didn't they?"
snoopy29
137 Posts
It's not about the cost of a procedure (I hope!) it's about preventing a child being exposed to a frightening experience plus a dose of irradiation unless it is deemed clinically necessary.
Criteria have to be met in order to justify the use of CT and the assessing nurse and doctor will look at a whole range of indicators including methodology of injury and Glasgow Coma Score to name but two.
In my experience doctors tend to err on the over cautious and on occasions scan when a wait and see approach could be justified. I have to say given the improving observations (I would expect a pulse rate of 160 in a crying distressed child) and the normal GCS I would have supported the doctors proposed course of action.
That said I wasn't there and assessing on paper rather than in reality is always very different.