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!
Now I'm just a new grad so I'm in no position to nitpick your post and I won't flame you, but here are some tips...
I did not read through the posts so I apologize if this has been said, but next time you come across a possible/definite head injury please use c-spine precautions and immobilize.
Also, while you are immobilizing the child have someone call 911 immediately call me a Nervous Nelly, but I'd almost never transport a child with a moderate to severe injury of any kind...
Always always always remember your ABCs for everything. You did really well to clear the blood from her mouth to maintain her airway (again, there is a way to do this while maintaining c-spine). Obviously her airway & breathing was fine since she was screaming so that's great. Then you moved on to put pressure on the lac...perfect.
As for the MD, I really don't think he was out of line but you could have taken her to another ER for a second opinion if you felt she needed at CT. Just like the nurses, he has a license to protect...he's not going to risk it by not ordering a CT if he feels the kid is in danger.
It might help if you look up what normal respiratory and heart rates are for a five year old child as you seemed focused on these "abnormal" findings. You will find that they differ greatly from the population you usually care for.
To the op,.I wasn't there. I didn't see the child. But as an ER nurse, who see's this all the time maybe I can try to help you understand what the doctor was thinking.
First of, a fall from a standing position (as opposed to a MVA or fall from a roof) is very unlikely to cause a severe injury in an otherwise normal healthy child. As another poster said,...it's okay to let these kids sleep,..when was the last time you had a good hard cry?? It makes you sleepy :)
When was the last time you fell or were hit hard enough to "knock the wind" out of you? I remember that feeling after falling on my back out of a swing. Scary stuff,..makes you feel like you can't breathe or move for a minute or two!
We look for unusual behaviors and neuro deficits. Was the child moving all her extremities? Was her vision changed? Was she acting appropriately for a kid who just got the wind knocked out of her and "oh my gosh there was blood"? Kids usually over react. They are scared. We expect that, it's normal.
I was told at a recent Trauma seminar that for every 100 CT's we do, we give one person cancer. If the doc thought the kid was acting normal. Neuro was normal, and even watched for an hour to be sure,..how would we help that child by sending her to CT? Most kids don't like to be still in the CT,..then we need sedation (a whole new set of risks),..then we tell Mom the CT was normal,..but now in theory she has a 1% of having cancer that she didn't have before she came here. Did we really do what was right for the child,..or harm the child in order to make everyone feel better.
As a Mom I completely understand the idea of no matter what it costs make sure my kid is okay! But,..let the folks who are trained in these situations make the call!
call me a Nervous Nelly, but I'd almost never transport a child with a moderate to severe injury of any kind...
From what has been stated here, the child did not have a "moderate to severe injury." The child fell from a standing position and sustained a lac somewhere (lips, tongue, oral cavity, somewhere) that did not require suturing. The child was monitored, and then discharged.
OP, if you want to gain some knowledge from this experience, then ask yourself ... what was I looking for to be different? You mentioned labs ... what labs would you have been looking for and what would have been the clinical significance of the results? What are normal vital signs in a 5-year old and were the vital signs of this child concerning?
From what has been stated here, the child did not have a "moderate to severe injury." The child fell from a standing position and sustained a lac somewhere (lips, tongue, oral cavity, somewhere) that did not require suturing. The child was monitored, and then discharged.
Right, but the potential was there for a head & spinal injury which I would consider "moderate to severe" in nature.
Like I said, maybe I'm overly cautious r/t kids, but I wouldn't have transferred her. OP said it was a 25 min drive I believe. A LOT can change in 25 min...especially with kids.
Geez Louise. OP, I certainly do think you got flamed unnecessarily, for asking a simple question. Never have I seen so many uptight, pompous ppl. Chill out. If you couldn't answer the lady's question in amicable manner, then maybe you shouldn't have answered at all. Ugh.
In Australia in the hospitals I have worked in, any child/person who hits their head/suspected of hitting their head is given a CT - mainly to cover the hospital not them (that's reality unfortunately), so the hospital doesn't get sued.
So what if the poster isn't an RN? Does it matter? I think it is great the poster is asking for advice under what could have been a disastrous situation. If we can help educate people on here that is great too. You don't have to be an RN or nurse to be in situations like this - my Dad was a supervisor and had to deal with situations like this ie: work accidents all the time, and he was highly trained in advanced resus/CPR techniques etc, and he had to sit exams as well.
RescueNinja
369 Posts
Now I'm just a new grad so I'm in no position to nitpick your post and I won't flame you, but here are some tips...
I did not read through the posts so I apologize if this has been said, but next time you come across a possible/definite head injury please use c-spine precautions and immobilize.
Also, while you are immobilizing the child have someone call 911 immediately call me a Nervous Nelly, but I'd almost never transport a child with a moderate to severe injury of any kind...
Always always always remember your ABCs for everything. You did really well to clear the blood from her mouth to maintain her airway (again, there is a way to do this while maintaining c-spine). Obviously her airway & breathing was fine since she was screaming so that's great. Then you moved on to put pressure on the lac...perfect.
As for the MD, I really don't think he was out of line but you could have taken her to another ER for a second opinion if you felt she needed at CT. Just like the nurses, he has a license to protect...he's not going to risk it by not ordering a CT if he feels the kid is in danger.