Tips for bringing your child to the ER (rant)

Long Term Care Columnist / Guide · Dec 20, 2003

Excellent post, but people with the mentality of those described wouldn't know how to read such a list!

ER-RN2 · Dec 20, 2003

Also, let your child crawl all over the ER floor and eat things off the floor, and then tell the nurse "I just don't know why they are sick":idea:

LilgirlRN, ADN, RN · Dec 20, 2003

Believe or not parents have concluded that if they do not treat the child's fever then they will be seen faster, so they treat the kid up until 4 hours before coming in and then give them nothing for fever. Most of the time they are right, I do not want a kid with a temp of 105 out in the waiting room or even in triage with me. I want them in the back where the doctor is in case there is a seizure. We have been so busy lately however that I treat temps of 103.5 and put them back in the waiting room and just recheck the temp later. I can't imagine witholding treatment just so that I can get the visit over with more quickly.

harry Krishna · Dec 20, 2003

Originally posted by LilgirlRN
Believe or not parents have concluded that if they do not treat the child's fever then they will be seen faster, so they treat the kid up until 4 hours before coming in and then give them nothing for fever. Most of the time they are right, I do not want a kid with a temp of 105 out in the waiting room or even in triage with me. I want them in the back where the doctor is in case there is a seizure. We have been so busy lately however that I treat temps of 103.5 and put them back in the waiting room and just recheck the temp later. I can't imagine witholding treatment just so that I can get the visit over with more quickly.

Febrile seizures are caused by a rapid rise in the temp not how high it goes. Infants could have a seizure at 101.

I do see what you are saying though, I am not criticing, just throwing out a piece of info.

SmilingBluEyes · Dec 20, 2003

good advice....

but you are preaching to the choir, I fear. the ones who MOST need this advice are NOT getting it here....

excellent points! I can't blame ya for the rant.

flashpoint · Dec 20, 2003

We see it all the time...people will bring kids to the ER with huge temperatures and tell us they didn't treat it becasue they want us to see how bad the temperature is. We're also had people come in and tell us not to give their child any pills or liquids becasue their child won't take them...don't give the cild any shots either...he doesn't like anything that hurts. (???) We've also been seeing a lkot of people who see the doctor in the clinic in the morning and are in the ER in the evening...didn't bother to start the prescriptions, but they are mad as hatters because their kid isn't feeling better yet.

We give any kid with a fever tylenol or motrin before they go back to the waiting room or before the doctor sees them...we never make people prove they have diarrhea, we don't get proof for fevers either. :)

NYCRN16 · Dec 20, 2003

I should have added, we give motrin or tylenol at triage to any kid with a fever, and then send them back out to the waiting room and recheck the temp in one hour if there are no beds available. It seems that all the children we are seeing have temps of 105, so we cant have them all in the back with the doctor in case of a seizure. If they happen to seize, then they will be taken back. Luckily, none of them have had that happen.

MICU RN · Dec 20, 2003

That is exactly why I don't miss the ER and have no desire to go back. It is not worth twenty something dollars and hour, and guess what? It only is going to get worse as more people use the ER as a primary clinic b/c of lack of insurance. I can see why some er docs are willing to do it , mainly b/c of the shift work and they make anywhere from 150k-250k a year. But as a RN you can find shift work in many other areas and get paid the same 40k-60k and not have all the headaches. But hey someone has to do it, I am just glad it not me anymore. Don't get me wrong, we need good nurses and doc's attending to the ER, but it can sure be a thankless job at times.

SnowymtnRN · Dec 20, 2003

Originally posted by imagin916
I was working in the pediatric ER the other night, and by the middle of the shift, I felt like jumping off the Verazzano Bridge. We had about 50 people waiting to be seen in the waiting room, with the average wait time about 6-8 hours. I am tempted to print this out and post it by the area where you sign in.

Feel free to add to this list!!

1) If your child has a fever, TREAT IT. Please dont let your baby have a 106 fever all day and not give them motrin or tylenol because "you want us to see that the child has a temp" or "my child doesnt like the taste of medicine". I doubt you or your child will like going into febrile seizures either. It wasnt the best idea for you to let your child have a fever for 3 WEEKS and then come in and expect to be seen RIGHT NOW.

2)If your child has a fever, dont keep them bundled up in a snow suit, 3 sweaters, wrapped in 2 blankets. I know the baby feels chilly, but they dont need to accumulate any more heat.

3) I know you know how much your baby weighs approximately, but we DO need to weigh the child again, and yes, we also need to weigh them without all the clothes/shoes on. Pediatric medications are based soley on weight, and we need an exact weight in kilograms order to not over/underdose them.

4) The order of being seen is based on patient acuity, not time of arrival. The child that checked in 2 minutes ago that can hardly breathe IS going to be seen before your child with the flu. Yes, we know your child is sick and that you have been waiting here for 6 hours, but the ER is not first come first serve. We need to see the sickest (and youngest in some cases first) The baby who is 6 weeks old who is sick cant wait, but the 2 year old probably can. We are trying our best to get you in and out as fast as we can.

5) Yes I know your pediatrician called ahead and they sent you here, but so did everyone elses. It seems that pediatricians these days are sending people to the ER for bloodwork/x-rays, ect that could wait to be done in SOME cases until you can get to the lab/radiology center the next day. If waiting to the next day is an option, do it. Chances are, you will be in the waiting room until the next day anyway before you are seen.

6) If your child has an earache or some other minor ailment, please bring them/call the pediatric office before you head to the ER. I promise you, if you bring your child to the ER for an ear infection or strep throat (unless instructed by your doctor or the child has an extensive medical history), you WILL be there all night waiting.

7) Yes, we do need to do a rectal temperature. I know your child doesnt like it, but we need the most accurate temp when the child has a fever in order to treat it.

8) If your pediatrician is sending you over, please ask for written instructions/orders. Parents tend to overdramatize the childs condition, and when I read the report/orders from the doctor they are usually much different from what the parent says. The parents will tell me that the child is in "severe respiratory distress" and the report says mild/moderate, and the child is sitting up, awake with an oxygen saturation of 100%. Besides, 9 times out of 10, the doctor will have given the child medication in the office and we need to know exactly what was given, how much and what time. Telling me that the child got "two breathing treatments and a steriod" doesnt help.

9) I know waiting in the waiting room is equal to a stay in hell, but I dont advise you to be going in and out. If they call you while you are out, they are going to think you left, and you probably wont be called again. If you really need to go outside to make a phone call ect, let the clerk know you will be right back.

10) I know you and your child dont like having an IV started or having blood drawn. Sometimes we need to do this. Dont start crying or freak out while we are doing this. Your reaction has a huge impact on how the child reacts. If you act like we are stabbing you in the neck, the child is not going to be calm either. Once the IV is in, please dont touch it. I know it sometimes hurts, but if you fiddle with it and it falls out of place than we need to do it all over again. If it looks "funny" or is causing pain, call the nurse/doctor and we will take a look at it and see if its OK.

11) If you gave your child any medications before you came in, please write down/remember what time you gave it, how much and what you gave them.

12) We know you have been waiting a long time, but we honestly cannot tell you when you will be seen. It could be 10 minutes, it could be 10 hours. Coming to the desk every 5 minutes asking, trying to choke the clerk, or trying to break the door down (this actually happened) is not going to get you seen any faster. In fact, it may buy you a visit from the police and/or child protective services.

I KNOW this was a rant. I've been there working in the ER (not full time yet, butyou KWIM) but TRY to keep in consideration a few factors. Of course some of these i'm speaking as a mother, not a RN.

MANY pediatricians instruct their parents NOT to treat fevers. I've gotten into many battles with my past peds over this. I'm not about to let a fever climb over 103 and NOT do anything.

Many people don't have insurance, or they can't get into their pediatricians office for treatment. They'd RATHER go there of course, but when you've been up with a sick kid for days, what are you supposed to do?

Nobody th inks that another child is sicker than theirs. Its all about THEIR needs in the moment. BUt preaching to them about bringing in orders (which many docs won't do), wanting to know what meds specifically they've gotten (when often doc office nurses won't even tell them what their child is getting) probably IS asking a bit much. yes its a PIA, but honestly they just want their child to be better.

I COMPLETELY agree with your rant however. Many times its amazing how stupid some parents can be. But as a parent, i try to remember that if i were in their situation and didn't know what i do as a nurse, i'd probably be freaky too. kwim??

kids · Dec 20, 2003

My personal favorite (from doing phone advice/triage):

No, head lice is NOT an emergency.

and

Yes, you will have to treat your child, including picking the nits out yourself.

athomas91 · Dec 20, 2003

i would like to add a few points to the already excellent rant....

1) if your child is vomiting (probably once prior to coming in) - those doritos and chocolate milk are probably not the best idea

2) i don't need to see the diarrhea that you've saved over the past 24 hours

3) telling a nurse "you only get one stick and i am outta here" is not a good idea

4) "they won't take their medicine" is not a good reason to come to the ed - MAKE them take it

5) we may actually NOT find the cause of that generalized abd pain and no we are not doing ultrasounds etc tonite....

6) tylenol and motrin ARE NOT the same - and guess what - they can be used together