UGH! May have missed something

[100kids, BSN, RN]

5th grade boy came in 2 days ago after recess and says his pinkie hurts, he hit it during recess. I look at it and it's not swollen or misshapen. He lets me feel it and there's notihg that seems out of the ordinary and he is not in obvious pain as I'm touching it. He moves it so I gave him some ice. He asks to return to class after a few minutes and I tell him to keep the ice on for 10 minutes come back if it does not feel better. I see him later in the hallway joking with some classmates and he doesn't come back to see me. Flash forward to this morning, mom sends in a note that his finger is still swollen and painful amd she thinks he may have broken it in school Monday so Dad is going to pick him up @ 10:00 to take him to the Dr to check. UGH! I hate to have missed this and screwed up.

What else should I have done?

[Flare, ASN, BSN]

Did you contact the parent after the initial injury? I don't know that i necessarily would have, but as long as your assessment is well documented, you'd be okay. did you check ROM? If that was okay along with everything else then i'd have high suspicions that the kid hurt himself after the initial incident and it's getting pinned on the injury 2 days ago. If the ROM was limited, there is a sliiiiiight possibility that he jammed it, but in the absence of swelling, deformity, pain and self limitation of horseplay - i'd be doubtful. I suppose if it was mildly irritated from the incident monday and aggrivated it further afterward in a different incident, causing swelling and pain.

The only thing i do as a part of my checks that you may not do is to use a tuning fork to help rule out a fracture- it sounds like you did everything right.

[bsyrn, ASN, RN]

i would not worry about it at all. you did a good assessment and treated appropriately. maybe next time just call the parent.

flare- how do you use a tuning fork to help rulw out a fracture? i never heard of that and am curious.

[100kids, BSN, RN]

Thanks both of you for your responses. Dad took him to the Dr and he does have a small fracture. I didn't contact the parents after the initial injury because I really didn't think it was anything. I probably will do it more so going forward even if it's nothing. Anyway thanks for making me feel better!

[Flare, ASN, BSN]

bsyrn - we had an orthopedist come in and show us this trick! You take a tuning fork (available in School health catalogue for about 5 bucks) and whack it on a desk to get it vibrating then put the end of the stem of it on the bone where the injury is. If it's likely broken, they will wince/ cringe/ have some type of reaction to the vibration of their bone. I don't consider it definitive, but it is another trick to help take doubt out of your mind.

There is also a method using a tuning fork and a stethoscope to listen for fracture in a long bone.

[Purple_Scrubs, BSN, RN]

Ugh, I hate it when that happens. Unfortunately, none of us that I know of has x-ray vision (Supernurse, where are you?), so occasionally it does happen. You just have to make the best assessment you can at the time and go with it. Honestly, I probably would not have called home for the situation you described. I had a very similar injury yesterday and I chalked the student's response to being a drama queen. Fortunately mine had a better outcome, and there was no underlying injury, but had the fates been different I might have been in your same predicament. Assess, document, and pray for the best. We are all human and we will sometimes get it wrong. Try not to beat yourself up about it.

My most recent snafu was a student who c/o CP only when she coughed. Afebrile, VS wnl, heart and lungs sounded great. Just had a minor cough. I chalked it up to sore muscles from coughing. This was the Friday of a long weekend. On Tuesday I found out she had been hospitalized over the weekend with pneumonia. Ouch. Luckily she was fine and the parent understood that it must have been early in the disease process. I still felt like crud about it.

[QuirkyRN]

I just had a similar situation yesterday with a toddler that fell on the playground. As far as the teacher could tell he had landed on his back when falling but was complaining that his hand hurt. The hand was slightly swollen with a small bruise on the back. He was able to move his wrist and fingers and let me move his wrist though its full ROM without flinching or pulling away. I put ice on it and after 15 minutes the swelling had gone down and he said it still hurt. He went back to his room for lunch and the teachers said they would keep an eye on him to see if he was babying it or using it normally, they also called the parents to give them a heads up. Dad actually asked if I had done and x-ray! Yes, it is a private school in a wealthy area but really?!? But I digress. About an hour later he woke up from his nap crying that his hand hurt. I rechecked it and nothing had changed. I was also told that he was using the hand normally and wasn't avoiding it. The teachers called the parents again to let them know so they could make the decision to come and get him or not. I left about an hour later and sitting at a table, no tears, using the injured hand to eat.

Apparently a note to the teachers was sent with his older sister today stating that his arm was broken. I feel so bad that he was in pain for so long and keep going over what I did trying to decide if I should have done something differently. If only we had they x-ray machine at school!

[100kids, BSN, RN]

thanks to all of you for your stories. I really appreciate you all sharing and making me feel better.

[Supernrse01, BSN]

LOL... I'm right here Purple_Scrubs :) Unfortunately, my name didn't get me the super power of x-ray vision! I too have missed a fracture :/ That was my lesson to ALWAYS call home, no matter how small you think the injury may be... Let the parents know and they can decide what the next step will be.

[schoolnursejennie]

flare thanks for the tuning fork idea..i will definitely use it!!! as to 100kids, what else could/should you have done? nothing.