This can't be right...

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! Last edit by rn/writer on Jul 18, '10
Pinknurse20 are you an RN?

I'm not a nurse, just a nursing student. I don't have all the answers but it definitely seems (to me) that more should have been done besides just monitoring.

Clearly, this is not a nurse asking these questions. It sounds like the typical scenario of somebody attempting to pump the members of this site for medical advice.

Quote from gilarnclearly, this is not a nurse asking these questions. it sounds like the typical scenario of somebody attempting to pump the members of this site for medical advice.

So the MD said she was going to be fine and sent the girl home.The girl was fine like the MD said.What's the problem? You'd prefer racking up a hefty ER bill for tests that don't need to be done? Want to expose a child to lots of radiation that is unnecessary? For what? This is exactly the reason ER patients are over tested and over irradiated. Because people think more tests = better care. MDs are taught assessment skills. They know how to use them.

I'm not really sure why people are assuming this person isn't a nurse... but that's ok. Anyways, no one gives medical advice on here, so I'm not sure what people are worried about. I'm just a student, and this is just my opinion (not advice about what to do or whatnot) but if this entire scenario is 100% accurate and nothing has been left out, and the doctor was told everything that happened, then I would be concerned why nothing else had been done. However, I'm a volunteer in the ED and when parents or spouses think they need more treatment or want explanations as to why something isn't being done, they are told why, they aren't left hanging. Just had a lady today demand to see the doctor about her husband's care and she didn't leave until she had all the info she could get.

I work on a Med Surg floor as a tech and I am in school for nursing. So no I am not yet a RN. I do have some kind of idea what I'm talking about though. The reason I am asking the question is because I would like to learn. What if a situation like this happens again? Although unlikely it could happen. Maybe next time the child won't be okay. I need to know when to make sure more is done. I plan on doing missions to improvished nations when I am a nurse and lets face it the chances of a doctor in some random place making a mistake is very likely. You can't rely on other people figuring stuff out, you gotta know for yourself.I had a gut feeling from what medical knowlage I do have that enough wasn't being done which means patient care was suffering and that is what I am appaled at. It's just an innocent question, I didn't think people would get so judgemental. How am I suppose to learn if I don't ask?

If you really want people to read your post paragraphs will help them do so. Most members will not bother to read it because the block text is too difficult to comfortably read.I have no idea what your post was even about.

Quote from FribbletSo the MD said she was going to be fine and sent the girl home.The girl was fine like the MD said.What's the problem? You'd prefer racking up a hefty ER bill for tests that don't need to be done? Want to expose a child to lots of radiation that is unnecessary? For what? This is exactly the reason ER patients are over tested and over irradiated. Because people think more tests = better care. MDs are taught assessment skills. They know how to use them.

Quote from CrazierThanYouI 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 think the basic question is concussion care. Concussions are scary. Just now I read up on concussions again. Learned some interesting stuff. For one is it ok to let children fall asleep, let them sleep, the Dr. in the ER can awaken them and a good evaluation tool for the Dr. is how easily they awaken. CT's are not routinely recommended. Anyway the OP is how to care for possible concussions, what to do, etc., I think it is a very timely important post. As for ER doctors making mistakes, yesterday my patient had been in an MVA in a major metropolitan city several weeks earlier, taken to a large ER. Sent home, several days later as she felt worse, went to another ER found she needed a bowel resection, had a broken clavicle, spinal fractures, etc. Really poor care for a large ER!!!!!!

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.