A Trip to the Emergency Room
By Lauren Bumpus, Emergency Department RN
Emergency nurses at Mary Greeley work with children daily. We see many different ages of children, as well as a variety of situations that bring them into our department.
Age is one of the first things to note when working with a pediatric patient. It is helpful to know how to communicate both verbally and non-verbally with each age group.
In my experience, it is helpful to get on eye level with children ages one year and up. If the patient is able to communicate verbally, I try to introduce myself to them, let them play with my stethoscope, and give them stickers to distract them. This is all while I am talking to the parents, and also observing/assessing how the child breathes, watching their behavior, and looking for any obvious injury or point of pain on the child.
I almost always use the Faces scale to ask a child about their pain, and use terms like “ouchies/owies.”
When I have to do invasive tests and procedures, I try to explain them first in children’s terms. I tell the child what we will do and how long it will take. Sometimes I can show them.
When starting an IV, for example, I try to first demonstrate on a stuffed animal. I take an IV out of the cabinet and show it to them before treating the toy. I explain that they will feel a poke at first, something like a quick pinch or shot. When the “hub” is positioned, I tell them the needle goes away and throw it into the “sharps” container. I then tape the blue hub to the arm of the stuffed animal and let them hold it.
Most children do best with a parent or loved one right next to them, holding their hand and comforting them throughout the procedure. Kids also respond well to the promise of ice cream!
When the Parent is the Patient
Children need attention even when they are not the direct patient, but are at the hospital for a family member. They can suffer from mental and/or emotional trauma. It is important to remember that the situation, no matter how big or small, needs to be talked about with the child and their family and/or close friends.
Little gifts of toys, stickers, coloring books and stuffed animals can help distract children, whether they are the patient or related to the patient.
Unfortunately, we see death in the Emergency Department. And, sometimes, it is unexpected. Children grieve too. They need support, and they need to talk and express their grief in different ways, just like adults do.
A trip to the Emergency Department is not usually in the plans for any given family’s day. But, we hope to make the experience as smooth and helpful as possible here at Mary Greeley.
Get the Crash Cart
This equipment is vital when responding to pediatric emergencies.
Crash carts are used when responding to a medical emergency in the hospital. They contain equipment and medications that might be needed, depending on the patient’s condition.
Mary Greeley has specialized crash carts for pediatric patients. These patients are treated differently than adults because of their size. When it comes to emergencies with pediatric patients, size is key.
The carts are typically used when a patient’s vital signs are unstable, which can lead to a medical emergency. A Broselow emergency tape is used to measure a pediatric patient’s length. This information provides a guide as to the patient’s weight, and, subsequently, the appropriate dosages of potentially life-saving medications and fluids.
The patient’s size is color coded, based on the Broselow tape, which tells responders which color-coded drawer in the crash cart to access. Each drawer is stocked with size-appropriate equipment and medicines prepared at the appropriate dosages. Each drawer is sealed, and the seal is broken when a drawer is opened. A sealed drawer indicates that it is properly stocked.
Mary Greeley has pediatric crash carts on Birthways, Pediatrics, Intensive Cardiac Care Unit, Operating Room, and the Emergency Department. There is also one that is always on standby, ready to take the place of a cart that has been used and in need of restocking. Each cart goes through regular quality checks to ensure that everything is in working order, and that no medications have reached an expiration date.