#paediatric

Me: perfectly fine during a trek or a hike

(Disclaimer; this isn’t necessarily true for every ER, but it is what I have personally experienced in a busy hospital that serves a county of 703,700 people)

The waiting room is more likely to be crowded at night than during the day, if the hospital has a paediatric department then the children will be moved quicker than the adults because of typically less children waiting.

One example would be five people in the waiting room at 10am compared to 50 people at 10pm.

The children’s ER will most likely get busiest at night (this is when sick kids tend to worsen and parents tend to worry).

The emergency room tends to slow down a bit around 1-2am and they might turn some of the lights off in the hallways for patients to sleep.

If the hospital has a paediatric unit it will admit everyone under the age 18, and depending on policy it may admit under 21. Children’s hospitals specific ER’s may admit anyone under the age 25.

If the waiting room is busy there will likely be people waiting in both chairs and wheelchairs, as well as security making regular rounds.

Psych patients may get moved back quicker due to the possible danger they can pose to themselves and others, they are also likely to be watched by security until they’re taken back. 

On the topic of psych patients- they get most of their personal belongings taken. They’re most likely allowed to keep their cellphone and a book while in the ER, but everything else will be confiscated.

Pencils, pens, phone chargers, shoes, etc are a big no no for psych patients. Psych patients are forced to change into scrubs, socks, and will have a nurse watching them at all times.

Many hospitals have phone chargers for patients to use at the nursing station, you must leave your phone there to change it but they’re likely to allow it.

EKG’s are standard on everyone coming into the ER, even psych patients will usually be submitted to an EKG.

Unlike in TV shows, there is hardly ever room for ever patient to have a bed and bay. Patients having beds in hallways, sometimes with a privacy screen (but more likely not) are very common because of overflow. (This seems to happen more at nighttime).

They’re probably going to ask you to pee in a cup, if you have a period they’ll almost always run a pregnancy test.

They’ll ask anyone over the age of roughly twelve about sexual activity, drugs, and alcohol. Most people lie.

General emergency patients aren’t usually stripped of their belongings

Hospitals are understaffed to the point that it’s not uncommon to see EMS and Firefighters helping in the emergency room.

Psych patients are usually on 24/7 watch no matter what they were brought into the hospital for.

Of course, when the beans are this mad/anxious and working this hard to breathe, there's no way you can get them to take any oral medications. My nursing colleague and I attempted to decrease his stridor in whatever ways did not require him to swallow--I put him face-down in my arms with his chubby little cheek smooshed against the lateral condyle of my elbow, rocking him and patting his little diapered butt. Eventually that calmed him enough to stop crying, and his stridor improved enough for my nursing colleague to get him to take a few puffs from an epinephrine MDI. His stridor got a bit better still and now could be heard faintly as the chunker dropped off to sleep, probably exhausted from crying and breathing so hard.

Unfortunately... we already knew this little guy would start screaming again if we moved him, and he was now too sleepy to actually swallow any oral meds... so we weighed the options with his caregiver and opted to give his steroid medication as an intramuscular injection, since then we could at least ensure he received the whole dose. Predictably, the little guy was NOT happy to be poked while he had finally nodded off, so I resumed rocking him and patting his little butt.

Maybe twenty minutes later, after all his medications were in, I arranged the little bean in his mother's arms in the same prone position as he had been in mine; he protested stridorously for a few minutes before settling back to sleep. (During this transfer over to mom, we all became acutely aware of the string of drool from the beany bean's face down my elbow and reaching literally all the way to the floor... I was honestly kind of impressed.)

Thankfully, the steroids kicked in as expected and when I checked back in the next few times our little chonk was fast asleep in his carseat with no stridor and no work of breathing. Eventually he and his brother were discharged with an anticipatory dose of oral steroids in case his brother developed similar symptoms, and instructions to come back if those symptoms returned or worsened. The babies' poor caregiver looked so exhausted (but relieved).

Hey!

So first year of becoming a student nurse was a rollercoaster of ups and downs that pushed me to some of my absolute limits and made me realise how much stronger I was than I originally thought. I was only 18 at the time and had ended up going to a University a few hours away from where I lived meaning I had to stay in halls. This was a scary concept what with being in a flat with 11 people I had never met, they all ended up being lovely but there were challenges with that as well (this is another story for another day!).

We start our training as a mixture of careers to ensure we get used to working as a multi-disciplinary team. This meant I got to know a lot of adult nurses, paramedics, midwifes, mental health nurses, ODPS and of course fellow paediatric nurses, highlighting to myself the importance of working together. Our University has amazing facilities with simulation suites making practice as realistic as possible! This sounds incredible but having never done anything like this before, it was all very daunting. We had actors, simulation dolls and had to work together and figure out situations that none of us had ever experienced before, but this was something you slowly get used to...even though I would say it still isn't my favourite aspect of the degree even approaching the end of the three years.

After 6 months of simulation practice it was time to get out into the real world. My first year placements (also another story) all taught me so much and allowed me to develop not only as a nurse but also as a person, you see and witness so much of the world that you have never had an insight into before that you can not help but grow and appreciate the little things in your life. I went from a very intense placement to spending some time in the community and seeing the invaluable service that nurses provide within people’s homes as well as in the hospital.

As a second year nursing student in my program I can take out IVs, but not insert them (this is something we learn this fall and I’m SO EXCITED). I’ve taken out quite a few IVs in the past year. It’s a skill I feel very comfortable with. In the winter semester this past year I was on a surgical floor with a lot of patient turnover, so I had the chance to take out a of of people’s IVs.

I continued my streak of (almost) always discharging my patients on paeds during my practicum. I took several IVs out of several small humans. 

The first IV I (tried) to take out on my first day was in the ER. I had an eight year old patient with abdominal pain and vomiting. She was diagnosed with gastritis, and discharged. She had an IV (I don’t know why, she wasn’t dehydrated, I don’t think she got any medications, she didn’t really need it, but WHATEVER), and I was going to take it out before she left. I went into her room with the nurse I was working with and explained to her and her parents what we were doing. I started taking the dressing off, and she started S C R E A M I N G. I didn’t know what to do, nothing like this had ever happened to me before. She was screaming and crying and she did not want me to touch her. The RN I was working with ended up taking it out. (Great start lol).

Most of the IVs I took out were out of babies. Kiddos under the age of two. Not really talking a lot, not necessarily understanding why I was doing what I was doing. Most of them were under the age of one. I love babies. They’re great. So cute. They all screamed or cried a little bit, but generally I think it went well.

The last IV I took out was on my last day of practicum, or very close to it. The last week sometime I think? It was another eight year old, but one I knew better. She had been my patient for a day and a half, and I had a really good relationship with (I think.) I explained what I was going to do, and she was a little bit nervous about it. She wanted to do it in 20 minutes, I said 5, and we settled on 7. I came back in actually exactly seven minutes. My instructor came with me, I can’t remember why, but it was good and chill. I talked her through everything I was doing, and she handled it well for being so nervous. I gave her a clean IV catheter and extension thingy with the needle taken out to take home, and she thought that was pretty cool. It was so much better than the first time!

Patent ductus arteriosus – PDA is one of the most common congenital anomaly that transpires in new-born babies when a temporary blood vessel, called the ductus arteriosus fails to close naturally within 24–48 hours after birth. Premature babies are more vulnerable and hence post birth must be carefully examined by the doctors. If PDA goes undetected in a baby, then it will exist in adulthood as well unless a corrective measure is taken. The ductus arteriosus opening can range from small to large. Large openings invariably aggravate the severity of the patient’s condition. Most common symptoms are poor weight, lack of interest in feeding, abnormal breathing, murmuring sound during heartbeat and fatigue.

While PDA is easily treatable in a baby, it is the incidence of other diseases along with PDA which makes a patient’s condition worse. Debika Biswas Roy, a young mother from Naihati had to face such a situation when her new-born baby had both Patent ductus arteriosus (PDA) and Congenital Rubella Syndrome. Rubella is a contagious viral disease and better known as German measles. Congenital Rubella Syndrome is one of the leading causes of deafness in unborn children. Rubella leads to miscarriage or serious birth defects in a developing baby if a woman is infected while she is pregnant. Vaccination is the only way to prevent this disease. MMR (measles-mumps-rubella) is the most prescribed vaccine. Debika’s child was infected by Rubella after he was born and he already had a congenital PDA which didn’t close spontaneously. However, her child’s survival story is unique in every sense because she found hope amidst such impossibility, when all the renowned physicians and hospitals of this city had given up on her son.

Debika Biswas Roy got the shock of her life, when in a routine check during her pregnancy, the doctor mentioned that the USG showed that the baby was in danger since the amniotic fluid had reduced. As her delivery date approached she visited few more gynecologists but nobody could help her much. Eventually, she had to go for an emergency delivery and she gave birth to a son. The baby weight was very low, so he was kept in neonatal intensive care unit. The baby was also born with reddish rashes which the doctors immediately suspected to be Rubella. While doing an echocardiograph the doctors found out that the baby had Patent Ductus Arteriosus (PDA), a congenital heart condition that affects blood flow in the heart.  Soon the baby started developing chest infection and without further delay, Debika and her husband admitted their baby boy to CK Birla Hospitals BMB. The baby was put under the care of expert paediatric cardiologist Dr. Subhendu Mandal at the hospital.

Dr. Mandal who performed the surgery, says, “Patent ductus arteriosus (PDA) is not rare in babies. Every baby is born with an open Patent Ductus Arteriosus (PDA) and the ductus arteriosusclose after birth within a stipulated time. However, this baby was born with Congenital Rubella Syndrome as well, which led to the failure of closing the ductus arteriosus. It was a 6mm PDA and that was very large for this new-born who weighed only 6kg. And this couldn’t be solved without an intervention or a surgery. Sparing the child from surgery I decided to go for devise closure to give the best clinical outcome with my skill. The cardiac defect was closed through intervention using an extremely advanced implant device. In Eastern India, this was one of a kind PDA intervention done on a newborn child using a device. The child has now been permanently cured of PDA and he can lead a normal life “

Debika Biswas who had lost all her hope initially, found the will to live for her son when Dr. Mandal gave her assurance. When most doctors and hospitals had given up on Debika’s baby, she took her biggest chance atCK Birla Hospitals- BMB. Even now she believes her son’s survival was nothing short of a miracle. She maintains “It is still unbelievable for me that I can hold my son in my arms. When all the doctors told me my child won’t survive, it was only Dr. Mandal who made me believe that there was still a chance. My child got his second life because of him. I would also like to mention how the dedicated post-operative care given by the nursing staff has boosted my son’s fast recovery. I am extremely thankful to CK Birla Hospitals- BMBand Dr. Mandal for all that they have done for us.”

CK Birla Hospitals – BMB has been a symbol of trust over the years and has earned the distinctive reputation from its patients of being a safe destination for cardiac treatment. The hospital has achieved some successful landmarks and will continue its pursuit to save lives.

By,

Dr. Subhendu Mandal, Consultant at Department of Paediatric Cardiology,

CK Birla Hospitals BMB

« A modern Outlook on the Heart Attack

Assessment Of Paediatric X-Ray Examination Practices In Two Tertiary Health Institutions In Enugu Metropolis

This Research Work is on Assessment Of Paediatric X-Ray Examination Practices In Two Tertiary Health Institutions In Enugu Metropolis

Introduction

Justification and optimization are the key principles in the protection of patients exposed to ionization radiation from diagnostic purposes. This is more important in the imaging of children because they are more susceptible to the effect of ionizing…

How do paediatric patients respond to trauma? How does it differ from adults?