Pediatric ER

The Good Doctor S1/E5: Lying to Kids is a Good Thing?

/ Jordyn Redwood / Leave a comment

When The Good Doctor starts messing with pediatric scenarios . . . well, I just cannot keep my mouth closed. You can see other posts I’ve done on The Good Doctor here, here, here, and here.

In this episode (spoiler alert!) Shaun is convinced that a pediatric patient, a boy around the age of fourteen, has been misdiagnosed with cancer. This patient first comes to the hospital for a bone fracture and Shaun goes in to consult. Shaun is over identifying with this patient because he looks just like his brother that died during his younger years.

Issue #1: A first year surgical resident consulting on an ortho case. There’s really no reason for Shaun to even be consulting on this case. An orthopedic resident, yes. If no orthopedic resident, then an ortho attending. But this is outside the realm for a general, first year surgery resident.

Issue #2: There is a tendency in these shows to separate parents from children during treatment. This is not really done or encouraged at all anymore unless the presence of the parents put the child at risk in some manner.

Issue #3: This child has had a cancer diagnosis for SEVEN months and his parents haven’t told him he has cancer. This is unconscionable. We don’t need to lie and hide the truth from children. They are so much stronger than we give them credit for! Also, this is highly unethical and would not be supported by any decent pediatric medical team. Great effort would be made to help the parents give their child this news.  It doesn’t benefit him or protect him to be told this lie. Plus, is he not receiving treatment? The episode proves this point when the patient tells Shaun he already knew he had cancer.

Issue #4: Because his parents haven’t told him, Shaun decides to without their permission. Again, we would work very hard to have the parents tell the child this news. It’s unethical for any healthcare provider to do this without the parents permission no matter what. So much would be done to help these parents talk to their son. I’ve never seen this happen in pediatrics . . . like ever.

Issue #5: In order to prove his alternative diagnosis, Shaun decides to perform a medical procedure on the patient without the parent’s consent. This is legally dicey and Shaun should suffer disciplinary repercussions for doing so.

Issue #6: A patient after having open heart surgery is in recovery with only an IV and simple monitoring. Any patient who has had open heart surgery will have a variety of tubes— like chest tubes. It’s not a simple recovery.

Are you watching The Good Doctor? What do you think of this surgical resident getting away with all these bad things without repercussions?

 

Are Kids Just Small Adults?

/ Jordyn Redwood / Leave a comment

I started in adult nursing. For three years, I worked adult ICU and a community centered ED which primarily saw adult patients with a few kids mixed in.

I thought I knew everything I needed to know about treating pediatric patients. Needless to say, my eyes were opened when I took a class called Pediatric Advanced Life Support (PALS). That was just a taste of discovering I knew very little about the uniqueness of a pediatric patient.

During my time in the adult world, I discovered my joy of working with kids. In fact, I would bargain with my co-workers to take all of their patients eighteen-years-old and younger if they took everyone over the age of seventy-five. Surprisingly, this was an easy trade and I began to learn most adult centered nurses were very uncomfortable working with a child– particularly a young child.

Then, an epiphany happened. There are places . . . whole big hospitals . . . where there are only kids. I need to go there. That began my career in pediatric nursing and I’ve never regretted choosing kids over adults.

What irks me about some of my adult counterparts is that they’re very unwilling to admit that pediatric hospitals are the best places for kids to go. They think they can do it the same or better. Trust me, I’ll be the first to admit that if you have crushing chest pain, I can do the basics to save your life, but I’ll also be the first one to drag you by the shoulders across the threshold to the adult ED because I know you’ll fair better there.

Why? Because they do adults every day and you get very good at what you practice.

I found this article very interesting. Confessions of a Preemie: How I Am Different than a Full-Term Baby. Isn’t that amazing to think about? The difference four months can make in development?

In a humorous way . . . it got me thinking about things pediatric nurses have to consider that would be very odd for an adult ER nurse to have to think of or deal with.

1. When stripping for the scale— kids are handing off favored stuffed animals, blankets and toy cars.
2.  The size difference. We have at least eight different sizes of BP cuffs (probably more when you get into preemie sizes.) In fact, we have multiple sizes of everything where as an adult focused ED might have a very small supply of pediatric equipment.
3. Vital signs are different according to age group. A newborn’s resting heart rate can be 160 where as this would be considered abnormal for a teen. We have to memorize a large range of “normal” vital signs for about five different age groups. The only vital signs consistent across age groups is temperature and oxygen level. Heart rate, respiratory rate, and BP all change with age.
4. Does your child suck their thumb? If so, which one? Hopefully, my adult counterparts are not asking this question (and if they are, maybe adding a psych consult) but in pediatrics, it’s very important when it comes to IV placement. We don’t want to put an IV in the hand that contains their favorite thumb for soothing. Ultimately, everyone gets cranky because the child will be cranky.

That’s just a very small sampling of some of the things that pediatric nurses have to deal with every day. Do you think you could do pediatric nursing?

Author Question: Consent Issues Peds ER

/ Jordyn Redwood / Leave a comment

Carol Asks:

Scenario:

Hero’s daughter is spending the night at the heroine’s house b/c he has to work. They think she has the flu but is appendicitis and is gonna burst [based on a friend’s kid’s experience ;)]. Heroine wakes up to hear her crying in the middle of the night. Goes to check on her and gets her roomie who is a licensed [but not practicing] paramedic. Says we gotta get straight to the hospital but hero isn’t answering phone.

So, they get there, but dad’s nowhere to be found. Heroine knows daughter’s name/birthday but that’s it [not even an address].

1. Will they still try to find a patient in the computer based on the info they have [patient’s name, birthday, town, dad’s name etc]?
Jordyn: How old is the child? A first or second grader should know their address so they would look up her name and birthday and try and match the address. If not, they’ll just create a new chart. It’s possible to merge electronic records at a later time. Do they not even have a phone number to reach him? That would be pretty odd.
2a. How much credence will they give to the medic since it’s not someone they know? He’s gonna rattle off information [HR, BP, temp, etc] and don’t they have some sort of ID card he could use to back up his claim that he knows what he’s talking about?
Jordyn: It’s anecdotal. We’d probably be most interested in the temperature. She’ll get her vital signs taken at the time and it might be curious if they are markedly different than what the paramedic got. But, we won’t ask for his ID. We’ll just want to know what treatment they provided at home and probably the last time she ate or drank (for purposes of surgery that’s important to know.)
2b. Should they call the ER en route?
Jordyn: No, this is cheesy. People do it but it won’t move you up in line, it doesn’t reserve a spot, etc. We’ll say, “Okay, see you when you get here.” Unless they are requesting emergency info—like how to do CPR—it doesn’t make a difference in the care of the patient when they arrive. You’d be surprised how many people call and then never show up.
2c. Is it plausible they’re not too busy at 3am on Sunday morning? And go pretty straight back?
Jordyn: Yes, this is plausible.
3. Will the medical staff allow the heroine/medic back into the ER room etc. before dad gets there?
Jordyn: Yes, if she is the only adult and the daughter is comfortable with her, she’d be allowed back.
4. When dad gets there, will they require any ID for him to prove he’s dad?
Jordyn: Typically, we get ID and insurance card if they have one. Before that—attempts will be made to reach him via phone to get verbal consent to treat. This is a big deal with minors. If it’s not an emergency—medical treatment can wait. If it is an emergency—we can go ahead and treat regardless on consent. 

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When she’s not writing about her imaginary friends, Carol Moncado is hanging out with her husband and four kids in the big yard of her southwest Missouri home, teaching American Government at a community college, reading, or watching Castle and NCIS. She’s a member of ACFW and RWA, founding member and current facilitator for the MozArks ACFW group, and a category coordinator for ACFW’s First Impressions.