Back from the ER and need to vent

[Tiramisu]

Our trip to the ER was rather disappointing. Dd has been sick since Saturday night, intense vomiting, diarrhea, and now an ear infection. We've been to the ped's office twice and two doctors there have been calling and checking up on us a few times a day, and telling me what to watch out for in case we needed to take her to the ER for IV fluids since she has been showing signs of dehydration. She hasn't eaten since Saturday afternoon and is really lethargic. Legs and stomach hurt if she walks.

 

When things took a turn for the worse this morning with the intense vomiting returning, I called the peds office and they said go right over to the ER. Dd hadn't peed since yesterday afternoon.

 

At the ER, they decided to try to hydrate her orally instead of with the IV that our ped wanted. They gave her zofran, which is what we've been doing for three days. Then she got a popsicle. That's all. I had to go look for a nurse to try to get gatorade because dd was thirsty. We got one cup of gatorade and an hour later the nurse comes back in with discharge papers.

 

Hello? I'm not leaving until dd pees. So she peed about a half inch and we were sent away.

 

The ER was supposedly full of kids like this. A bad stomach virus is going around.

 

I felt like they didn't treat us very well or communicate very well. The nurse had the nerve to say, "Usually if something is serious, your pediatrician will call us before you come." That didn't make me happy since obviously the peds are very concerned or we wouldn't be there. Then she seemed to say that pediatricians overreact but our peds have been watching over this for two days before deciding to send us down. I've raised for kids and have been through some very serious medical issues and that young nurse made me feel like she thought I and my pediatricians are very stupid.

 

I called the peds office and one of the doctors we've been dealing with was with a patient and the other in a meeting somewhere so I talked to a nurse. The nurse was not happy. I'm not happy. I was reassured that they are there for us if we need them for anything.

 

I realize all we need to do is hydrate her, but now we're at home and she won't drink because her stomach hurts.

 

One more thing, the doctor said 8 ounces of liquid taken orally is the same as 8 oz of liquid in a vein. I disagree.

 

Vent over. Thanks for listening.

[magnificent_baby]

I find that unacceptable. Did they draw lab to determine her hydration status? What color was her urine? I would be tempted to return to ask for lab work to be drawn, or at your doc's office at minimum.

 

If they did draw lab and have proof that oral rehydration was appropriate, then I suppose the treatment they gave was within standards. If they didn't draw lab and you end up back in the ER needing IV fluids, I would be tempted to speak with administration and refuse to pay (or your insurance to pay) for another room charge.

[Seasider]

When this happened to my then tiny 4yo, the pediatrician sent us to the ER specifically stating that no amount of orally forced fluids would be able to make up for the loss, thus necessitating the IV. Your case may be different but I'd be mad, too, in your shoes!

[Tiramisu]

No blood draw. :(

 

A thing one ped was worried about is that dd is acting very dehydrated while looking moderately dehydrated which makes me think a blood draw would have clarified the situation.

[magnificent_baby]

No blood draw. :(

 

A thing one ped was worried about is that dd is acting very dehydrated while looking moderately dehydrated which makes me think a blood draw would have clarified the situation.

 

 

Is she still lethargic? Did you see the urine color?

 

If I were in your shoes, I would return and ask for lab work if she hasn't improved at all and is still lethargic. Do you have another ER you could go visit?

[Danestress]

Your poor daughter! Did she keep down the popcicle and Gatorade?

[Tammyla]

:grouphug: :grouphug: :grouphug:

Poor kid, I'm a little angry for both of you.

[Tiramisu]

Yes, she kept down the popsicle and gatorade. Thanks to the zofran. We just don't know how much of it she's absorbing because of the diarrhea. Ironically, we only have two more zofran at home and the ER doctor didn't want to give us a script for more. At least, it's only a virus and it should get better soon. Fortunately, we live within driving distance of two children's hospitals in case things don't start improving.

[unsinkable]

What was the reason they gave you for no IV?

 

 

[Tiramisu]

 

Is she still lethargic? Did you see the urine color?

 

If I were in your shoes, I would return and ask for lab work if she hasn't improved at all and is still lethargic. Do you have another ER you could go visit?

 

 

She's still lethargic and not moving around, but at least she asked to watch a movie when we came home. She also started crying loudly when didn't come running right away when she called, which shows me there's some energy there. Grandma just brought over two boxes of popsicles.

 

The urine color seemed dark, but it's hard for me to tell how dark is too dark. It was tested but the doctor asked to check it out himself before he let us leave--probably a good sign. TMI but...mine is usually brighter yellow--possibly due to B vitamins--hers was a browner yellow, but not brown if that makes sense.

[Tiramisu]

What was the reason they gave you for no IV?

 

 

Not to have to put her through it if she could keep fluids down on her own.

 

They also told me not to worry if she starts to throw up again or that she's not eating. It's hard not to as a mom, right?

[Tiramisu]

I might also add that we've had somewhat of a GI history in our family. I caught a bug four years ago and had severe nausea and diarrhea for six weeks. It was a great diet. I've also had CDiff. An older dd had something similar happen when she was little. She had a virus and ended up with diarrhea that went on forever it seemed, so bad it would fill up her footie pajamas. We were overseas at that point and the doctor said not to worry as long as she was acting normally and there was no blood in it. Because of this, I start to get nervous if it I don't see things resolving.

 

I ordered small size probiotics yesterday.

[magnificent_baby]

 

She's still lethargic and not moving around, but at least she asked to watch a movie when we came home. She also started crying loudly when didn't come running right away when she called, which shows me there's some energy there. Grandma just brought over two boxes of popsicles.

 

The urine color seemed dark, but it's hard for me to tell how dark is too dark. It was tested but the doctor asked to check it out himself before he let us leave--probably a good sign. TMI but...mine is usually brighter yellow--possibly due to B vitamins--hers was a browner yellow, but not brown if that makes sense.

 

 

Glad she's perking up slowly. I would continue pushing as much fluid as she is able to tolerate. I'm sure you already are. if the diarrhea continues though, you won't be getting ahead and should return. Sounds like she is dehyrated by the color of the urine. Poor kid!

[Miss Mousie]

Oh, poor girl! I'm sorry she's feeling so bad. And I don't blame you a bit for being upset with the ER. What terrible treatment! I hope you see great improvement very soon. :grouphug:

[unsinkable]

What about an immediate care place? We've never had a difficult time getting a quick bag of fluids there.

[Twigs]

:grouphug: :grouphug: :grouphug:

[Tiramisu]

What about an immediate care place? We've never had a difficult time getting a quick bag of fluids there.

 

 

Funny you mention that because the ped just called and told me she wishes she had the supplies because she would do it herself. She made she I knew how to find her or the other doctor for the next few days in case we need them. And she agreed, if we need it, there's always the children's hospital.

 

She wanted the name of the doctor and nurse who treated us at the ER and thinks that when the other doctor hears about it that he's probably going to call over there.

[Supertechmom]

Can your ped not call in and order fluids? We have had that done before. Just wondering why the peds can't place the order and the hospital do it?

[unsinkable]

Can your ped not call in and order fluids? We have had that done before. Just wondering why the peds can't place the order and the hospital do it?

 

Yeah... I don't get it. But I'm not very ready-comprehensiony sometimes.

 

The peds sent you, didn't call over there, now they're annoyed that your DD didn't get an IV? I feel like I missed something.

[Alice]

Can your ped not call in and order fluids? We have had that done before. Just wondering why the peds can't place the order and the hospital do it?

 

 

We can’t call and order fluids, at least not in the ERs around here. They will not take an order from us for medications or for IV fluids. We can send someone in to get an Xray or bloodwork without being seen (if it’s after hours and the outpatient facilities are closed) but they won’t do orders for meds or IVF.

 

I don’t necessarily call for every patient I send to the ER either. Usually if I think it’s really obvious (which typically vomiting/diarrhea and dehydration are) than I might not call. Calling doesn’t get someone seen faster (despite what patients think) and really doesn’t do anything except communicate specific concerns we might have or to let them know who to call back after the patient is seen. Or to give a heads-up if it’s someone really sick. I would say in an ideal world we’d always call but sometimes in the midst of seeing other patients and a busy day we don’t if it seems like something simple.

 

I have had my patients have similar situations in ERs and I have called to voice my displeasure and complain to the head of the department. We also avoid sending people to ERs where we have had issues in the past.

 

To the OP...hope you daughter is feeling better. If not, don’t hesitate to take her in again. Hopefully you will get better care.

[stripe]

I recently had a conversation with a nurse about a sick child, which turned out to be irrelevant, but she was advising me that if my child became dehydrated, go to the ER for IV fluids. I am therefore surprised to hear what happened to you.

[ktgrok]

Are you in central florida by any chance? We just had that bug, and DH has it now. It has been AWFUL. worst stomach bug I've ever seen.

[Ottakee]

I had that with a foster baby. We ended up in 2 ERs with her and they were NOT concerned that the colored pedialyte they gave her ran right through her and her diaper was that color while we were still in ER. Then they gave her a med, maybe zofran, that had lactose in it and she was highly lactose intolerant.

 

By morning I took her to our ped. and she sent us right back to ER for a direct admit (they do that occ. here) and ended up keeping her for fluids, etc.

[Whereneverever]

We had a terrible stomach bug here, too. It seems to really be going around. I hope she feels better soon.

[Supertechmom]

 

We can’t call and order fluids, at least not in the ERs around here. They will not take an order from us for medications or for IV fluids. We can send someone in to get an Xray or bloodwork without being seen (if it’s after hours and the outpatient facilities are closed) but they won’t do orders for meds or IVF.

 

I don’t necessarily call for every patient I send to the ER either. Usually if I think it’s really obvious (which typically vomiting/diarrhea and dehydration are) than I might not call. Calling doesn’t get someone seen faster (despite what patients think) and really doesn’t do anything except communicate specific concerns we might have or to let them know who to call back after the patient is seen. Or to give a heads-up if it’s someone really sick. I would say in an ideal world we’d always call but sometimes in the midst of seeing other patients and a busy day we don’t if it seems like something simple.

 

I have had my patients have similar situations in ERs and I have called to voice my displeasure and complain to the head of the department. We also avoid sending people to ERs where we have had issues in the past.

 

To the OP...hope you daughter is feeling better. If not, don’t hesitate to take her in again. Hopefully you will get better care.

 

 

Thanks for that explanation. Maybe it works differently here or was just done out of courtesy or something. Nice to know that in case it happens again.

[kroe1]

At least in the ERs I have worked at in the past, private physicians can call in orders if they have admitting privileges at the hospital. Usually when the pediatrician requests privileges, there is a long check off sheet. One of the boxes will usually have emergency hydration or emergency care. Since fewer and fewer pediatricians want to take call at smaller hospitals that do not allow them the volume to make a profit, fewer have privileges at these smaller facilities.

 

I am not a nurse, but have worked in ERs for 20 years. The ER physicians I have worked for always appreciate a call from the private physician, irrespective of privileges or type of physician. Your physician should call in the future as a courtesy if he can.

 

The other thing to note is perspective. An ER physician usually does not raise an eyebrow until death is eminent. They are dealing with 15 patients at once, usually 5 near death. A pediatrician may have the same number of patients in his office, but perhaps only a few per year are near death. So what gets a pediatrician excited will not phase an ER physician. Also, ER physicians judge hydration based on physical signs of the child, and not always lab. They tend to avoid needlesticks in children more often than pediatricians. If a child will get better without an IV, even if it may take a little longer, an ER physician will normally go that route more often than a pediatrician. Both kinds of doctors ultimately want the child to get better. It is just the approach that may be different sometimes.

 

I have read several articles over the years that says oral hydration is just as effective as IV hydration up to a point in the dehydration spectrum.

 

I certainly would not want to downplay or advocate any specific care you received at the ER or from your pediatrician. And it sounds like the discharge instructions at the ER did not allow you to have all of your concerns addressed. But I am excited to hear your child is starting to get a little better. It sounds like you have been through a very scary illness. And I did want ro give you just a tad of the differences between the two types of physicians.

 

 

 

[Tiramisu]

Thanks to everyone for your support and sharing your thoughts.

 

We aren't in central Florida, but I'm wondering if this is the Sydney norovirus that I had heard of a while back.

 

Dd went nearly 24 hours without peeing, which was rather scary. She was still very lethargic for most of yesterday and hardly moved, but she slept better last night.... and woke up hungry! She has had a few dry Cheerios and a spoonful or two of chicken noodle soup--a major accomplishment! She hasn't complained of nausea or had diarrhea, just pain today.

 

One of the doctors who has been watching over dd, with phone calls a few times a day, was very involved in setting up this pediatric ER and he was shocked that they didn't do bloodwork at the very least before deciding how to treat. I'm getting the feeling that some local doctors have been disappointed with the service provided to their patients since the pediatric ER was taken over by a major children's hospital group of physicians.

 

In any case, today I'm trying to focus on the positive. I saw a smile today.

[Tiramisu]

I had that with a foster baby. We ended up in 2 ERs with her and they were NOT concerned that the colored pedialyte they gave her ran right through her and her diaper was that color while we were still in ER. Then they gave her a med, maybe zofran, that had lactose in it and she was highly lactose intolerant.

 

By morning I took her to our ped. and she sent us right back to ER for a direct admit (they do that occ. here) and ended up keeping her for fluids, etc.

 

 

How scary that this could happen to a baby!