Archive for the ‘Emergency Department’ Category

My child has a fever. What should I do?

Tuesday, April 2nd, 2013

By Erin Dobie, CNP

Fever is one of the most common reasons parents seek medical attention for their child or infant. All kids get fevers at some point. Studies reveal parents are most worried about fevers due to the fear that they can cause brain damage or even death. But, there is no evidence to support these concerns.

As a nurse practitioner in the Emergency Department at Children’s Hospitals and Clinics of Minnesota, I frequently see kids with fevers. The questions from parents are usually the same. I wanted to answer some of those questions here.

What is a fever? Fever is defined as a body temperature greater than 100.4°F (38°C). It is part of the body’s natural defense mechanism and a normal body response to fight infection. Fevers help the body fight infections by stimulating the immune system. Fevers slow the growth and reproduction of the virus or bacteria. They also increase production of antibacterial substances in the immune system.

Should I treat a fever? Otherwise healthy children and infants (3 months and older), whose temperature is between 100.4 and 102°F (38.0-38.9°C), do not require any medication to reduce the fever unless the child is uncomfortable. Consider how your child is acting before treating with medication. Is he/she still playful? Drinking and urinating? These lower grade fevers help the body fight off illness. Fevers greater than 102°F do not always indicate a more serious illness. Does your child have other specific symptoms or complaints that are concerning or need medical attention? It’s important to remember to treat the child, not the fever.

When should I call my child’s health care clinician? You should call your child’s physician or nurse practitioner if your child is:

    • younger than 3 months old with a rectal temperature of 100.4°F or higher
    • crying and can’t be consoled or extremely irritable
    • somewhat difficult to wake up
    • refusing to drink fluids
    • experiencing painful urination
    • not vaccinated

If your gut tells you something wrong or if your child has a chronic condition, then you should also call.

When should I call 911? Pick up the phone if your child has:

    • trouble breathing
    • purple spots on skin
    • extreme difficulty waking up

Which medication should I use to treat my child with a fever? Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil) are two fever-reducing medications recommended for children and infants. Do not give Ibuprofen to infants younger than 6 months. Do not give Aspirin to children of any age. Be aware that many other over-the-counter medications often contain acetaminophen. Therefore, please read the labels carefully to reduce the risk of overdosing your child. Medication dosages are unique for children based on your child’s weight.  See Fever Dosage Charts for more information.

Remember, treating the fever with these medications doesn’t treat the illness causing the fever so when the medications wear off, the fever will most likely return until the body is done fighting off the illness.

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A night in the ED with a child life specialist

Wednesday, March 27th, 2013

A 3-year-old girl needs her bottom lip sutured. A 2-year-old sibling is bored to tears – literally – while she waits for her brother to be released so they can go home. A 7-year-old needs an IV start for blood draws and medicine.

Who are you going to call? The child life specialist.

Mindy Teele, child life specialist

On a recent weekday night in the Emergency Department, Mindy Teele, a certified child life specialist at Children’s Hospitals and Clinics of Minnesota, is in demand. A patient is about to have an IV start, so an RN asks Teele to explain the procedure ahead of time. In another exam room, a patient is waiting for results, so Teele brings toys. A few minutes later, she returns to the patient with the IV start to distract the patient during the procedure.

“Child life specialists focus on the psychosocial and developmental needs of children to minimize their fears, clarify misconceptions, build coping abilities and enhance understanding when kids are in the hospital,” said child life manager, Sheila Palm. “Being better prepared improves long-term adjustment to medical conditions, increases cooperation and reduces pain during procedures.”

Children’s deploys certified child life specialists throughout the hospital – to the medical-surgical, pre-surgery, critical care, and cancer and blood disorders units. Child life specialists work in home care and hospice, too. Children’s also has child life associates who help on some of the units and in the Sibling Play Area. Philanthropy helps support child life specialist services; their work is not reimbursable.

In the ED, Teele helps reduce the stress of what can be a traumatic visit by providing age-appropriate information, coping strategies and parent coaching, Palm said. Gaining cooperation from the patient and family can reduce the time of the procedure, need for sedation and need for an extended ED stay.

A 2008 Children’s study in the ED compared parental satisfaction with their child’s experience during a laceration repair in the presence and absence of child life services. Overall, there was greater satisfaction when a child life specialist was involved.

Patients experienced less anxiety when they left the ED when a child life specialist was involved in their care. Child life specialists received a significantly higher rating than other providers in their efforts to relieve anxiety. Children’s also received a rating of excellent from families more often when a child life specialist was present.

“I find the presence of child life services in our ER to be a tremendous asset. The care that they provide in alleviating the apprehension and pain of the sick and injured children we care for on a daily basis is wonderful. I appreciate working alongside such caring individuals and see their effect in many of the patients I come across during my shifts,” said Dr. Mark Schnellinger.

Teele has worked at Children’s for 13 years, 12 of which she’s spent in the ED. “I feel like my personality fits this environment,” she said. “I like the instant gratification.”

In the ED, time is not on Teele’s side. She often only has minutes to explain and prepare patients and families for a procedure. So she relies on analogies to explain them. Instead of calling herself a child life specialist, she tells patients she’s a teacher – a term kids can understand.

“Anyone can go into a room and tell a child what’s about to happen,” Teele said.

But, a child life specialist is able to assess the child and take him or her through the experience on their terms, she said. If a child needs a CT and loves princesses, Teele might develop a scenario from “Snow White.” If the child is obsessed with video games, Teele explains the procedure like it’s a video game with various levels for advancing.

On this recent weekday night, a little boy is minutes away from having a needle inserted into his hand for an IV and blood draws. Teele explains that the RN will use a J-tip, which helps minimize pain with needles, to make the area feel soft. An RN will then use “soap” to clean the skin. Using the same tools for the procedure, she shows him what everything is supposed to feel like. She shows him the “straw” and explains that, unlike a juice box straw, it will give him medicine to make him feel better.

A night in the Emergency Department with a Child Life Specialist (Part I) from Children’s of Minnesota on Vimeo.

Later in the evening, she’s called in to help during an IV start with another patient. The ED has run out of J-tips. Armed with a Disney book, Teele holds it up for him and together they identify the characters while the RN inserts the needle, draws blood and then gives the boy medication. Distraction works. The patient remains calm the entire time.

A night in the Emergency Department with a Child Life Specialist (Part II) from Children’s of Minnesota on Vimeo.

“I think I have a very rewarding job,” Mindy said.

Learn more about child life services.

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Ramsey County kids ‘lost’ in the medical system are found at Children’s

Thursday, November 29th, 2012

A child is left with a family friend, and the parents are nowhere to be found.

A teacher notices bruising over several weeks and worries the student is being abused.

The police are called, and the child is taken to the Emergency Department at Children’s Hospitals and Clinics of Minnesota before being placed in short-term foster care.

Through the Ramsey County Shelter Program, kids who are victims of abuse, neglect or abandonment in the county are taken to Children’s in St. Paul and given a full medical screening, new clothes thanks to the Children’s Foundation and a meal. Once they get the care they need, they’re placed in short-term foster care.

“We can get these kids healthier so they have a better childhood and a healthier, long-term life,” said Dr. Kellee Street, the medical director of the program.

There have been more than 12,300 patient visits since the program’s start in 1993, said Jean Henry, program coordinator. Children’s sees an average of one to two at-risk kids per day. As of mid-November, there had been 368 visits this year.

It’s critical for police officers to know they can take kids to a safe place to be evaluated, said St. Paul police Chief Tom Smith.

“This does make a huge difference here (in the community),” Smith said.

A recent lead gift from the Peter J. King Family Foundation has helped transform the St. Paul Emergency Department, and those physical changes help it continue to be a safe space for youth in the program. The updates also improve care and dramatically cut down on patient and family wait times. (Pioneer Press story here)

Street believes the county program is one of a few, if not the only, in the United States where kids to be placed in short-term foster care are first screened by medical staff.  In other counties and beyond Minnesota, children typically aren’t screened for up to 48 to 72 hours, she said.

Often, they lack current vaccinations, have poor dental health or have increased lead levels due to exposure where they live, Street said. Elevated lead levels can result in long-term developmental problems.

Children’s staff contact the child’s provider – if there is one – or inform the county if follow-up care is needed, Street said. In some cases, the child is admitted into the hospital.

“There are things we pick up that most people would never have found,” she said. “These are kids that are lost in the medical system.”

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Fireworks safety: Avoid the ER on the Fourth of July

Tuesday, July 3rd, 2012

This is a post by Dr. Robert Sicoli, co-medical director of our emergency department. Dr. Sicoli is a fellowship trained Pediatric Emergency Medicine physician with over 20 years of experience. This post originally appeared on Parents.com GoodyBlog. 

(Credit: iStock photo by rozbyshaka)

While lighting off a few bottle rockets or running around the backyard with a lit sparkler may seem like relatively harmless ways for kids to celebrate our nation’s independence, thousands of people each year are injured by fireworks, many of them landing in an emergency room.

According to the Consumer Product Safety Commission, there were more than 8,600 injuries involving fireworks in 2010. Forty percent of those injuries involved children younger than 15. While the safest bet is taking your family to a public fireworks display, many states allow the use of various types of fireworks for private use. If you live in a state that allows fireworks for private use, following these safety tips while using fireworks will help keep you and your family safe this Fourth of July.

 

Before use:

  • Make sure the fireworks you buy are ready to use. Avoid kits that require assembly or crafting your own at home.
  • Don’t buy fireworks with brown labels or wrapped in brown paper. Those are usually made for public displays and not intended to be used privately.
  • Always follow the directions on the label carefully.
  • Always light fireworks outside and away from combustibles, like dry leaves and grass.
  • Choose the proper area for the fireworks you’re using (i.e. don’t use bottles rockets in a wooded area or near a busy street).

During use:

  • Don’t let kids under 10 use any type of fireworks, even sparklers. Sparklers burn at a temperature of up to 1800 degrees Fahrenheit, which is hot enough to melt some metals.
  • Light fireworks one at a time, never lash multiple fireworks together, never point them toward another person and make sure to wear eye protection.
  • Keep a hose or bucket of water nearby.

After use:

  • Never try to re-light a “dud.” Wait at least ten minutes and then douse it with water.
  • Soak all fireworks in water before throwing them away.
  •  Store extra or unused fireworks in a cool dry place.

While following these tips will help, sometime injuries happen. The most common areas of the body that are injured tend to be the hands, fingers, eyes, head and face, mostly with burns. If your child gets inured, considering the following:

  • If your child is burned by a firework and the burn is relatively mild (red or irritated skin), rinse it with cool water and apply an antibiotic ointment to the affected area.
  • If the burn is more severe (blistering, peeling and/or very painful) call your doctor or seek medical attention immediately.
  • If smoke or other particles get into the eyes, make sure your child doesn’t rub them; it will only make the irritation worse. Try cleaning their eyes out with cool water, but if your child complains of continued visual problems or is still in pain after flushing their eyes with water, seek medical attention.
  • Smoke inhalation is also another factor to consider when using fireworks. If your child has inhaled smoke, remove them from the smoky area and let them rest in a cool, ventilated area. If they continue to cough, their coughing is severe or they have difficult or labored breathing, consider calling 911 or bringing them to the emergency department.

The Fourth of July is a great time for families to have fun together. Here’s to a safe and happy Fourth!

For additional injury prevention tips, please visit our Making Safe Simple website.

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Water safety tips from Dr. Madhok

Wednesday, June 27th, 2012

This is a post by Dr. Manu Madhok, director of the pediatric emergency medicine fellowship program at Children’s Hospitals and Clinics of Minnesota. He’s a board member of the Minnesota chapter of the American Academy of Pediatrics.

Every summer, we read and hear about children who die due to accidental drowning. Sadly, this summer has been no exception in Minnesota.

Drowning is the leading cause of accidental death among children ages 1 to 4. According to the Centers for Disease Control, most drownings among children ages 1 to 4 occur in the pool at home. Drowning remains the second leading cause of unintentional injury-related death behind motor vehicle crashes among children 1 to 14.

While drowning is a tragedy, it’s one that can be prevented. I’ve compiled a list of tips I commonly share with parents and caregivers to make sure their kids are safe in and near the water.

Children ages 1-5

A common misconception is that kids only drown in deep water. A child can actually drown in only a few inches of water.

  1. Always keep children within arm’s reach.
  2. Inflatable aids are not substitutes for adult supervision.
  3. Enforce pool safety rules. That means no running or pushing.

Children ages 5-12

  1. Don’t allow horseplay.
  2. Make sure your child never swims alone and is always within view of an adult.
  3. Children should receive swimming lessons from a qualified instructor.

Open water

  1. Never allow a child to dive in without first checking the depth.
  2. Choose a swimming area that is under a lifeguard’s supervision.
  3. A child should always wear a life jacket while riding in a boat.

Backyard pool

  1. The pool needs to have a 4-foot tall fence surrounding it on all sides.
  2. Use a rigid cover for the pool.
  3. Install complaint, anti-entrapment drain covers.
  4. Pool owners should know CPR.

While kids are our thing at Children’s, we prefer to see them healthy and not to see them in the Emergency Department. Follow these tips so your child doesn’t become a statistic this summer. For more information about injury prevention, please visit our Making Safe Simple website.

For additional resources:

Minnesota Department of Health swimming pool links

Minnesota Department of Health injury data

Centers for Disease Control unintentional drowning data

Water Safety and Young Children

Water Safety for Older Children

Summer Safety Tips – Sun and Water Safety

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