Five Tips (and One Funny Story) From the ER

and Guest Blogger, Kimmery Fleischli

A visit to the Emergency Room is something we all hope to avoid … unfortunately for us, we’ve been twice in our son’s 5 short years. Luckily all was okay both times, but extremely scary situations at the moment! And being that he’s a boy, I’m sure those won’t be our only 2 visits!! Hopefully, you will never find yourself in need of heading to the ER, but in an unfortunate case that you do, guest blogger Kimmery is here with a few great tips. Kimmery was a recent Smarty Mom and is an Emergency Room doctor at 2 local hospitals here in Charlotte. I’m sure has seen it all and it’s great to hear her perspective on the whole ER bit from the doctor’s point of view.

As a mother, I have a whole new appreciation for how devastating a child’s injury or illness can be. There is some parental instinct that makes us desperate beyond all reason to protect our children from suffering of any kind. And we know that children all handle things differently– some are brave and stoic, and some are like my own 4 year-old, who recently howled hysterically for 45 minutes after a skinned knee, while demanding a “pedaticeen”. (An ER doctor was not acceptable for this crisis, apparently.)

We do try really hard to keep things moving as fast as possible in the ER. As you can imagine, the continual flood of mayhem and carnage makes this challenging. Patients are seen according to the severity of their complaints, not the order in which they arrived. That being said, there are things you can do to make the (possibly) excruciating wait and ordeal of treatment easier for you:

Take an activity bag with you.
As the mother of preschoolers, I keep one of these in the car at all times. Coloring books, alluring toys, stickers, hand held computer games, whatever your little darlings are likely to find interesting. Treats that are normally strictly rationed are also good, especially for siblings of the patient (but see #3 below). If you have time to grab a laptop and movies, even better. Think of it like the 4 hour plane ride to Grandma’s house with ornery toddlers: go for whatever allows you to survive it without resorting to infanticide. Hopefully, you’ll be whisked back to an exam room immediately, and painlessly treated, so that you won’t need any of this….

Consider your options.
In general, evenings are heinous. Everyone from the teenager with a socially crippling zit to the unresponsive coding 70 year-old comes in at exactly 6:00….or so it seems. Meanwhile, you and your irate little guy with the possible ear infection are withering away from boredom and irritation. If it’s not emergent, talk to your pediatrician’s office before you come (they usually have someone to answer phone questions 24/7). You might be able to avoid a night-time ER visit with some guidance from your doctor or nurse. That being said, most of you are in the Emergency Department because you have no other options. You may, however, have some choices regarding the actual treatment. Good examples: dermabond versus sutures, and observation versus a CT scan. If you are uncertain about something, it doesn’t hurt to ask, “What happens if we don’t do this?”

The ER doc might also be able to call whoever is on call for your pediatrician to arrange a follow-up visit for your child first thing the next morning if that is warranted– and they can also ensure that your doctor is aware of test results. I do this a lot to make sure a child who is borderline for admission doesn’t slip through the cracks the next day. Pediatricians, who tend to be the nicest people on the planet, rarely complain about a late-night ER doctor’s call about one of their little patients who needs particular attention.

Time savers:
1) Don’t feed the patient. There are some injuries and illnesses which could require sedation. Doctors worry that during sedation the contents of the stomach could possibly whoosh up from the esophagus into the lungs—an occurrence called aspiration– which can cause all kinds of badness. Sometimes sedating someone with a full stomach is unavoidable, and sometimes the risk is judged to be low, but check with the triage nurse for an okay before you give food or drinks to any child waiting to be seen in the ER.
2) On a somewhat related note, check with the same nurse before going to the bathroom, in case a urine sample might be needed. This could save you hours later on.
3) Ask the triage nurse if numbing cream can be applied to a laceration in the waiting room– these take awhile to be effective, so applying them early could save some time later. Keep track of how long a cream has been on.

Don’t be hesitant to ask for help.
You may have to wait a long time, but if your child is in pain, or getting worse, speak up. The triage nurse can ask if the doctor can approve pain medicine, or reassess her place on the list. If there is still going to be a long wait, she can at least explain why. Once in the exam room, there still might be a delay until you are seen; someone can bring you warm blankets, drinks if they are approved, even toys sometimes. Part of our job is to make your unfortunate experience as pleasant as possible. Of course, it helps to realize that the doctors and nurses are often incredibly busy. There are shifts where I keep having to delay seeing a patient who has been there forever, as one ambulance after another arrives with something urgent. I hate to wait in doctor’s offices as much as the next person, so I really do sympathize.

What to expect if your child is critical:
There is a good chance you will be able to remain in the room with your child. Hospitals routinely used to ask parents to wait outside during codes and procedures, but now we try to keep the parents present if possible. There are exceptions, of course, like severe traumas and other instances where the room will be very crowded with people and equipment. If you are in the room when your child undergoes a painful or frightening procedure, speak calmly and lovingly to him. Try to hide your own anguish if your child is awake, and focus on comforting him. If you are squeamish, sit down or wait outside … I have seen more than one parent hit the deck during a spinal tap on a newborn. If you can, write down what information the doctors and nurses give you, along with your questions, so you don’t forget it later. And finally, please know that we will care for your dear child as if she was our own– as kindly and compassionately as we can.

Now, to lighten things up a little:
I was explaining to a 5 year-old boy that I was going to be using dermabond on a facial laceration he had so that he would not have to have stitches. The cut was near his eyes, so I was trying to emphasize to him how important it was that he remain still during the application. “This doesn’t hurt at all,” I told him, “but if you wiggle, and this glue stuff gets into your eyes, it could glue your eyes closed.” He was immediately intrigued. “Then what happens?” he asked. “We’d try to get it out, but you wouldn’t know what was going on around you because you wouldn’t be able to see for awhile,” I explained. He pondered this for a minute, and then leaned forward and whispered conspiratorially to me, “Okay, but do you think you could put just a little of that stuff in my Grandma’s eyes?”

Share your funny (or even not-so-funny) ER experiences or any other tips you may have picked up.

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