4.11.2014

our trip to the ER {7qt}

I planned this week's quick takes to be about our spring break trip..... a fun, uplifting post for the end of the week... But it will be for another day.


Linking up with Jen this week. disclaimer: bodily fluids such as emesis, stools and urine will be discussed. so feel free to skip.... I won't mind.


1. I read Jen's post Wednesday about her newborn's stay (now 1 year old!) at the NICU. Little did I know, her post will come to mind 24 hours later as I watched my youngest get an IV.



My Sebastian had vomiting and diarrhea the day before. We hoped it was just a 24 hour GI bug that would go away. But he got so behind on his fluid needs. He threw up the pumped milk my FIL gave him. He threw up after I nursed him. He also had runny, green stools (sorry for the description).






2. Fevers
That 102.3F fever was awful. I am sure Bastian felt miserable. his heart rate was up to the 170s-200. He won't even make eye contact. He cried and cried until Derrick came back from the pharmacy with another bottle of tylenol. To make matters even more complicated, the meds were left at my parents-in-law's house.



I wanted to help Sebastian and ease his pain... I felt hopeless while waiting for the medicine. I rocked him, kissed him and whispered prayers in his ear. Oh the power of prayer. {again, Jen's post came to mind} Prayer calmed me, took away my anxiety and in return I was calm and strong for him.



3. Pedialyte can be a friend but also THE ENEMY. After throwing up again the second day, we finally said: that's it... we will give your tummy a break as suggested by the peds nurse. So wednesday night, we offered the pedialyte in a bottle: nope. Bastian refused. Offered it in a 5 mL syringe, he still refused but we basically force dropped the liquid. I used my peds training to calculate his maintenance dose and it came up to 30 mL or an 1 oz per hour. That’s just maintenance fluids and not even taking into account the fluid loss from all the vomiting and diarrhea.



I pumped that night instead of nursing. My husband gave pedialyte to a screaming infant. He got himself so tired that even after 3 x 5mL of pedialyte filled syringe, he fell asleep for 2-3 hours at a time. Overnight, we tried pedialyte unsuccessfully. When I calculate what he received, it averaged to 5 mL per hour! I then had a terrible sinking feeling… Seeing my listless, quiet, not smiling baby and I knew it was part my fault that he was behind on his fluid maintenance!



I called the nurse that morning. I gave her the history and she basically told us to come in. There were no openings in the morning so we saw the pediatrician after lunch. I packed the diaper bag with extra clothes for Sebastian and some gold fish snacks for Isabel. My mommy-doctor gut told me that we will be sent to the ER. And yes, we were sent to the ER. We got to our appointment early. After being seen and ordered to go, I wasted no time. I went straight to the place where we should have been maybe 12-18 hours ago.





4. difficult stick
I always tell my sister: "that's why I am not a nurse". Nurses have such difficult jobs. It took 5 hours and 4 IV attempts before we successfully got an IV. Checking one limb, next to the other limb, for a vein that they could palpate. First person: right arm, tourniquet on, palpate, inspect, nothing.... moving on. right leg, tourniquet on, inspect, palpate, nothing... moving on..... turn him around. Left arm, tourniquet on, etc etc... limb after limb....



There were 5 different nurses who palpated and looked. Three tried. They also gave him breaks in between because I’d console him after the attempts. He was worn out. He nursed… and we wanted him to keep what he just ate. Hence, it was a total of 5 hours from getting triaged, roomed in, seeing the ER physician, orders being placed, and the IV attempts. (My sister said, there's nothing emergent in the emergency room... unless it's a trauma case or ACLS situation) ~~ ain't that the truth.



Babies have "pudgy" limbs to begin with anyway. And Sebastian has a lot of birthmarks on his wrists and ankles and top of his feet. They can be easily mistaken for veins. But RNs were not fooled. They went by feel and since he was so dry, the veins were so small and tiny, depleted of intravascular volume.



5. DC
Finally around 9pm, the 3rd RN found the vein finder. I have asked for the ultrasound machine and the red light they use at other hospitals. Each time, the RNs who have tried tell me they were better feeling for the vein rather than using a machine. I am glad they listened and found the vein finder by the 4th attempt.



Every time they attempted to place an IV, I enveloped my arms around Sebastian’s torso, arms and head. I placed my face close to his and whispered prayers asking St. Sebastian and St. James to pray for us.



Once the IV was placed (the 4th attempt, first with the vein finder (!), we finally got the show on the road. They sent bloodwork checking how dehydrated he was (BMP). He received a total of 30 mL per kg of normal saline. He did not “perk up” right away. (Maybe I was expecting something like Jesus making the lame walked)




I waited and waited for that wet diaper. Even after 4 sticks, one would think he would give us a tiny, teeny drop of urine but that did not happen. When the first 20 mL/kg of NS finished, I checked his diaper and the urine bag had maybe 1-2 oz of urine. Praise God! I don’t think I was ever that excited to see pee… It had been >12 hours since his last wet diaper and every second without that IV, I was close to freaking out.



Labs came out not overtly abnormal. Urine test was clean. RSV and flu swabs were negative. As soon as that IV pump beeped, telling us that fluid bolus is completed, the RN came in with our discharge papers! (I forgot to mention that in between IV attempts and while he was getting his IV fluids, he nursed a few more times and kept everything down!) He got his tank filled! He was nursing and kept the milk down. He had a wet diaper! CHECK, CHECK, CHECK. Sign that discharge form!


6. back at home
There’s always a first for everything.

First ER trip with my child… going there as a mom and not as a doctor.

First pharmacy trip at 1am.

First drive through experience at the drugstore.



Bastian fell asleep as soon as I placed him in the carseat. I did not want to carry that heavy carseat all the way inside. Thankfully, the 24 hour pharmacy just a mile or two down the hospital had a drive-thru. I dropped off the prescription. Parked in the lot for ~15-20 minutes, then drove back to the drive through.



Praise God that we are back at home. Bastian is not 100% back to his happy self yet. I miss his giggles.But let's look at the bright side: He is tolerating his feeds. The zofran they gave us is helpful. But the diarrhea is still there.



7. Note of thanks
Thank you for my sister and our friend, S. Texting them kept me sane when Derrick was with the children and I was alone in the ER room holding Sebastian.

Thanks for my mother for coming over with such short notice.

Thanks for all the prayers, dear friends. you are amazing prayer warriors. Sorry my sister’s post scared some of our relatives. I just could not text everybody play by play updates. I had to be there for Sebastian. I did not want to leave his side… (I waited for Derrick to come back, just so I can go to the bathroom ~ I was that anxious about leaving him).




Typing all this made me wonder how I could have prevented all this:

I should have woken him up several times throughout the night and persistently gave him pedialyte.

I should have gone to the ER when he had that high temperature.

I should have gone to the ER that morning instead of going to see the PCP first.

I should have offered the breast much sooner and given up on the pedialyte.

I should have.. . I should have…



I am just thankful that my baby is fine, sleeping quietly next to me as I hit publish. Thank you again for the prayers!



For all the moms and dads who have been or who frequent the ER because either their child have a chronic medical condition or just because things happen: you are amazing! I will use this experience to be even a better doctor when I see you at work.




Keep in touch


3 comments:

  1. Poor little guy :( I used to feel so bad putting IVs in kids when I was a nurse, can't imagine having to watch my own little baby go through that. So glad he's home and hopefully feeling much better!

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  2. IVs are the worst. We are definitely ER veterans but I still have a hard time not crying watching then try to put IVs in Andrew. I decided it is now worse that he knows what is coming and can scream "mama". I can't imagine a baby as little as Sebastian, though!

    ReplyDelete
  3. So sorry about this! Poor thing. I'm glad you all are okay.

    ReplyDelete

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