Working a tough shift this week because I get home just in time to go to bed and get up to do it again. Makes posting tough. I’m working with pediatric patients this week. My last shift looked like this:
- a 14 year old with developmental delays who admitted to being sexually active. Her mother knew and was OK with it. She was my sickest patient of the day.
- an entire family (2 adults, 3 kids aged 9 months to 8 years) who came in with body lice because they are homeless
- a 15 year old and her mother who came in with bed bugs from the long stay motel they are living in
- A 3 year old who fell out of bed and broke her collarbone.
- A 17 year old who had a bruise across his abdomen from a dirtbike accident
- a 16 year old with chest pain that gets worse when he breathes in
- plus a parade of sniffles, fevers, and sneezes that cause screaming children, which are the reason why I don’t like working pediatrics, but it’s my turn. I think I had around 25 or 30 patients overall, but I lost count. Most were easy- in and out in about 90 minutes or so.
One of the things that makes pediatrics hard is that all of the medication dosages are weight based. Because of that, it’s easy for people to screw up. Last night, 5 minutes before my quitting time, a Doctor ordered medication and discharge orders for a child. The dose appeared to be too large. I sat down and did the math. This is what my day was like:
The Drug Reference says that the dose is supposed to be 20-50 milligrams per kilogram of body weight per day, divided into three doses. The ordered dose was 1080 milligrams to be administered to a 5 year old child who weighed 27 kilograms. It required calls to the pharmacist, messages to the doctor, cancelling the original order, getting a new order, administering the medication, returning the excess to the pharmacy, processing the discharge, and I finally got off work, 30 minutes past my scheduled time.
Nursing.
8 Comments
Joe Blow · October 9, 2023 at 6:20 am
Sadly I fear you are quite the minority Good Sir.
I thank you for your efforts and hard work, even if I live in a different state. I have such a horrible opinion of the medical field at large due to the kung flu, but stories such as yours have me holding on for hope. I wonder why some days, but I still do.
It’s sad really, and a telling tale of the greater problems facing us as individuals in this world? I believe that people are inherently good, they don’t deliberately try to harm people (for the most part….) However when looking at the world we inhabit, so many of our systems are bad, inherently so, designed that way (whether intentionally or unintentionally), and that blame then gets transferred to the individual.
Take fast food – you bitch at the kid behind the counter, not the corporate marketing people who created all the false advertising (if just ONE of their hamburgers looked like the pictures, I’d STFU. Just one, once, that’s all I need).
I can’t stand big-box hardware stores and all the other self-checkout shops, but that’s hardly the fault of the girl working the register in landscape supplies, no point giving her the business. But stop and talk to her, she gets it good and hard all day long.
It’s not accidental. The people doing this are deliberately insulating themselves, so your ire gets directed elsewhere.
I think it’s impossible for the world collective to ‘fix’ this problem. We’re just too stupid and easily manipulated, when taken en masse. Individuals with spines of steel and steady hands could solve it all in a matter of days, but who among us is willing to do what needs to be done? God help Klaus if he ever comes stateside, boy howdy!
Grumpy51 · October 9, 2023 at 8:36 am
Lest readers think it’s just simple math – those same drug calculations are based of ideal body weights (IBW). With today’s obesity epidemic, you can’t just do the simple actual body weight. That 5-year-old can weigh anywhere from about 35 pounds up to over a 100 pounds (remember to convert over to kg though).
IF you were lazy and did actual body weight on a 120-lb 5-year-old (I’ve seen more than 1), you would be overdosing by at least twice and some meds have a VERY narrow therapeutic range.
Welcome to medicine (directed at readers).
Divemedic · October 9, 2023 at 8:46 am
Our drug calculations are based upon actual weight. The child is weighed when they arrive in the unit. The dose then becomes mg/kg, with the maximum being the adult dosage.
The tricky part is in recognizing the wrong dosage. That does get missed, but because doctors are human and make mistakes, it’s important that it doesn’t.
Grumpy51 · October 9, 2023 at 9:47 am
Thanks for making me look it up (I’m old, started medicine in 1981). Looks like recommendations (<18 y/o) are to do actual body weight if under 40 kg and actual body weight if over 40 kg (not exceeding max adult dosages).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5341538/
Learn something new everyday…..
Cederq · October 9, 2023 at 10:55 am
I remember those days and don’t miss that. Too many dosing errors and having to be smarter than the doctor to catch those errors. I refused to work any pediatrics, not a kid person. I only worked Neonatal ICU and some L&D.
GuardDuck · October 9, 2023 at 11:49 am
My wife definitely prefers peds. Especially if the alternative if psyc.
Dan D. · October 9, 2023 at 7:56 pm
Good catch on the mg/kg for the kid, dude. Seems like busy work at the time but I’ll tell you its noble – trust your gut. On a recent podcast from Prolonged Field Care the interviewed anesthesiologist basically said “You don’t do math in public. Either you know going into this what the dosing roughly is or you’re in the wrong job.”
Mark J · October 10, 2023 at 11:32 am
Drug dosages can be tricky. Even though as an AEMT I only do a limited amount of IV/IM drug administration, I still have to pay close attention to dosing for epi 1:1000, benadryl, and zofran for peds.
Man that case with the 14 yo must have been rough, even though you most likely seen similar to me it can still get to you.
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