To be a tad annoyed with a&e

[elf0508]

Yesterday around 7, my son started throwing up. Very unusal as he's normally a well baby. This continued until 8 so I phoned NHS 24, they told me as its only been an hour they won't do anything. Que loads of changes of sheets etc. By 10.30 he was still being sick, had a temp but also shaking. Phoned them again, they finally said to bring him in. After an hour wait, he was seen as said he either has a tummy bug or a urine infection he has a tummy bug before, it didn't make him spew eight times in 5 minutes! Still spewing today and now he has got a rash. Phoned NHS and they said "I realise you are both distressed but if he's not got a stiff neck we can't do much" why won't people help!!

Boom....if the child is vomiting hes not going to absorb it and not get the benefit of it,,,,the clue is in the name DIORALYTE....i think the child may need iv fluids if he is that dehydrated....but hey im just a nurse, what do i know when there are all these experts on here!

Potatoe. As an A&E nurse with 9 years experience and 3 years at NHS direct before it changed, I dealt with this all day. Also done ATLC paediatrics, but what do I know! Read the instruction on the dioralyte packet! It will also need a prescription for babies.

www.nhs.uk/conditions/vomiting-children-babies/Pages/Introduction.aspx

NHS advice is to give oral rehydration drinks in the case of vomiting, with or without diarrhoea. The only oral rehydration powder I have come across is Dioralyte. As a nurse, you must know you lose electrolytes with vomiting and dioralyte contains, you've guessed it, electrolytes!

MrsD. I've sat with many parents in A&E spooning in tiny sips of rehydration fluids, or just plain water, and very rarely do we need to admit and rehydrate intravenously. Never once put in an NG tube. Both horribly invasive procedures. However vulnerable children or children who have seen their GP and have a letter of referral will go straight to the children's ward and bypass A&E, so I haven't seen those.

It emphasises again that seeing a GP or ooh Dr in all but emergency cases is the best practice and gets you where you need to be.

Hopefully op's baby has been seen by the ooh and treated.

I have a loathing for NG tubes and have only successfully passed one! Only tried a couple of times and the success was a newborn as they have straighter airways. I've only seen NGs in adults with pancreatitis, bowel obstructions and the like. Never on a child.

Severe dehydration usually gets an iv as the NG doesn't do anything to stop vomiting. Evil things.

Ds had an NG tube put in in a and e but it was part of stabilising him before moving him to the ward and then ITU.

are you currently nursing?......111 and NHS direct just read off a script....if the child has been vomiting for 24 hours he needs to be reassessed...its better to be safe than sorry, i wouldnt take the advice of a complete stranger on here who thinks dioralyte is the answer...no disrespect to you but we never give dioralyte on ward based patients....imo its rubbish

i have passed hundreds of NG tubes ....they are good for emptying of stomachs when there are other causes other than gastric bugs....the child needs a set of full bloods to see if his electrolytes are ok.....and ooh services dont do bloods

I am on a baby break but FYI at NHS direct (defunct) I read from a script but as an experienced band 6 nurse, I also used my experience. FYI the 'script' is standard medical advice that you find on NHS choices and patient.uk. (And A&E)

I was allowed to deviate from my 'script' as and when I felt necessary to meet the needs of the patient, and often overrode my 'script' because a 'script' does not cover all eventualities.

A child can vomit for 48 hours. It is the affect of the vomiting in the child that is important. Dehydrated and floppy (a worry), listless but having wet nappies (not a worry). You can't make a blanket statement based on numbers. How many times have you been told to look at the patient not the numbers/machines?

Ds has a very severe vomiting reaction to a high temperature - and can vomit many many times, and become dehydrated very quickly. When it first happened we went to A+E. We stayed on the children's ward to be monitored, whilst syringing tiny amounts of dioralyte in every 5 minutes. This went on for hours, but fortunately we were able to eventually give him some paracetamol, which he was able to keep down, and the vomiting stopped as the temp came down.

We have followed this regime whenever it has happened since, with the advice that we are to go into hospital if the vomiting doesn't stop.

A vomiting child does not need a full set of bloods unless there is a clear reason. Ie extremely ill. They need rehydrating. I have never seen a NG passed on a child just for vomiting if it is a normal childhood bug. There is no way a child with a GI bug would tolerate an NG unless they were almost comatose and by then they would need iv.

I would say sedation in the case of vulnerable children is the kindest thing to do.

This thread was meant to be helping a baby.
It's turned into a conversation out of Alice in Wonderland.

Absolutely right hazeyjane. Treating a fever will often reduce vomiting. I would always give paracetamol too.

Dioralyte tastes so unutterably vile that it makes me vomit, which is rather unfortunate, considering... I've often been told that flat Coke is almost as good, which has always made me wonder, therefore, why does it have to taste so appalling?! I wouldn't inflict it on a child who can't even hold down water, unless I wanted to hasten the need for an IV drip. Have the people who prescribe it ever tasted it themselves?

As mum has taken the child to where it presumably should be, and depending on his current condition, it makes sense to dispel some of the myths that are being proposed.

Round. I did say it tastes vile (it's the salts) and coconut water is a great alternative as it also contains some of the salts lost in d&v, so it's a replacement fluid. Frankly plain water is just as good. I've never managed to get a child to drink it.

I assume you are at a&e now. Please let us know what's happening. I'm watching this tread! Good luck! Hope everything is ok.

i look at my patient and do the 'numbers'.....i never read from a script so dont need to deviate from it....i do a full assesssment of my patients, which you can only do when you have the patient in front of you....as a qualified nurse i would never phone NHS direct or 111 and advise anyone who is worried about a young child to see a doctor in person...i have over 30 years experience and am lead nurse on my shifts.....i do hope in this case you are right and this child only needs dioralyte and does not need admitting to hospital, and is well again in a few days

Potto. I said she should contact her ooh Dr. Not just take dioralyte.

I did plenty of full face assessments of patients in A&E . With the 4 hourly target we were the first people to see patients after triage and had the ECGs, cannulas and bloods all done by us before setting eyes on a Dr. That is a great learning experience for anyone doing a telephone assessment (which GPS also do at our practice). Telephone assessments have their place but they are more cautious because they are not face to face. I've never worked for 111 and don't personally think much of it as a service compared to NHS direct.

we agree on something. Not to use 111!

And I did get in trouble for deviating from my script! Actually the worst job I ever had was NHS direct and I would amputate my arm rather than work for a similar service. Not because it was a bad service but ..... Timing your toileting breaks!!!

The call handlers have a script. The nurses, CPNs, doctors do not have a script beyond the housekeeping admin stuff. This is nhs24 not 111.
They can refer a child to see an OOH dr if necessary or send to a&e if appropriate.