Dd injured - not happy with A&E.....

[whojamaflip]

Posting here for traffic

Dd took a crashing fall from a height at sports training last night and has hurt her foot and unable to bear weight on it.

Went to A&E last night and they took X-rays and said her ankle was fine. They wouldn't listen to her when she repeatedly told them the pain was under her arch and across the top of her foot not in her ankle. Sent her home still unable to weight bear with no crutch's and a self care leaflet for ankle injuries.

Would ibu to take her to our local minor injuries unit today for a second opinion? She's on paracetamol and ibuprofen alternating every 2 hours and it's only just taking the edge of the pain. Foot is swollen along the outside and across the bridge and is very painful to the touch. She also has a high pain threshold so when she is crying in pain I sit up and take notice!

Dh reckons they will review her X-rays as a matter of course this morning and will ring if they've missed anything - is this right?

I damaged my foot in a similar way a few years ago. They told me that if it's not broken and is "just" ligament/tendon damage, you have to still try and weight bear a little once the swelling's gone down (hence no crutches) and to keep it mobile.

But yes - they should have x rayed her foot, not just her ankle. I would get a second opinion.

Terrible advice. Brufen is just a brand name of Ibuprofen.

It is a strong drug. 3x 24hours ONLY.

It's unlikely that DD is taking doses while asleep. Alternating paracetamol/ibuprofen every two hours under medical supervision during waking hours for a short period is perfectly normal medical advice.

From NHS website -

The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor.
the expectation of four times a day is during waking hours, which works out at a dose every four hours, interspersed with paracetamol.

@whojamaflip, carry on with the dosage which the medical staff advised, not the posters on Mumsnet. I hope DD is feeling more comfortable soon x

Sorry I am aware you CAN take it every 4 hours. I never do with myself or my children, because in my experience you end up overnight with their temperature shooting up again or you being in loads of pain and can’t sleep. So I try to always spread them out evenly ish over the 24 hours. It sounded like OP’s daughter wasn’t going to be in less pain any time soon, so was probably going to struggle to sleep through the day with no pain relief.

I’d definitely want her foot xrayed.

No you can’t take Ibuprofen every 4 hours it’s a 3x a day drug which works out 8hourly

Aaaaaah. Brufen is the same as ibuprofen. A fracture is the same a a break (break is common parlance, medical professionals would use fracture). Always check dosing on the medication packet - or follow the advice of your doctor.

OP - do get a second opinion. If you daughter does have a fracture of one of the bones in her foot, it would need to be managed appropriately. As others have mentioned, tendon/ligament injuries can also cause similar pain and wouldn't be seen on an x-ray. Both types of injuries can be painful for a long time and are often managed conservatively.

From NH S online
"The usual dose for adults is one or two 200mg tablets or capsules 3 times a day. In some cases, your doctor may prescribe a higher dose of up to 600mg to take 4 times a day if needed. This should only happen under supervision of a doctor."

@usernamealreadytaken

i am a paediatric healthcare professional
paracetamol is every 6 hours (maximum 4 doses in 24 hours) and ibuprofen is 8 hours (maximum 3 doses in 24 hours)

Go to Urgent Care - you often get seen quicker and they can fast track you to A & E if it’s at another hospital. We took DD2 to Urgent Care at Guy’s and they told us to take the staff shuttle bus to A & E at St Thomas’s where they were expecting her and whisked her through. They also do x rays via Urgent Care.

My GP advised me recently to alternate ibuprofen and paracetamol every two or three hours.

@Maldives2006 I have just read the instructions for Nurofen and Liquid Nurofen and you CAN take it four hours apart as long as you don’t have more than three doses in 24 hours. I have also been advised BY A DOCTOR to alternate two hourly with paracetamol when my DS had a very high temperature that wouldn’t come down with Calpol alone. BUT - AND HERE IS THE KEY POINT - WE DIDNT GO OVER THE MAXIMUM DOSAGE PER 24 HOUR PERIOD.

Paracetamol - every 4-6 hours (max 4 times in 24 hours)
Ibuprofen - every 6-8 hours (max 3 times in 24 hours)
So if you actually took the paracetamol every 4 hours it wouldn't be nicely spaced over 24. If a day starts at midnight you'd have had all your doses by 4pm
If you actually took all the ibuprofen doses every 6 hours, you'd be taking 4 doses in 24 hours which is above recommended limit.
You can alternate so that you can take a paracetamol, and then 2 hours later take an ibuprofen, but you can't keep on doing throughout the day, as the meds would be out of sync by next dose and you'd go over your total for both in 24 hours if you continued to do that.
You'd be taking 5 doses of paracetamol and ibuprofen each.
If pain relief is ok overnight, it's not a biggy to take 4 doses of paracetamol in 16 hours, or 3 doses of ibuprofen in 18, it just leaves nothing for overnight.
Doses are often calculated by weight in children so I haven't mentioned those.
Can take higher dose ibuprofen but only on doctor's recommendation.
Never advised to go above recommended paracetamol dose.
So don't give anyone paracetamol every 4 hours if it adds up to more than 4 doses in 24 hours.
Just a friendly PSA!!

We have been advised on several occasions to use ibuprofen every four hours, staying within MEDICAL advice from a doctor. DD is 16, so different dosage and advice to a toddler, granted, but following the device of a doctor who has seen the patient is what@whojamaflip should do.

Not a doctor or medical in any way, but I had a very similar experience with very similar symptoms. I was told it was a bad sprain, but ultimately it turned out to be a lisfranc (midfoot) fracture with ligament tears. Apparently they are easy to miss if no weight-bearing xrays are done, as the bone displacement can be extremely hard to spot on standard xrays, but becomes clear once weight is placed through the foot.

I was hobbling around in agony on mine for over a week before going back when I really couldn’t cope any more. It was diagnosed via a second set of far more comprehensive xrays (including weight-bearing) and I was lucky to avoid surgery, but was in a boot and completely non-weight-bearing for almost three months, then weight-bearing in a boot for a few weeks followed by rehab physio.

If it had just been a rolled ankle or similar I would probably have said give it a couple of days, as a bad sprain can also be really painful, but given she has had a fall from height, so there was definitely an impact I would want a second opinion.

Every 4 hours not every 2 hours, maximum 4 doses in 24 hours.

DEFINITELY go back. My badly broken foot was missed at the time….and then they neglected to call me when it was picked up.

Eventually noticed by physio 10 days later after I’d been trying walk on it. Put back my recovery by about a year.

I've had multiple doctors telling me it's ok to alternate paracetamol and ibuprofen for my children when they're in pain. It's not taking both every 2 hours, it's alternating them so calpol at 2pm, ibuprofen at 4pm, calpol at 6pm and so on. It isn't taking a higher dose, it's taking the recommended dose for each different medicine.

When I was young I had an ankle injury, went to an and e told it was torn ligaments no breaks (after x ray) it was excruciating took months before I was back to normal but ankle always week after that. A few years later similar accident, back to hospital for an X-ray, they said there was chip of bone out of my ankle but it was an old injury! Must have been from the first time and was missed, so it does happen!

If you're not happy at the time, you need to tell them. Don't just accept what they are saying and hobble out of A&E.

Maybe say, 'she is unable to weight bear and I am unhappy with the amount of pain she is in. I'm not happy going home with her like this.'

Gently, and with the best of intentions, you’re not any kind of health professional. Bandaging doesn’t add any kind of ‘support’. (Strapping is completely different and a very skilled job) You don’t know if it needs ‘support’ or what the risks and benefits of bandaging at this point are (it’s likely that the risks at this point considerably outweigh any fairly dubious benefits) especially in unskilled hands, so perhaps listen to actual health professionals (who undertook a significant number of years of study and experience) and stop treating her yourself?

I’m really sorry your DD is in pain, but the reality is foot injuries are painful, broken or not. It doesn’t automatically mean anyone is not doing their job properly. Weight bearing and movement are essential for, and actually help proper healing. If people are discouraged by giving crutches, they don’t heal as well long term, even if the first few days are a bit trying. It’s not like DD can’t get to the loo or is weak and frail, is it? Immobilising a joint has very significant drawbacks and is done only when there is clear indications that things will be worse if you don’t. The pain threshold thing is utterly meaningless. There are lots of different kinds of pain, and if you have a deficient sense of some, that doesn’t mean they are all deficient, or uniformly deficient all over. Feet especially have lots of very essential nerves for balance etc and often cause seemingly disproportionate pain, which is why stubbed toes are so unreasonably painful!

‘Ankle’ in anatomical terms includes a considerable part of what most people would call a foot. An x ray isn’t a 6x4 snap, even on centred on the ankle would still include most, if not all, of the foot. It’s likely the red lines denote boundaries, not centres.

I know you are worried about about your DD and I understand. It’s terrible when our children are in pain. But you are assuming skilled and dedicated people are not doing the best they can, and that’s unlikely (although sometimes we all make mistakes) By all means take her back, but starting from the assumption that there is anything else they should, or even can, do is unhelpful. There probably isn’t. We are very used to getting poor service, complaining about it, and then getting something additional. But health isn’t like that. The outcome you have in mind isn’t necessarily the best clinical decision, and health professionals shouldn’t fulfil your uninformed requests (for example bandaging) when there is no clinical indication to.

@KalvinPhillipsBoots when people are talking about alternating every two hours they mean paracetamol at 10am, Nurofen at 12pm, paracetomol at 2pm. They don’t mean paracetamol (or Nurofen) every two hours.It is fine to do that as long as you don’t go over the total recommend dose per 24 hours for either drug. It can really help with high fevers to get the maximum permitted dose into you as quickly as possible to bring the fever down.

I broke my foot - I felt it ‘snap’ and the pain was awful it just felt broken

went to minor injuries twice- was told it wasn’t broken after x rays. I was in agony. One nurse queried if I was attention seeking as there was no swelling.

the next evening i had a call that my x rays had been reviewed and it was in fact broken

If you don’t get anywhere with the NHS,
do you have the means to use a private GP service. There’s one at my local private hospital and they refer you to the hospital X ray / scanning department. Yes, it is at a cost (around £85 for the GP consultation plus the cost of the X-ray/scan) but they have picked up stuff for me that the NHS didn’t (e.g. a stress fracture in my foot).

just take her back or to minor injuries, don’t fanny about on here!