Julie Sutherland

I had been working in emergency on my night shifts, on the first night I worked I had taken care of a pediatric patient, he had the most beautiful blue eyes and blond hair. He had presented to our ER with a respiratory problem. The patient had a unique name, after being assessed by our ER physician it was felt that he had a viral infection and was started on the classic medication regimen and admitted to the pediatric unit. I gave a report to the receiving nurse and sent this patient and his family up to the floor.

I worked two nights in a row, so the very next night I was working, and I heard this patient being called from the waiting room. This surprised me because he had been admitted the night before. He was brought to a treatment space right across the desk from me and although he was not my patient, I went into speak with the mom and check on babe. The mom reported that they had been discharged by the MD, but she felt like her son was still sick. The patient was assessed by our ER MD and re-admitted to the hospital, when this occurred, I asked the nursing supervisor for a pediatric bed, however there was no available bed. I requested a crib to be placed in the room as the patient was only 9 months old, when the crib came, I moved the patient and their family to a more suitable location. Once in their dedicated space I called RT because the baby appeared to me to have an increased work of breathing. With RT and I at the bedside I removed the babies’ clothes to do a proper pediatric assessment. We noted that the baby had some intercostal indrawing when auscultating the chest, he had reduced air entry and wheezes throughout bilaterally. I removed the diaper intent on checking urinary output, which there was very little, however he did have a red rash to his scrotum, penis, and pelvic area. Alarm bells rang in my head as soon as I noted that the panic set in. I compressed the red rash to see if it would blanch-it did not. My stomach dropped to the floor; this was petechial hemorrhage. I quickly flipped the baby over to see if there was any on the back side, and I noted one lager purpura on the left shoulder. I was panicking internally trying to keep my composure in front of the family. I simply laid the baby back down; I asked RT to stay at the bedside and told mom and grandma that I would be right back. I hurried out to the MD and requested him to come look at his rash that I was sure was petechial hemorrhage, he complied and followed me to the room. Once in the room, I showed the MD the rash, he nonchalantly said that this was not convincing, I rotated the baby to show him the purpura on the left shoulder and he shrugged and said it was a little more convincing. He then left the room. I again asked the RT to stay at the bedside and that I would be right back. I followed the physician out the desk and asked, “are you going to page the pediatrician?” He responded that he felt that was unnecessary. I told him I was going to rephrase the question, “I am going to call the pediatrician, would you like to speak with him, or shall I?” He conceded and the pediatrician was paged. I grabbed some IV supplies. I knew that I MUST get a line in the child before his system crashed. I placed a line successfully and locked it at present as there were no orders to give or infuse anything. I stayed at the bedside with this child until the pediatrician arrived. It took approximately 60 minutes for him to arrive and by the time he got there the baby had a change in LOC and was rapidly deteriorating. When he arrived things became very busy, added blood work, and IV solutions, IV antibiotics and more. The patient was moved into our recusation bay and required one on one nursing care. We were waiting for flights to come in and pick up this patient. I ended up staying 3 hours past my 12-hour shift before this child finally flew out. I was sure he was not going to make it. I left the hospital in a zombie state, realizing that I had tried my very hardest to keep this patient alive.

About one month later the grandma and mom brought this patient back to see me! He had survived! The doctors and nurses at the specialty hospital told the family that had I failed to act when I did, this baby would not have survived. Till this day I can still picture this sweet baby face in my mind with the big blue eyes. I am so glad that I had the clinical judgment to act. Days after this patient left our hospital the ER MD who needed convincing to call in the pediatrician did pull me aside to thank me. Sometimes as a nurse you must take a stand and insist on doing the right thing by our patients. I fully believe that there was a reason there was no bed available on the pediatric unit and that reason was so that I would see this petechial hemorrhage and understand the significance of its presence. Had I never taken PALS or ENPC perhaps I would have missed this subtle sign and the cost would have been the life of this child. I will always advocate for education for nurses’ it saves lives!

Julie Sutherland RN
Clinical Nurse Educator- Ambulatory Care/DI Recovery​
Grande Prairie Regional Hospital