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Pediatric ED Journal
On October 21st, 2019, I had the opportunity to experience an evening shift in the
Pediatric Emergency Department at Akron Children’s Hospital Mahoning Valley. I had heard
mixed reviews from fellow nursing student’s experience in the ED, however I was very eager to
see what the night would bring for me. I knew there is always the possibility of a slow night, but
with school in session I was hoping it wouldn’t be the case. Previously, I had volunteered at
Akron Children’s Hospital Mahoning Valley and would walk by the ED entrance on the way to
hand out passes. Finally, I got to be the person behind the ED desk. After arriving, we were
acquainted with the unit. Cody, a ER nurse at Mahoning Valley, did an excellent job of teaching
main points regarding the ESI or Emergency Severity Index. The ESI is used as a triage
algorithm tool that prioritizes the clinical relevance of patients who come through the emergency
room. The greater the severity of injury or life threatening situation the higher the priority. This
scale is based on numbers 1-5, 1 meaning immediate lifesaving measures is required and 5 being
the least urgent. This algorithm was developed by two emergency physicians, Richard Wuerz &
David Eitel developed the original ESI concept and initiated pilot testing in 1998.
The role of a pediatric nurse in the emergency department is very unlike any other
nursing role. Not only do these nurses must be prepared for anything that may come in, but they
have the responsibility of taking care of the child and the parent/caregiver who is scared and
unsure during this process. The parents/caregivers are trusting the ED nurse to perform accurate
and priority assessments to find source of the problem within a short amount of time especially if
the issue is very severe. I very much enjoyed this experience and believe we should get a chance
to experience the ED in a regular adult care setting as well in other professional nursing classes.
During the first few hours of the clinical, the ED was very slow. I was feeling bittersweet
about the situation as it is nice to have a calm easy night, however I knew this may be my only
opportunity to experience pediatric emergency care. Luckily, after moving from triage back to
the area designated to ESI 1, 2, 3’s, I was able to witness a work up on a 5-month-old baby. The
mother with her distressed/fussy baby came in complaining that the baby had never been this
fussy before. The mother even explained she felt a raised fontanel on the top of the baby’s head.
The baby’s cry was very high pitched shrill, the nurses began to explain they suspected of
neurological impairment of some kind. This febrile baby would hysterically cry when moved in
any direction. Also, baby was showing signs of poor feeding and vomiting following feedings
earlier on in the day. The baby was ordered a urine specimen, lab draws, CT scan, and a spinal
After the lab draws came back, the WBC count showed no evidence of infection. The
nurse did also explain to me that the child was mildly dehydrated secondary to crying, vomiting,
and the increased respiratory rate from increased agitation. CT scan showed no signs of bleeding
or other abnormalities. I slowly developed a rapport with the mother as she was by herself and
wanted to support her through this stressful time. I believe sometimes seasoned nurses forget the
true purpose of nursing is to care for someone. Sadly, we get caught up with documentation and
other protocols that need to be carried out instead of taking more time with our patients. Not
soon after did the doctor explain the need for a spinal tap to check for infection in the
cerebrospinal fluid which could indicate possible meningitis. As the mother was alone with the
baby following the doctor leaving, the mother started to become emotional. I explained that
maybe she should call a family member or friend to come and offer support. After everything
was set up for the spinal tap, the scared mother sat down. Since no one could get there in time to
sit with her, I held the mother’s hand while the child underwent the procedure. After the results
came back, the doctor diagnosed the 5-month-old baby with viral encephalitis. It was rewarding
to know that I may have not provided any hands-on care to the baby, but I helped that mother by
just holding her hand. Nursing is much more than just crazy experiences in the ED; nursing is
showing compassion to every patient or person that you encounter even if that just means