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Harlie Silberman

Youngstown State University

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

tap to find a definitive cause of these vague symptoms.

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

reminding the person you are there for them.

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