Parkland 5: Pedi ER (Part One)

Many moons ago, Children’s Medical Center in Dallas did not have an ER. They did have a clinic that was open during business hours, however. That meant that Parkland’s ER would always take Pediatric Trauma and it would manage all other Pediatric Emergencies daily from 4pm until 8am and 24 hours/day on weekends.


For a nurse with one year of ER experience, Pedi ER was scary but remains as one of the best clinical experiences I have ever had.

Opening daily at 3pm with two RN’s, a Patient Care Assistant (PCA) and a Pediatric Resident, we would prepare for the onslaught of sick children and anxious parents.

The gauntlet of waiting parents and kids sitting on the floor of the long hallway leading up to Peds was daunting. We didn’t have a lot of treatment rooms, so kids with asthma would be corralled into one room, sat side-by-side on two stretchers and hooked up to nebulizer treatments in hopes of an improvement in their condition.

Depending upon the chief complaint, children were seen as quickly as possible. We became expert in a 30 second pediatric assessment - check vital signs, listen to lungs and determine if the kid looked ‘good’ or ‘bad’. That was about it. Documentation was minimal. Starting IV’s and drawing blood even from the tiniest infant was common practice. Infusion pumps were rare back then, so we resorted to the use of controlled fluid administration via a device called a Buretrol that would allow only a specific amount of fluid to be administered – they ‘went dry’ a lot. Pulse Oximetry had not been invented yet (eeek) and our resident would obtain urine specimens by manually withdrawing urine from baby’s bladders via a needle and syringe.

Any Pediatric Trauma patient would be triaged to the Surgery Pit, not Pedi ER. Thank God.

Children that looked ‘bad’ (or worse) would be placed in one of two resuscitation rooms. One RN, a PCA and the doc would work the situation. The other RN would have to manage the rest of the Pedi ER. We would frequently have kids that “looked bad.”
Enough said.

Pedi ER was (at best) nightmarish from about 6pm until 2 am. Compounding an already stressed department with not only the numbers of sick children but also with the persistent crying, overcrowding and rising anxiety level of exhausted parents.


I loved it.

Parkland 6: Pedi ER - Part 2