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ER room last night - Page 2

post #21 of 79
Thread Starter 
he DID suggest a spinal tap, but he dropped it after i refused the catheter and after his white blood count came back normal. could he still have a uti w/ a normal wh blood count? what are the dangers of a uti in a newborn? his temp is now 100.2......isnt that a good sign? now i'm scared......
post #22 of 79
Quote:
Originally Posted by Quirky
Just want to point out that you're not the odd one out....there was only one post suggesting that the fever wasn't an emergency. No other posters suggested that the OP shouldn't have gone to the ER.

Maybe I'm being a little over-sensitive but we have had a rash of people accusing the regular posters here of giving bad medical advice and I don't see any of that on this thread. In fact, it was the ignorant, arrogant doctor who was about to commit bodily injury to this poor sick baby.
Well I apologize if my post seems overbearing, this topic just happens to be very near and dear to my heart since I have lived with it for 6 years since my kidney reflux baby was born. I am sensitive to the lack of information that I sometimes see here, along with this attitude that anything to do with medicine or doctors is evil or wrong. I don't see anything wrong with what the doctor in the ER was suggesting (other than the retraction issue) and it saddens me to see so many people bashing the ER as being overly aggressive in treating this baby. It concerns me that the baby might be seriously ill, and the mother may come here and see all these posts saying the ER doc was wrong for wanting to cath the baby, etc, and this child may not get the help he needs.

Quite often on this board I see medical opinions being tossed around as facts and it can be a very dangerous thing Not trying to step on anyone's toes.
post #23 of 79
Quote:
Originally Posted by babykaoss
he DID suggest a spinal tap, but he dropped it after i refused the catheter and after his white blood count came back normal. could he still have a uti w/ a normal wh blood count? what are the dangers of a uti in a newborn? his temp is now 100.2......isnt that a good sign? now i'm scared......
The way it was explained to me at the ER, is any temperature over 100.1 (taken rectally) in a newborn is considered a "significant fever". If it was my child, I would absolutely take him back to the ER and have him checked. If he isn't coughing, no runny nose, no other signs of illness....it would be highly unlikely that this fever is something viral. JMHO, not to be taken as fact, that is why I suggest taking the baby to the hospital where he can be seen by the people who are best equipped to handle this situation.

HUGS ((((HUGS)))) because I know how scary and heartbreaking it is. But like an ER nurse once told me....meningitis in newborns is SO common, but SO easily treated....why take that chance?
post #24 of 79
yup !! my body has hydronephrosis that needs constant monitoring & I'm so glad we found it via U/S while in utero.

I think a minor mini-cath to rule out infection is not seriously evasive like a spinal tap.
As I said... no retraction is neccesary & if you have a Pro do it, it's no time at all.
I've very medically medical no touch but you can't be too sure with a newborn with fever of UKO
post #25 of 79
Quote:
Originally Posted by babykaoss
he DID suggest a spinal tap, but he dropped it after i refused the catheter and after his white blood count came back normal. could he still have a uti w/ a normal wh blood count? what are the dangers of a uti in a newborn? his temp is now 100.2......isnt that a good sign? now i'm scared......
100.2 should be ok but I'm no med professional.
As long as he's eating & peeing - that's a good sign hon!!
my ds got really listless & stopped nursing so that's a red flag

his wbc should have been elevated if he had UTI.
is he nursing & peeing w/out discomfort?
post #26 of 79
Quote:
Originally Posted by Frankly Speaking
Actually, it's two words that sound like three, suprapubic aspiration. Just like a blood sample is taken, they go through the abdomen into the bladder to get a urine sample. It's the most accurate way and the least likely to be contaminated. It's probably a little more painful than an injection but not much. Definitely much less painful than getting the foreskin ripped away from the glans.
Frank, I cringe at the thought. To me, the invasiveness (and probably the pain) is probably similar to amniocentesis. They would probably need to significantly restrain him, use ultrasound guidance, and there's probably a risk of poking other organs, infection, and bruising.

I think they're both crappy alternatives to doing a clean catch using a bag or catheterization w/out retracting the foreskin.

I guess I just feel like if the aren't smart enough to 'fish' for a urethra with a soft rubber tube...I don't want them 'fishing' around in my child's abdomen with a long, sharp needle. KWIM?

Jen
post #27 of 79
Thread Starter 
i never meant that i wouldnt get medical attention for him. his pediatrician's office, who we called first thing this morning, was closed for the 'holiday'.....so we're taking him tomorrow.....

he sure is eating a lot, every two hours, sometimes he'll do these little cluster feeds every half an hour for a few times too.........his diapers are very wet and full, and dont have a urine smell and are almost clear........his belly has sounded really gurgly and loud though, which i mentioned to them and they didnt really seem concerned........his nose sounds stuffy but there is nothing visible in it, although i have been giving the saline drops when he sounds stuffy, i can't suction anything out........
post #28 of 79
Quote:
Originally Posted by shaylahc
But like an ER nurse once told me....meningitis in newborns is SO common, but SO easily treated....why take that chance?
Not to contradict you, but what exactly does "SO" common mean? 50% of babies? 25%? 10%? 5%? 1%?

This article puts the risk of neonatal meningitis at .25% per 1,000 births: http://www.emedicine.com/neuro/topic239.htm

This information from the AAFP says, "Bacterial meningitis has an incidence of about 20 to 100 cases per 100,000 live births during the newborn period." http://www.aafp.org/afp/990515ap/2761.html

To me, that doesn't qualify it as "SO common".

I know it's a bit OT, but if anyone has any other info showing a significantly higher risk, please share because I'm interested in learning more about this topic.

Jen
post #29 of 79
Thread Starter 
Quote:
Originally Posted by PuppyFluffer
I believe you did the exact correct thing! You are the responsible party for the care of your child. If you know better about a procedure, insist that it be done right and by people experienced in doing it right.

My advice: If you instincts tell you "NO" about a medical procedure for your child....listen to them.

In a situation like that, can you request a patient advocate?
what is a patient advocate?
post #30 of 79
If you do decide to take him back to the ER, would (and this question isn't just for you, it's for the more knowledgable ER patrons too) it be possible to call ahead and tell them you're coming in, you suspect a UTI in your son and he's intact, and that you want someone waiting who is schooled in cathing an intact penis without retracting, and if not you'll be going to a different hospital? Or would that unreasonable? I'm just thinking if you're proactive and give them advance notice to get someone down from Peds or the NICU to cath him maybe it won't be as much of a struggle.
post #31 of 79
Thread Starter 
that's a good idea Lisa. I'll be seeing his regular, intact friendly ped tomorrow, maybe that's something she can make sure of for us, should a catheter be indeed necessary.
post #32 of 79
Good job sticking up for your son.
Makes me more and more hesitant to go to the doctors for anything, especially when i have children.
If everyone on this board became a doctor, it'd be one hell of an awesome hospital, lol.
post #33 of 79
I absolutly think you did the right thing!! to you for protecting your son!!
post #34 of 79
Quote:
Originally Posted by babykaoss
The doctor said he felt remiss in not checking for a UTI. Did I do the right thing in refusing? I'm so confused.

Please give me your opinions.
IMO, it doesn't matter if the dr was right or wrong, if the procedure was right or wrong, the treatment options were right or wrong, if you weren't comfortable with what was happening then nothing should have happened until you were comfortable with things. That dr sounds like he had ADS (Arrogant Doctor Syndrome)....very common .
post #35 of 79
I successfully cath intact babies all the time in the ER where I work. I *do not* retract. And would never do so.

I would also advocate (and have done so) for using the bag with a mom who is uncomfortable with me cath'g her son.

I will say that getting a cath urine in a baby with a fever without any other obvious signs of infection (such as an ear infection, cough, etc) isnt unusual. Especially because your baby is a "stranger" to us, unlike your regular ped who knows you and your baby.
post #36 of 79
Quote:
Originally Posted by sunflower_mommy
Frank, I cringe at the thought. To me, the invasiveness (and probably the pain) is probably similar to amniocentesis. They would probably need to significantly restrain him, use ultrasound guidance, and there's probably a risk of poking other organs, infection, and bruising.
Just looking at photos of the procedure is enough to make any of us quiver but it's not all that bad. The bladder is a quite large organ and for someone experienced, would be at the least, difficult to miss. There is no more risk of infection than with drawing a blood sample. An infant's abdominal muscles are not developed like an adults so there is less discomfort and bruising.


Quote:
I think they're both crappy alternatives to doing a clean catch using a bag or catheterization w/out retracting the foreskin.

I guess I just feel like if the aren't smart enough to 'fish' for a urethra with a soft rubber tube...I don't want them 'fishing' around in my child's abdomen with a long, sharp needle. KWIM?

Jen
I understand that and suprapubic aspiration is a far second in preference to catheritization by a knowledgeable operator but is preferable to forcible retraction of a firmly adherent foreskin during the cath procedure.



Frank
post #37 of 79
Quote:
Originally Posted by sweetbaby3
Last edited by sweetbaby3 : Today at 12:43 AM. Reason: Frank taught about cathing intact boys, as well as other parents here in this forum.
Another graduate of The MDC School of Medicine? :

I have had 3 MDs PM me about their learning experience here, A pediatrician, a family practitioner and a OB/GYN as well as a veternarian and several nurses and other doctors and nurses have posted here as well. Why haven't we been receiving your tuition checks?

Seriously, I am glad the members here have been able to make such a difference outside this forum. It validates the time we spend here and puts fuel in our tanks to continue our work. Thanks for the feedback! We thrive on it!



Frank
post #38 of 79
UTI is the most common infection in a newborn. It is very treatable. Geez, I've had both my boys cathed, the second one so many times, without incidence of retraction, both in Salt Lake City and in Houston TX. Not the meccas of intactness exactly.

The bag is not reliable. Someone already mentioned above. And yes, you can have NO elevated white blood cells and still have a low level kidney infection.

Suprapubic aspiration is much more painful and more invasive than an injection. And it will scar your bladder which is a far more important organ in the scheme of things. It requires fluoroscopy and being strapped to a board to be held completely still.

The weirdest thing though is that the DOCTOR wasn't gonna cath the baby in all likelihood. The nurse was. Talking calmly and gently to the nurse who was going to do the procedure, and explaining how to do what they need to do through the process is a much more effective technique than refusing treatment. In fact, first assessing the nurse's skill level, making sure it wasn't a student, asking how many intact boys they see, and perhaps offering yourself to show them just how much they may open the foreskin ever so gently. I don't know Frank's cathing protocol, but I wouldn't want a nurse fishing around inside the baby's foreskin for the meatus.

Now the doctor I wouldn't trust to the cath because they aren't trained, unless they are a urologist. And geez, even the very pro-circ urologists that I know never retract the foreskin to cath.

Seriously, I don't have enough fingers and toes to count the number of times my second son has been cathed by many different people.

Nurses, especially in pediatric hospitals, usually respond quite well to gentle instructions and information regarding your baby and what you would like done.

I think the mistake is people think they need to convince the doctor of their point of view in order to the such and such procedure. This is not true. In the words of my urologist: "You don't have to convince anyone of anything. You just tell them what they can and cannot do."

So in this instance, say, "I understand that there is a very high chance of a UTI in a baby with a fever and no other signs of infection. I'm willing to let you catherize the baby for the sample as it is more likely to produce a clean sample than a bag and is certainly less invasive than suprapubic aspiration. However, I would like for a seasoned nurse, not a student nurse, to do the procedure, and I would like to direct him or her on how I want my baby's foreskin to be handled in order to find the meatus and introduce the catheter into his urethra."

Throw in a couple of Latin words and they are good to go.

But maybe I just spend too much time in the ER.
post #39 of 79
Sorry I cross posted with you Frank. Would you mind posting a link to your info on how to cath an intact penis?

Why not just refuse the cath IF the foreskin was quite adherent. Isn't it easy enough to tell. Ya barely have to move the foreskin to find the meatus to cath.

mv
post #40 of 79
I hate doctor-bullies. Good for you for sticking up for your son. It's esp tragic that it happened in a Children's Hospital, for goodness sakes.
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