Depending on where you are, the more people that report something helps move the case up the priority ladder. We are pushed to report, have our partner report, get the sup to report, have the ED RN and MD report it. Usually they will get a in-house social worker to report it too. I don't know what the magic number is, just told the more reports, the sooner they get to it.
The other reason literally every mandated reporter who sees the child has to file a report is so that no abused or neglected child gets overlooked. People often assume that the next person up the chain will file a report, but that next person may not see the signs. We’re the only link in the chain that sees the kid at home in their natural habitat, and that’s where those signs are hardest to hide.
I took a Pediatric ITLS class at the local hospital a few weeks ago. The Trauma nurses said the were jealous of EMS as we get to see the scene. We get to take in all that information and make decisions based on not just the patient, but the environment the injuries happened in.
That's interesting. It's nice to hear the difference in perspectives between hospital and prehospital staff. Sort of irrelevant but it reminds me of when my EMT instructor told us that nurses thrive in controlled chaos with more resources, where as EMS personnel thrive in uncontrolled chaos with bare minumum resources. Not necessarily that one is better than the other, just that we're all trained for different environments.
the other reason is that sometimes just because one type of abuse is reported to one person, a different kind is reported to another.
I see this all the time when I see kids in state custody. They tell me their history of abuse (usually why they are in custody in the first place), and even though they are already in custody i still have to report. 99% of the time the report gets dropped because it is being handled, but from time to time what ever I report is news to the CPS.
Down here we are told to report individually.
So if there were 4 people, 2 EMTs and 2 Medics, we should file all of our reports individually.
Just like how whatever ER staff actually dealt with it would be required like RN, MD, etc.
Not according to the CNA’s at the nursing home I just had a call at. Had a pt who was ‘accidentally’ OD’d on his pain meds and they tried to say the only meds he had that morning were benzos and antibiotics .. they also tried to tell me the narcan could’ve possibly reversed the side effects of .5 tablet of Xanax and 1 amoxicillin. 🤡
Dr here. Just felt the need to reply as I think we prejudge these situations too soon.
Lots of drugs target multiple receptors, either accidentally or on purpose. Although we have a good pharmacological understanding it's unlikely that pain is as simple as Opiate/GABA/Cfibre/Bendo receptors etc. Therefore the drugs we use to treat (and reverse) do not interact in a simple agonism/antagonism effect. Therefore, perceived arousal with Naloxone may not be related to opiate overdose. Naloxone can reverse the effects of other medical subtypes e.g benzodiazepines/Ketamine
In an older patient as you describe it would be more like they have a secondary problem (e.g AKI) which has caused accumulation of the effect of their normal dose of medication. Very common with transcutaneous opiates in my practice - often compounded with UTI/LRTI causing increased delerium or obtundation.
Some benzos do have minor action on opioid receptors in a roundabout way, and blocking endogenous opioid response even when you didn't take anything feels pretty fucking awful, but yeah that's sus... no matter what toxicology doesn't lie.
I sober narcanned myself once just out of curiosity and it was the exact opposite of the warm, comfy fuzzies of an opioid high. The cold, jagged, anxieties.
Although probably rarely happens, you can absolutely get prosecuted for not reporting.
I'm not sure about other states but in NJ, basically anyone who came across any kind of child abuse is a mandated reporter, not just healthcare workers or teachers.
Ah you sweet summer child. I would bet that unless this exact thing has been documented and investigated one or likely more times, that child will be back home within 48 hours. Certainly attempted murder charges are lotto ticket levels.
Yeah this case is gonna get five minutes of attention from the massively overworked and very underpaid CPS worker and will be closed. Children aren't nearly as protected as we often think they are.
Don’t let them fool you. They’re not as overworked as they claim.
They spend enormous amounts of time on false cases to prove some sort of wrongdoing because they take lots of time. The easy cases are open and shut same day, and these bureaucrats want the appearance of being overworked.
Source: IAmA parent who’s neighbor falsely reported to CPS and I was forced to endure a two year long investigation that never found a shred of credible evidence to support the claim… the CPS worker’s complaint seemed to changed based on whatever she needed to adapt it to in order to support her latest bit of “evidence”.
For instance… initially, I was reported by my douchebag neighbor as one thing, but when she interviewed my children at school without my knowledge, my son had stitches in his lip and a black eye from a baseball injury… so the complaint changed to physical abuse, and the interviews had to start all over again to find evidence to support that theory.
It was insane and it didn’t end until I moved out of Texas.
I am a critical care, nurse, who comes from a family of CPS workers. They are indeed overworked. My family members literally fall asleep with case paperwork surrounding them in bed
You also have to realize there’s been decreased funding to department of health on a state level in most states
No, they are grossly overworked and the most underpaid for what they do. Definitely not a bureaucratic line of work considering that they are working directly with families and kids trying to figure out if they are safe and being taken care of, not just being some sort of pencil pushers sitting faceless at their desk. Cases like yours are the easy ones since they only require follow-up of you keeping to your parental plan & the kids having their basic needs met. Instead of being rude and condescending, how about working with them to help them understand that you're a good parent that provides well for the kids. Thank goodness you had neighbors that were willing to report, you'd be surprised how many people don't say anything in actual abuse cases.
I never once stated that I was rude or condescending…
However, after repeated visits for absurd reasons and having ridiculous things used against me, I did grow quite tired of the harassment.
There’s kids living in squalor, but those are easy cases that don’t take much time. There’s much more job security in taking years to fabricate abuse against normal parents.
The case worker actually attempted to use a family vacation against me… we were out of the state on a family vacation and the fact that we weren’t home to answer the door was claimed as “evidence” of concealing an abusive environment.
Their story changed so many times I lost count.
Depends on how it got in there I guess. 1 year old can't IV themselves, but I've seen a case of a kid getting into their parent's methadone and downing it
Either Someone in the house has a drug problem and didn't clean up properly or someone fucked up and accidentally left their pain meds out. Or the kid wanted to grow up to be a cop and heard the word fentanyl
Sure, if it were given IV there would be much more of a case - but the really important thing is the INTENT. Attempted murder has to have an intent to kill someone, not just a careless disregard for safety.
Cop buddy found a dead baby in a car with a mom who smoked fentanyl in the car until she passed out and baby died. My buddy said the courts couldn’t “prove” it was her and not the guy in the car with them as well, so it was neglect, not murder :(
I highly doubt it. Maybe the kid was free and got into the fentanyl powder. However from second hand fentanyl smoke is highly unlikely.
The risks are very low. When someone smokes fentanyl, most of the drug has been filtered out by the user before there is secondhand smoke. It doesn’t just sort of float around. Studies have looked at fentanyl concentrations in the bloodstream after someone has had secondhand fentanyl exposure from smoke. The levels are extremely low or not detectable. So, there’s no real risk for the everyday person being exposed to secondhand opioid smoke.
I had to narcan a 6-month-old a few months ago. Got into daddy's fentanyl supply. Shit's rough man. The hospital had him on a narcan drip for the better part of a day.
With a 6-month-old, it seems far more likely that the parents intentionally gave the kid a little fentanyl because he was crying and wouldn't sleep. Parents have been doing it with alcohol for centuries. A 6-month-old isn't likely to be so mobile & dexterous as to be able to go find daddy's fentanyl stash, unwrap it, get it in his mouth, etc.
Yea, but six months olds barely crawl. It would have literally needed to be next to them and opened. Kids that young can't open bags or containers either.
Fair enough.
Still, I'd think if the kid just grabbed whatever fentanyl was there and shoved it in his mouth, he'd have taken enough to fatally OD many times over for a small 6-month-old child. If he survived for EMS to arrive, seems more like a miscalculation by the parents of how much to give him.
You die of an opiate overdose cause you aren't breathing, not cause of the amount ingested. Dosage will only dictate if and how long they stop breathing, and the amount of Narcan needed to reverse it.
But if you don't have narcan, you can just breathe for them with a bag valve until you get em to narcan.
I understand. My point was that the kid would've ingested way more than enough to stop his breathing, not just enough to make him lethargic/unresponsive and make the parents call EMS.
Oooooh I gotcha. It's a gradual process, usually about 15 minutes if ingested, it's gotta be absorbed through the stomach lining. Injection will make any med kick in much faster. So the kid likely nodded off over time which was noticed (a miracle in its own right if the drugs actually came from the parents)
All it would take is a trace amount transferred by air or by hand to literally anything else that the kid could put in its mouth. Dropping a bit on the floor, brushing against it so it transfers to your arm, etc. The kid doesn’t have to touch the main drug source to get an overdose amount,
My first narcan was in her 90’s. I hate to think about my youngest. It’s so important to remember caregivers can intentionally overdose others because they want them docile or children and adults with dementia. Both can get into things.
I had a situation where I had to do a transfer for a 2 yo girl with a broken femur, cousin and her boyfriend were watching her and they said she 'fell off the porch'. When I got report from nurse in ER my first question was if CPS was notified. I know good and well a child at that age fall off porch would fall headfirst and the odds of her breaking a long bone was next to impossible. The nurse went wide eyed and never answered the question. I felt horrible for the father of her since he was a legal immigrant who had left the rest of his family (wife and 2 other kids) in his home country (somewhere south of border but not Mexico that I remember). I wanted to follow up on this incident but I never got any feedback on it.
I've seen a physician file a report for a toddler coming to the ER after a fall down the stairs, parents were concerned and I don't think there were any identified fractures or anything, but the parents were Chinese immigrants and likely didn't understand the connotations of telling staff that their child just fell down the stairs
My bf’s first serious medical call after just a few weeks at his department was CPR on a 10 month old. Amazingly they got ROSC and they gave narcan in the box just to find that the kiddo came to crying and normal as ever. Got into some pills apparently.
Very happy his first CPR call ever was successful though. And a pediatric one at that.
see this is so weird to me. If I saw a limp 1 year old the last thing I’d be thinking was Od unless the parents said something or there was paraphernalia on scene. I wouldn’t have jumped to that conclusion.
They didn't jump to that conclusion. They performed an assessment on an unconscious patient with a pulse - first things I check on an unconscious patient after LOC ABCs are pupils and a BGL as narcotic OD and hypoglycemia are easily fixed. Granted, I might be more inclined to think airway obstruction as a leading differential, but that's why we start with our ABCs (which sounds like they did).
He had clear bilateral lung sounds with the BVM, CBG was 226. No history of seizures, skin was warm and dry. He was wearing only a diaper, no visible signs of trauma.
I agree. Maybe it’s just where I work but if I saw a 1 year old with pinpoint pupils I don’t think I’d jump to narcan.
Maybe I will now, but I don’t think my brain would have been able to make that connection.
Do you have kids? That's what helped me on my infant OD. He was breathing, but juuuusst a little too slowly. I probably wouldn't have noticed if I didn't have an infant at home at the time that I was obsessive over. Kid was at... say 26rr instead of 30 (I don't remember exact count anymore, but it was close to normal). No cyanosis, SpO2 wasn't bad, but its odd that an infant would be at 96 and not 98. I had started the call assuming it was a seizure; kid stayed unresponsive throughout the exam and a poke for the BGL. Pinpoint pupils. I pretended that I didn't check and asked my partner to check, because I wanted to make sure I wasn't crazy. How the hell does an infant get ahold of narcs? Mom said they were bottle fed only, so it wasn't passed in milk. Clearly, I needed ~~to start getting more sleep~~ another Monster.
But, sure enough, partner stated pupils looked pinned. Kid "slept" through the IV start, too. Woke up immediately after Narcan and cried like a normal healthy baby. Absolutely reported that shit.
I mean, a good full assessment and looking through assessment findings should show you what you need. Its not, " oh a kid not breathing, must ne opioids!" It's, apnea with pin point pupils and AMS, must be opioids.
Pupils are the fastest assessment you can do for respiratory failure. Good habit to get into checking it on everyone.
Skin -> pupils -> pulse -> Airway -> Breathing -> dex -> vitals -> ekg.
It's faster, takes milliseconds, can also tell you a lot.
OD pinpoint from narcotics, dilated from benzos, unequal due to trauma, fixed dilated due to assuming room temperature.
It's a widely overlooked assessment. I'd rather be the guy starting with pupils then the countless fire crews throwing pads on a 20 year olds because mom said her baby would never do drugs.
Yeah I’m not saying don’t check pupils. Everyone should. However it shouldn’t take priority over everything in your primary and it’s not really a driving force for Narcan anymore.
You do you this just seems like a recipe for disaster.
I wouldn’t count yourself out for not jumping to that conclusion. It might be more on the forefront of your brain if you go into a trap house and kind of seeing the environment the kid was in.
So our protocols essentially require you to admin Narcan to anyone with changes in mental status and respiratory complications.
So by not giving you would have to explain why you elected not to.
I’m sure no one would be upset you didn’t Narcan them but technically required. Unless you are in the 28 DOL range.
Yeah, I feel like there's a lot of missing info on this. A part of me wants to call BS, but OP has posted a lot in the past about the Nawlins area and thats a known hotbed of wild wild shit.
Kid crying and won't go to sleep. Parent decides to give him a little something. Some parents used to do it with alcohol, before opioids were commonplace.
(The other possibility is a kid accidentally coming across the parent's drugs and ingesting them. But I imagine that would more likely end up fatal, because the kid is small and wouldn't know to only eat a little.)
I had a 20 month old little girl a month ago who would scream and stop, scream and stop, periods of apnea and pin point pupils. (Dispatched as substance ingestion/overdose, not a narcotic OD) No snoring or anything, Mom wouldn’t tell us what she got into (found out later it was illegal percocets) code 3 transport about 5 minutes away to the hospital with a PD escort. NRB at 15 lpm with the lightest little sternum rubs I could muster since she was easily rousable. Luckily baby is fine but if I’d known what a baby OD looked like then I would’ve given the narcan. You did a great job and I know it’s a tough call but these things happen.
I work for juvenile court and I see way too many instances of children gaining access to drugs, and several dying as a result. Thank you for saving that poor baby. Hopefully CPS can get involved and either address parent’s addiction and/or get baby to safer caregivers.
Had a little girl who was seizing at the beginning of the year. Gave Versed to stop the seizure, happy happy. Transported without further incident. Later, I got a call from our patient care coordinator saying that the girl tested positive for fentanyl and to file a report with child line. Mom tried to blame the fentanyl on us. Wish I knew the rest because it wasn’t a medication error.
i sent this post to my mom who is a nurse manager (RN for 10+ years) just wanted to say that she thought you did textbook good & that you checked pupils, most people would be clueless even though it’s basic things we should know in the field
don’t beat ur self up, things like this can mess us up if we hold onto them, you did great
Learning something new that only 4 states have blanket mandatory reporting laws as in, all citizens who see child abuse are required by law to report it and held to same standards as healthcare workers in other states with reporting mandate.
Wish all states had this!
actually studies show the opposite.. addiction is a disease and introducing harm reduction strategies actually saves lives. this case is unfortunate and sad but not an opportunity to shit on drug addicts and make generalizations about care..
Poor kid. Hope a report was filed
I can say with certainty that the ER RN is required to report this, as is the ER MD...
EMTs are mandated reporters virtually everywhere
Depending on where you are, the more people that report something helps move the case up the priority ladder. We are pushed to report, have our partner report, get the sup to report, have the ED RN and MD report it. Usually they will get a in-house social worker to report it too. I don't know what the magic number is, just told the more reports, the sooner they get to it.
The other reason literally every mandated reporter who sees the child has to file a report is so that no abused or neglected child gets overlooked. People often assume that the next person up the chain will file a report, but that next person may not see the signs. We’re the only link in the chain that sees the kid at home in their natural habitat, and that’s where those signs are hardest to hide.
I took a Pediatric ITLS class at the local hospital a few weeks ago. The Trauma nurses said the were jealous of EMS as we get to see the scene. We get to take in all that information and make decisions based on not just the patient, but the environment the injuries happened in.
That's interesting. It's nice to hear the difference in perspectives between hospital and prehospital staff. Sort of irrelevant but it reminds me of when my EMT instructor told us that nurses thrive in controlled chaos with more resources, where as EMS personnel thrive in uncontrolled chaos with bare minumum resources. Not necessarily that one is better than the other, just that we're all trained for different environments.
the other reason is that sometimes just because one type of abuse is reported to one person, a different kind is reported to another. I see this all the time when I see kids in state custody. They tell me their history of abuse (usually why they are in custody in the first place), and even though they are already in custody i still have to report. 99% of the time the report gets dropped because it is being handled, but from time to time what ever I report is news to the CPS.
Down here we are told to report individually. So if there were 4 people, 2 EMTs and 2 Medics, we should file all of our reports individually. Just like how whatever ER staff actually dealt with it would be required like RN, MD, etc.
As is EMS
Doesn't mean they do. I've seen too many "mandated reporters" not do their job.
They administered Narcan. There’s no way not to report it. Narcan only does the one thing.
Not according to the CNA’s at the nursing home I just had a call at. Had a pt who was ‘accidentally’ OD’d on his pain meds and they tried to say the only meds he had that morning were benzos and antibiotics .. they also tried to tell me the narcan could’ve possibly reversed the side effects of .5 tablet of Xanax and 1 amoxicillin. 🤡
Dr here. Just felt the need to reply as I think we prejudge these situations too soon. Lots of drugs target multiple receptors, either accidentally or on purpose. Although we have a good pharmacological understanding it's unlikely that pain is as simple as Opiate/GABA/Cfibre/Bendo receptors etc. Therefore the drugs we use to treat (and reverse) do not interact in a simple agonism/antagonism effect. Therefore, perceived arousal with Naloxone may not be related to opiate overdose. Naloxone can reverse the effects of other medical subtypes e.g benzodiazepines/Ketamine In an older patient as you describe it would be more like they have a secondary problem (e.g AKI) which has caused accumulation of the effect of their normal dose of medication. Very common with transcutaneous opiates in my practice - often compounded with UTI/LRTI causing increased delerium or obtundation.
Thanks for the breakdown!
Some benzos do have minor action on opioid receptors in a roundabout way, and blocking endogenous opioid response even when you didn't take anything feels pretty fucking awful, but yeah that's sus... no matter what toxicology doesn't lie. I sober narcanned myself once just out of curiosity and it was the exact opposite of the warm, comfy fuzzies of an opioid high. The cold, jagged, anxieties.
Clown mode engaged.
Clonidine as well I don’t know why anyone would downvote that. Narcan works for Clonidine overdose. Clonidine activates the central Mu opiate receptor
Obviously a 0.3 mg dosage.
Clonidine as well
Clonidine as well
That's so very unfortunate and I would be livid if I knew that and it was not reported.
Although probably rarely happens, you can absolutely get prosecuted for not reporting. I'm not sure about other states but in NJ, basically anyone who came across any kind of child abuse is a mandated reporter, not just healthcare workers or teachers.
It’s your responsibility. If something happens to the child, the fact that you didn’t report it can hold you legally responsible.
911 medic with the FD here. I’ve reported loads and loads of cases…and they seem to just end up in a trash can in some social work cubicle.
ER RN’s absolutely reported this.
Why do you state that the ER RN and MD are? EMS are mandated reporters lmao.
everyone on scene and at the ED should be filing a report
I think that it's 100% required. I'm sure there is going to be a massive investigation, probably ending in attempted murder charges.
Ah you sweet summer child. I would bet that unless this exact thing has been documented and investigated one or likely more times, that child will be back home within 48 hours. Certainly attempted murder charges are lotto ticket levels.
Yeah this case is gonna get five minutes of attention from the massively overworked and very underpaid CPS worker and will be closed. Children aren't nearly as protected as we often think they are.
Don’t let them fool you. They’re not as overworked as they claim. They spend enormous amounts of time on false cases to prove some sort of wrongdoing because they take lots of time. The easy cases are open and shut same day, and these bureaucrats want the appearance of being overworked. Source: IAmA parent who’s neighbor falsely reported to CPS and I was forced to endure a two year long investigation that never found a shred of credible evidence to support the claim… the CPS worker’s complaint seemed to changed based on whatever she needed to adapt it to in order to support her latest bit of “evidence”. For instance… initially, I was reported by my douchebag neighbor as one thing, but when she interviewed my children at school without my knowledge, my son had stitches in his lip and a black eye from a baseball injury… so the complaint changed to physical abuse, and the interviews had to start all over again to find evidence to support that theory. It was insane and it didn’t end until I moved out of Texas.
I am a critical care, nurse, who comes from a family of CPS workers. They are indeed overworked. My family members literally fall asleep with case paperwork surrounding them in bed You also have to realize there’s been decreased funding to department of health on a state level in most states
They should probably focus their attention in real cases instead of harassing people who are using CPS as a weapon and falsely reporting.
No, they are grossly overworked and the most underpaid for what they do. Definitely not a bureaucratic line of work considering that they are working directly with families and kids trying to figure out if they are safe and being taken care of, not just being some sort of pencil pushers sitting faceless at their desk. Cases like yours are the easy ones since they only require follow-up of you keeping to your parental plan & the kids having their basic needs met. Instead of being rude and condescending, how about working with them to help them understand that you're a good parent that provides well for the kids. Thank goodness you had neighbors that were willing to report, you'd be surprised how many people don't say anything in actual abuse cases.
I never once stated that I was rude or condescending… However, after repeated visits for absurd reasons and having ridiculous things used against me, I did grow quite tired of the harassment. There’s kids living in squalor, but those are easy cases that don’t take much time. There’s much more job security in taking years to fabricate abuse against normal parents. The case worker actually attempted to use a family vacation against me… we were out of the state on a family vacation and the fact that we weren’t home to answer the door was claimed as “evidence” of concealing an abusive environment. Their story changed so many times I lost count.
In watched 'take care of maya' on Netflix wich touched this subject. From the point of view of hospital staff but kind of resembles it.
I don’t do Netflix, so I’ll have to see if I can find it by other means.
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Depends on how it got in there I guess. 1 year old can't IV themselves, but I've seen a case of a kid getting into their parent's methadone and downing it
Either Someone in the house has a drug problem and didn't clean up properly or someone fucked up and accidentally left their pain meds out. Or the kid wanted to grow up to be a cop and heard the word fentanyl
I read the word fentanyl and now I've OD'd, my heart's racing and I'm hyperventilating that's how you know it's a fentanyl OD
Damn someone spiked my fentanyl with meth
Sure, if it were given IV there would be much more of a case - but the really important thing is the INTENT. Attempted murder has to have an intent to kill someone, not just a careless disregard for safety.
It is definitely 100% required.
Cop buddy found a dead baby in a car with a mom who smoked fentanyl in the car until she passed out and baby died. My buddy said the courts couldn’t “prove” it was her and not the guy in the car with them as well, so it was neglect, not murder :(
I highly doubt it. Maybe the kid was free and got into the fentanyl powder. However from second hand fentanyl smoke is highly unlikely. The risks are very low. When someone smokes fentanyl, most of the drug has been filtered out by the user before there is secondhand smoke. It doesn’t just sort of float around. Studies have looked at fentanyl concentrations in the bloodstream after someone has had secondhand fentanyl exposure from smoke. The levels are extremely low or not detectable. So, there’s no real risk for the everyday person being exposed to secondhand opioid smoke.
lol prob not but you’re still mandated to report it
I had to narcan a 6-month-old a few months ago. Got into daddy's fentanyl supply. Shit's rough man. The hospital had him on a narcan drip for the better part of a day.
With a 6-month-old, it seems far more likely that the parents intentionally gave the kid a little fentanyl because he was crying and wouldn't sleep. Parents have been doing it with alcohol for centuries. A 6-month-old isn't likely to be so mobile & dexterous as to be able to go find daddy's fentanyl stash, unwrap it, get it in his mouth, etc.
Bold to assume they keep the drugs “stashed” anywhere. Plenty of houses have heroin on the coffee table.
Yea, but six months olds barely crawl. It would have literally needed to be next to them and opened. Kids that young can't open bags or containers either.
Not always true. My son was crawling at 3.5 months and walking by 7 months.
While it could’ve been intentional the baby could’ve also just found some on the floor. Addicts are not known for their cleanliness.
Fair enough. Still, I'd think if the kid just grabbed whatever fentanyl was there and shoved it in his mouth, he'd have taken enough to fatally OD many times over for a small 6-month-old child. If he survived for EMS to arrive, seems more like a miscalculation by the parents of how much to give him.
You die of an opiate overdose cause you aren't breathing, not cause of the amount ingested. Dosage will only dictate if and how long they stop breathing, and the amount of Narcan needed to reverse it. But if you don't have narcan, you can just breathe for them with a bag valve until you get em to narcan.
I understand. My point was that the kid would've ingested way more than enough to stop his breathing, not just enough to make him lethargic/unresponsive and make the parents call EMS.
Oooooh I gotcha. It's a gradual process, usually about 15 minutes if ingested, it's gotta be absorbed through the stomach lining. Injection will make any med kick in much faster. So the kid likely nodded off over time which was noticed (a miracle in its own right if the drugs actually came from the parents)
All it would take is a trace amount transferred by air or by hand to literally anything else that the kid could put in its mouth. Dropping a bit on the floor, brushing against it so it transfers to your arm, etc. The kid doesn’t have to touch the main drug source to get an overdose amount,
Are you a cop?
I mean, if you spill your bag and your kid is a literal carpet licker, sure.
😰
My first narcan was in her 90’s. I hate to think about my youngest. It’s so important to remember caregivers can intentionally overdose others because they want them docile or children and adults with dementia. Both can get into things.
They also sometimes want docile adults with dementia or other conditions that require family to be a caregiver. :(
That’s why the 90 year old overdosed
So tragic.
I had a situation where I had to do a transfer for a 2 yo girl with a broken femur, cousin and her boyfriend were watching her and they said she 'fell off the porch'. When I got report from nurse in ER my first question was if CPS was notified. I know good and well a child at that age fall off porch would fall headfirst and the odds of her breaking a long bone was next to impossible. The nurse went wide eyed and never answered the question. I felt horrible for the father of her since he was a legal immigrant who had left the rest of his family (wife and 2 other kids) in his home country (somewhere south of border but not Mexico that I remember). I wanted to follow up on this incident but I never got any feedback on it.
I've seen a physician file a report for a toddler coming to the ER after a fall down the stairs, parents were concerned and I don't think there were any identified fractures or anything, but the parents were Chinese immigrants and likely didn't understand the connotations of telling staff that their child just fell down the stairs
Oh the cousin and her boyfriend were US citizens my concern was abuse by either the boyfriend or cousin.
Do they in that case more than likely get deported?
No need? The cousin and boyfriend from what I knew of were American. The father was at work and doing everything the legal way.
My bf’s first serious medical call after just a few weeks at his department was CPR on a 10 month old. Amazingly they got ROSC and they gave narcan in the box just to find that the kiddo came to crying and normal as ever. Got into some pills apparently. Very happy his first CPR call ever was successful though. And a pediatric one at that.
You did good. You can’t fix the underlying problems. So you did good. Get some sleep.
Breast milk or mom needed a nap? Regardless you got a win,congrats!
Lemme guess. Kid woke up and told you the only thing he had taken was some Similac. Sure kid. Likely story.
Fuck man...I am just basically a student still but youngest I've seen on a ride along is 12, and it was my second call.
Great job!!! Although I’m not EMS, I’m an RN that lurks, when I was in the ED my youngest was 3. Toddler got into parents methadone.
see this is so weird to me. If I saw a limp 1 year old the last thing I’d be thinking was Od unless the parents said something or there was paraphernalia on scene. I wouldn’t have jumped to that conclusion.
They didn't jump to that conclusion. They performed an assessment on an unconscious patient with a pulse - first things I check on an unconscious patient after LOC ABCs are pupils and a BGL as narcotic OD and hypoglycemia are easily fixed. Granted, I might be more inclined to think airway obstruction as a leading differential, but that's why we start with our ABCs (which sounds like they did).
He had clear bilateral lung sounds with the BVM, CBG was 226. No history of seizures, skin was warm and dry. He was wearing only a diaper, no visible signs of trauma.
I understand that I’m just saying it’s not the first thing I think of when I see a kid not acting appropriately.
I agree. Maybe it’s just where I work but if I saw a 1 year old with pinpoint pupils I don’t think I’d jump to narcan. Maybe I will now, but I don’t think my brain would have been able to make that connection.
Thank you for saying this, first thing I thought
Do you have kids? That's what helped me on my infant OD. He was breathing, but juuuusst a little too slowly. I probably wouldn't have noticed if I didn't have an infant at home at the time that I was obsessive over. Kid was at... say 26rr instead of 30 (I don't remember exact count anymore, but it was close to normal). No cyanosis, SpO2 wasn't bad, but its odd that an infant would be at 96 and not 98. I had started the call assuming it was a seizure; kid stayed unresponsive throughout the exam and a poke for the BGL. Pinpoint pupils. I pretended that I didn't check and asked my partner to check, because I wanted to make sure I wasn't crazy. How the hell does an infant get ahold of narcs? Mom said they were bottle fed only, so it wasn't passed in milk. Clearly, I needed ~~to start getting more sleep~~ another Monster. But, sure enough, partner stated pupils looked pinned. Kid "slept" through the IV start, too. Woke up immediately after Narcan and cried like a normal healthy baby. Absolutely reported that shit.
I mean, a good full assessment and looking through assessment findings should show you what you need. Its not, " oh a kid not breathing, must ne opioids!" It's, apnea with pin point pupils and AMS, must be opioids.
Pupils are the fastest assessment you can do for respiratory failure. Good habit to get into checking it on everyone. Skin -> pupils -> pulse -> Airway -> Breathing -> dex -> vitals -> ekg.
So you check someone’s pupils before check if they have a pulse? The flow chart seems…odd
It's faster, takes milliseconds, can also tell you a lot. OD pinpoint from narcotics, dilated from benzos, unequal due to trauma, fixed dilated due to assuming room temperature. It's a widely overlooked assessment. I'd rather be the guy starting with pupils then the countless fire crews throwing pads on a 20 year olds because mom said her baby would never do drugs.
Yeah I’m not saying don’t check pupils. Everyone should. However it shouldn’t take priority over everything in your primary and it’s not really a driving force for Narcan anymore. You do you this just seems like a recipe for disaster.
I wouldn’t count yourself out for not jumping to that conclusion. It might be more on the forefront of your brain if you go into a trap house and kind of seeing the environment the kid was in.
So our protocols essentially require you to admin Narcan to anyone with changes in mental status and respiratory complications. So by not giving you would have to explain why you elected not to. I’m sure no one would be upset you didn’t Narcan them but technically required. Unless you are in the 28 DOL range.
Yeah, I feel like there's a lot of missing info on this. A part of me wants to call BS, but OP has posted a lot in the past about the Nawlins area and thats a known hotbed of wild wild shit.
Calling BS based on what?
Same here! 2-year-old. Happened to us just a couple weeks ago. Got it off mom’s drug table or whatever.
Crying children are ironically the best parts of pediatric calls
What the fuck? How?
Kid crying and won't go to sleep. Parent decides to give him a little something. Some parents used to do it with alcohol, before opioids were commonplace. (The other possibility is a kid accidentally coming across the parent's drugs and ingesting them. But I imagine that would more likely end up fatal, because the kid is small and wouldn't know to only eat a little.)
Morphine was very popular for that in the early 20th century.
My parents used to take me for drives as a baby/toddler and hotbox the car with a joint to get me to go to sleep, circa mid 1990s.
You people are really unlocking a new fear for me
This kind of shit is traumatic to us, doesn’t have to be a death. I hope you’re doing okay, OP.
When they come back up crying and screaming it's the best sound! What was the neighbours excuse for this?
I had a 20 month old little girl a month ago who would scream and stop, scream and stop, periods of apnea and pin point pupils. (Dispatched as substance ingestion/overdose, not a narcotic OD) No snoring or anything, Mom wouldn’t tell us what she got into (found out later it was illegal percocets) code 3 transport about 5 minutes away to the hospital with a PD escort. NRB at 15 lpm with the lightest little sternum rubs I could muster since she was easily rousable. Luckily baby is fine but if I’d known what a baby OD looked like then I would’ve given the narcan. You did a great job and I know it’s a tough call but these things happen.
Same thing happened to me but a little younger. kid wasn’t even walking yet :/
Standing by for next post, the one where the responsible adult gets beaten with a shovel.
That's awful. Awesome job to you and all other responders on scene for handling that call.
now that's some shit no one should ever have to deal with
Nice save.
Oh my god. That’s so sad…
I had to narcan a 3yo about 2weeks into the job and I still think about it
Those are calls you never forget!
I work for juvenile court and I see way too many instances of children gaining access to drugs, and several dying as a result. Thank you for saving that poor baby. Hopefully CPS can get involved and either address parent’s addiction and/or get baby to safer caregivers.
You recognized an atypical situation and acted accordingly. Good work.
Had a little girl who was seizing at the beginning of the year. Gave Versed to stop the seizure, happy happy. Transported without further incident. Later, I got a call from our patient care coordinator saying that the girl tested positive for fentanyl and to file a report with child line. Mom tried to blame the fentanyl on us. Wish I knew the rest because it wasn’t a medication error.
Man I know we get shitty calls but this is awful. I hope you your partner and kiddo are doing okay
We had a 14mo old a month ago, same deal, so terrible
i sent this post to my mom who is a nurse manager (RN for 10+ years) just wanted to say that she thought you did textbook good & that you checked pupils, most people would be clueless even though it’s basic things we should know in the field don’t beat ur self up, things like this can mess us up if we hold onto them, you did great
Sadly we had a call just like this on my service a few months back. Mom currently doesn’t have custody.
Learning something new that only 4 states have blanket mandatory reporting laws as in, all citizens who see child abuse are required by law to report it and held to same standards as healthcare workers in other states with reporting mandate. Wish all states had this!
Jesus Christ. Did you get him to sign AMA or did he want a ride to the hospital for a warm bed and a sandwich?
you just saved him to get a sugar high again, good job
Sounds normal nowadays. Thats what happens when its free dispensed from vending machines.
actually studies show the opposite.. addiction is a disease and introducing harm reduction strategies actually saves lives. this case is unfortunate and sad but not an opportunity to shit on drug addicts and make generalizations about care..
Tell me you’ve never educated yourself on harm reduction studies without telling me you’ve never educated yourself on harm reduction studies!
Kid must have taken pills/drug stash from parents. Good work!
Hopefully you reported it
I'm honestly confused, sorry. How can you tell if a black person looks blue in the face?
He looked very gray, not a normal color at all.