How do you handle "The Screams"?

[BigFootsCousin]

This is something that we don't talk about much. Ok, in my circle of ER friends it's NOT brought up at all.

The childrens 'screams' are getting to me lately. The adults screams don't bother me at all.

I'm not talking about the usual bratty kids acting out, but the full blown horrified and acting like they're gonna die screams.....

(yes, screams are good, airway etc.) but........

What do you guys/gals do?

Thank you for ANY insights or methods of coping with this. BTW, I've been doing this for twenty years, and it's still nerve wracking.

BFC

[BigFootsCousin]

Wow.

16 'views' and not one suggestion yet.

I guess that it's a subject that's not easily discussed, and easier yet to just ignore.

BFC

[Reasonable Rascal]

Not being subjected to them on a regular basis I've always just waited them out. That said there is a reason I don't do Peds.

RR

[Austerenurse]

I try and make light of the screaming situation and opt to rate the scream on the CSLVI (that is of course, if you did not know <smile> the Child Screaming Lung Volume Index).

At first glance all those horrific screams all seem to get a 10/10. But after judging them a little more carefully (for tone change, duration, volume, depth of sound, the amount my hair stands up, and the reaction of the parents and people around them in the ED) I have determined that most of them are actually between 6 and 8 of 10. Gives me something to do... and while rating the scream it seems to distract me from the actual scream.

I wish there was a better method. For everything else there is Ketamine.

Cheers,

AN

[Craig]

Really not sure what you mean by not discussed and easy to ignore.

Smaller children are terrified at whats happening and get very distressed.

We work hard to make our ED child friendly and work towards the "painless ED" but ultimately for some kids the fear is so great they express their fear and/or pain by screaming.

You do what you can to minimise it, and do what you can to keep the procedure or intervention length to a minimum.

In terms of coping, if you cant you need to get out of Paeds ED - it goes with the territory - I dont have a coping strategy -it goes with the territory. Its not like your doing it deliberately to torture the child. Dont think of myself as particularly insensitive - but seriously, if you cant cope with the heat .....

Craig

[BigFootsCousin]

Really not sure what you mean by not discussed and easy to ignore.

Smaller children are terrified at whats happening and get very distressed.

We work hard to make our ED child friendly and work towards the "painless ED" but ultimately for some kids the fear is so great they express their fear and/or pain by screaming.

You do what you can to minimise it, and do what you can to keep the procedure or intervention length to a minimum.

In terms of coping, if you cant you need to get out of Paeds ED - it goes with the territory - I dont have a coping strategy -it goes with the territory. Its not like your doing it deliberately to torture the child. Dont think of myself as particularly insensitive - but seriously, if you cant cope with the heat .....

Craig


I can "Cope" with it. I'm just kinda edgey sometimes with the blood-curdling screams from gravely injured children.

I guess I'm just not as tough as you Craig. Thank you for your constructive advice.

BFC

[Craig]

Sorry if I came accross harsh - Im just not sure exactly what sort of answer you want. I dont think Im tough - but its a Paeds ED fact of life and you just focus on minimising the distress

Craig

[night driver]

I'm a wuss for kids and screams...

That having been said, I had an experience eons ago (12 or so years ago) that pretty much beat me over the head on steeling myself in terms of the screams.

Got into a situation where the kid was loud enough (and I was inexperienced enough at the level I was playing) that I didn't do the intervention in the best manner available because I was trying to be gentle and kind....

Hindsight (provided by my bride who was there) informed me that it wasn't a kindness to be gentle (or to try to be) nor was it in the interests of the kid for me to BE "gentle"....

End result, parents exited treatment station with a kid with 2nds over 50% of both feet, and I have no idea if the kid DID get properly treated.

I was COMPLETELY flumoxed. My bride (at a reasonably time removed point) took me "gently" to task and "modified" how I look at things with kids.... NOW the loop simply plays in the back of my head that I am FIXING the issue that is CAUSING the screaming, and " 'tis NOT a kindness to be gentle" and the QUICKER I get it done the better for BOTH of us.

[Reasonable Rascal]

I'll add my 2 cents worth in here.

Back in "00 when I had the Big Crash that caused my rather abrupt career change (okay, so it took another 2 years to even recover to that point) there were kids in the car that was traveling in front of us. The car was hit by the other guy before he hit us; we saw the crash and it had every appearance of being really bad for whoever was inside.

There were 3 kids in the car along with Mom and Dad. After the initial commotion from the double crash (3 vehicles, 2 collisions) died down they set up an anguished wailing that told you that someone in there was either very seriously hurt or even dieing. Over the course of 24 years I'd heard my share of "the screams" and this was not within that catagory, i.e. a scared kid overreacting. The crying and pleading had a quality all its own. There were no adult voices joined in.

Long story short version the kids came out okay and so did Mom and Dad, albiet there were a few fractures between them - couple legs for Dad, an arm for one of the kids - and little else. Even the family cat came out unscathed.

But had you been there no one could have convinced you that someone inside that car was not dieing if not already deceased. It took several years to be able to rationalize what I heard with what the eventual outcome turned out to be.

RR

[James Huffaker]

Gents, As an Ex-EMT, RN, and dad, I've heard my share of screaming kids. Peds isn't an area I know enough about, but to my mind, a child's screams are handled the same as any of the horrific things that we regularly deal with, you do what must be done to help them, as quickly, painlessly and efficiently as possible. Becoming lost in their situation serves no one.
Then we deal with it after the fact.
Regards, Jim