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SKH ED DC instructions

 

  • Asthma Discharge Instructions:

  • General Surgery Post-op Care

  • ABDOMINAL PAIN

  • ANAPHYLAXIS

  • Asthma/Wheezing

  • Bronchiolitis

  • Distal Radius Buckle Fracture

  • Cellulitis

  • Chest pain

  • Clavicle fracture

  • Concussion

  • Conjunctivitis

  • Constipation

  • Croup

  • Dental infection

  • Dental trauma

  • Diarrhea

  • Eczema

  • Epistaxis

  • Febrile seizure

  • Fever in Oncology patient without neutropenia

  • Fever without focus

  • Flovent (fluticasone)

  • For otherwise healthy children > 3 months of age with confirmed or suspected influenza virus

  • Fractured limb

  • Gastrostomy tube replacement

  • Head injury

  • Headache

  • Hives

  • Laceration (staples)

  • Laceration (stitches)

  • Migraine headache

  • Nasal congestion

  • New onset afebrile seizure

  • Otitis media

  • Pain control (acetaminophen)

  • Pain control (ibuprofen)

  • Pneumonia

  • Emergency Point of Care Ultrasound

  • Educational Point of Care Ultrasound

  • Pulled elbow

  • Rapid strep test NEGATIVE

  • Rapid strep test POSITIVE

  • Sickle cell pain crisis

  • Sickle cell with fever

  • Soft tissue infection

  • Soft tissue injury

  • Sore throat

  • Syncope (fainting)

  • Testicular pain

  • Ultrasound

  • Urinary tract infection

  • Ventolin (salbutamol)

  • Viral illness

  • Vomiting

 

 

Asthma Discharge Instructions:

 

1. Continue Ventolin (blue puffer) *** puffs EVERY 4 hours for the first 24 hours after discharge, then use 2 puffs every 4 hours AS NEEDED for wheeze, persistent cough or difficulty breathing (pulling in of the skin at the front of the neck or under and between the ribs, flaring of the nostrils, or very fast breathing).

 

2. Continue Flovent (orange puffer) *** puffs twice a day for AT LEAST 12 weeks. After that point, please reassess the dose and duration with your doctor.

 

3. Follow up with your primary health care provider within 72 hours (3 days).  

 

4. Return urgently to the Emergency Department if:

Your child has difficulty breathing, or you notice sucking in at the throat or between or below the ribs

Your child’s symptoms do not respond to the Reliever medicine (Ventolin - blue puffer)

Your child's symptoms return within 4 hours of the last dose of Ventolin

Your child cannot eat, sleep, walk or speak due to symptoms

Your child’s lips or skin look grey or blue

 

Key points to remember:

 

Ventolin is the reliever medicine – it helps to reduce symptoms as they occur. Your child should bring their Ventolin inhaler everywhere, in case of an asthma attack. Each Ventolin inhaler is good for about 200 puffs – please count puffs to prevent running out.

Flovent is a controller medicine – it works to prevent symptoms of asthma and decreases lung inflammation overtime. Continue this medication as ordered EVEN IF your child does not appear to have any shortness of breath, cough, or wheezing.

ALWAYS use the puffers with a spacer device to ensure the medicine is delivered directly to the lungs and not the roof of the mouth. The spacer should be washed once a week with warm soapy water and allowed to drip dry.

 

Further information about asthma and its management can be found at:

https://lungontario.ca

Https://www.aboutkidshealth.ca





 

General Surgery Post-op Care

 

Diet: diet as tolerated.

Activity: may return to normal daily activities as patient feels able.

Care of Incision: steri strips will fall off on own or remove after 10 days. Once steri strips removed, incision may be washed gently with soap and water.

Signs and Symptoms of Wound Infection: fever, redness around incision, drainage from incision, increasing pain around incision.

Call If: wound infection, vomitting, fever, abdominal distention.

Urgent Matters: please visit your nearest Emergency department.

Follow up Appointments: see family MD within 1 week of discharge; review dates of other SickKids follow up appointments.



 

ABDOMINAL PAIN

 

Follow up with your child's doctor for further evaluation as needed.  Return to Emergency if worsening abdominal pain, distended (swollen) abdomen, vomiting repeatedly, vomiting blood or green bile, blood in stool, persistent fevers, or otherwise more unwell.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca




 

ANAPHYLAXIS

 

Continue to give antihistamine medications as needed for ongoing mild allergy symptoms such as hives associated with itching.  Hives may come and go for a week or more. Give Epinephrine (Epi-Pen) and call 911 if your child is having a severe allergic reaction, including increasing facial, lip or tongue swelling, throat tightness, noisy breathing, wheezing, drooling, dizziness.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/anaphylaxis   



 

Asthma/Wheezing

 

See your child's doctor within the next few days if still not better.  Return to Emergency if trouble breathing or wheezing not helped by Ventolin every 4 hours.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/asthma



 

Bronchiolitis

 

See your child's doctor within the next few days for reassessment.  Return to Emergency if increased trouble breathing, blue lips, poor feeding, or seems lethargic (sleepy) or very irritable (crying).

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/bronchiolitis  



 

Distal Radius Buckle Fracture

 

It is not usually essential for a child to see a doctor about this injury after they leave the hospital. Most children with this injury heal very well and return to their usual activities within four weeks.  The Emergency Department doctor will tell you if your child needs a follow-up visit with your family doctor. Return to the Emergency Department if there is increased pain or swelling. For more information on care for this injury and expected recovery please see the AboutKidsHealth.ca section on "How To Treat a Buckle Fracture of the Distal Radius".



 

Cellulitis

 

Take the antibiotic as prescribed, and follow-up with your family doctor in 2-3 days if needed.  May give acetaminophen or ibuprofen for pain or fever. Return to Emergency if the redness and swelling continue to spread, increasing pain, persistent fevers, or other new concerns.




 

Chest pain

 

Follow up with your regular doctor for further care as needed.  Return to Emergency if the chest pain is severe, or you experience shortness of breath, palpitations, rapid heart rate, dizziness, or fainting



 

Clavicle fracture

 

Use sling for comfort, but not during sleep.  Give pain medications as needed over the next week or more.  Follow-up with your family doctor in 2-3 weeks for further advice about activities.  No contact sports for 3 months.



 

Concussion

 

It is important for your child to rest. This includes physical rest such as avoidance of sports, exercise, and other physical play, as well as brain rest from activities such as reading, media, and video games. The amount and duration of rest will depend on your child's symptoms, but generally no sports until free of symptoms for at least one week.

 

You can treat any headaches with pain medications as needed. You should see your regular doctor for further advice in the next few days, particularly in regards to activities and attending school. Further information about concussion and Return-to-Play / Return-to-Learn guidelines can be found at www.parachutecanada.org .

 

Return to Emergency if worsening headache, repeated vomiting, difficulty walking, vision problems, slurred speech, confusion, drowsiness, weakness, or other new concerns.




 

Conjunctivitis

 

May clean the eye with warm compresses to remove any discharge.  Apply eye drops/ointment as directed. Avoid contact with others, and wash hands often.  See your doctor if the infection does not improve within a few days.

 

Return to Emergency if there is increasing redness and swelling of the eyelids, eye pain, high fevers, persistent headache, vision problems, or other new concerns.




 

Constipation

 

Follow up with your regular doctor for further discussion.  Return to Emergency if having severe abdominal pain, repeated vomiting, distended abdomen, fevers, or blood in the stool.


 

Croup

 

See your child's doctor if having fevers for more than 2-3 days.  Return to Emergency if trouble breathing, trouble swallowing, drooling, blue lips, severe sore throat, neck stiffness, lethargy, weakness, or excessive crying.



 

Dental infection

 

Start the antibiotics as prescribed, and use pain medications as needed.  Follow-up with your regular dentist in a few days for reassessment and further care.  Return to Emergency if worsening pain, increasing redness and swelling of the face, high fevers, or other new concerns.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/dentalcare


 

Dental trauma

 

Please follow the instructions as per the dentist, or follow-up with your regular dentist if advised.  Return to Emergency if your child develops severe dental pain, facial swelling and redness, or fever.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/dentalcare



 

Diarrhea

 

Your child may eat a regular diet.  It is not necessary to dilute or avoid milk products. Recommended foods include rice, potatoes, bread, lean meats, yogurt, fruits, and vegetables.  Return to Emergency if there is blood in the diarrhea, increasing abdominal pain, or signs of dehydration including dry mouth, sunken eyes, weakness or dizziness.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/diarrhea

 

 

 

Eczema

 

Bathe child at least twice daily using Aveeno or Alpha Keri oil in the bath water.  After bathing, apply a thin layer of steroid creams/ointments as prescribed to affected areas, then cover the entire body (except face) with Vaseline.  May give Benadryl or Atarax for itching.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/eczema


 

Epistaxis (nosebleed)

 

Coat the inside of the nostrils with a thin layer of Vaseline (petroleum jelly) twice daily.  A vaporizer or humidifier in your child's room may be helpful. Avoid picking, rubbing, or blowing the nose if possible.  If bleeding returns, pinch the soft part of the nose for 5-10 minutes, with head leaning forward. Return to Emergency if unable to stop bleeding, or if your child is becoming weak, dizzy, or pale.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/nosebleed


 

Febrile seizure

 

See your child's doctor if the fever lasts for another 2-3 days, or sooner if concerned.  Return to Emergency if lethargic or weak, excessive crying, neck stiffness, another seizure, or appears unwell.

 

Further information about this and other conditions may be found at: www.aboutkidshealth.ca/febrileseizures

www.aboutkidshealth.ca/seizuresymptoms


 

Fever in Oncology patient without neutropenia

 

You may give acetaminophen (Tylenol or Tempra) for further fevers today, but do not give tomorrow unless you have documented a fever and have spoken with your Oncology Clinic nurse or the Oncology Fellow.  They must be contacted if the fevers persist. We will call you if any cultures are positive. Return to Emergency if your child is lethargic/weak, irritable, dizzy, vomiting repeatedly, having trouble breathing, or seems more unwell.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/fever



 

Fever without focus

 

See your child's doctor if still having fever in 2-3 days.  Return to Emergency if your child appears unwell, lethargic/weak, severe headache, neck stiffness, chest pain, trouble breathing, frequent vomiting, or a rash that looks like small purple dots.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/fever



 

Flovent (fluticasone)

 

Flovent (orange puffer) is an inhaled steroid medication that helps control lung inflammation over time, and does not work immediately to relieve wheezing.  Give 2 puffs of Flovent twice daily for the next several weeks, and see your regular doctor to discuss how long your child should remain on Flovent.

 

Further information about this and other conditions may be found at: www.aboutkidshealth.ca/asthma

www.aboutkidshealth.ca/asthmaspacer


 

For otherwise healthy children > 3 months of age with confirmed or suspected influenza virus

 

Your child has either been confirmed to have, or suspected of having, an influenza virus infection.  Unlike a common cold, this infection tends to give high fevers that can last for up to 7 days. Most healthy children will recover on their own and not experience any complications, however, some children will develop ear or chest infections as a secondary bacterial complication.  The influenza virus itself does not respond to antibiotics, and antibiotics would only be given if there are signs of a bacterial infection.

 

Symptoms may include:

  • high fevers

  • cough

  • runny nose / congestion

  • sore throat

  • muscle aches

  • mild vomiting and/or diarrhea

  • mild headaches

  • mild decreased energy

 

Children will appear and behave more unwell during the times when the fever is high, but should look better and behave more normally when the fever is under control with fever medications.  The medical assessment today finds that your child currently appears well, has appropriate behaviour, has normal vital signs (heart rate and breathing rate), and has a normal physical examination.

 

You should manage your child with fever medications including acetaminophen (Tylenol  or Tempra) and/or ibuprofen (Motrin or Advil). DO NOT give aspirin (ASA) to your child.  We do not recommend giving cough and cold medicines to young children due to their side effects.  Encourage drinking, and keep your child home to avoid spreading the infection to others. You may give your child a warm (not cold) bath.

 

We recommend that you see your primary care family doctor or pediatrician in the next 2-3 days if the fevers persist in order to ensure that your child is remaining without complications.  However, you should bring your child back to the Emergency Department if at any point you feel that their illness is getting worse and you are more worried about their condition. Signs to watch for, and reasons to return to Emergency, include:

 

change in behaviour, with poor energy, weakness, or fussiness despite good fever control

confusion, disorientation, drowsiness, or dizziness

poor drinking or repeated vomiting

heart rate is very fast even when the fever is down

difficult, fast, or noisy breathing

blue lips even when the fever is down

chest or abdominal pain

neck stiffness or severe headaches that will not go away with fever/pain medications

seizure or convulsion

limping, or refusal to walk

fever lasting longer than the expected 7 days

 

Please also see information on the AboutKidsHealth.ca  website.


 

Fractured limb

 

Return to Emergency if you cannot control your child's pain with the pain medications, if there is increased swelling, discolouration (white/blue), numbness, or tingling, or if the cast gets very wet, breaks or falls off.

 

Further information about this and other conditions may be found at:

www.aboutkidshealth.ca/elbowfracture

www.aboutkidshealth.ca/forearmfracture

www.aboutkidshealth.ca/lowerlegfracture

www.aboutkidshealth.ca/upperarmfracture

www.aboutkidshealth.ca/wristfracture

www.aboutkidshealth.ca/cast

 

 

 

Gastrostomy tube replacement

 

Your child’s G-tube has been replaced by a temporary Foley catheter, which can be used as usual for feeds and medications for the next 2-3 weeks.  Please contact the G-tube clinic nurse at 416-813-7177 to arrange for a new G-tube. Return to Emergency if having pain, vomiting, fevers, persistent leakage or redness around the G-tube site, or other new concerns.

 

 

 

 

Head injury

 

Return to Emergency if headache will not go away, repeated vomiting, difficulty walking, vision problems, confusion, irritability, drowsiness, weakness, or other concerns.

 

Further information about this and other conditions may be found at:

www.aboutkidshealth.ca/concussion

www.aboutkidshealth.ca/sportconcussion

 

 

 

 

Headache

 

Follow up with your regular doctor for further care as needed.  Return to Emergency if the headache is getting worse or waking your child at night, repeated vomiting, high fevers, neck stiffness, trouble walking or seeing, seems lethargic or weak, or other new concerns.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/headache

 

 

 

Hives

 

See your child's regular doctor if the hives are not going away within the next week.  Return to Emergency if trouble breathing, wheezing, throat tightness, swollen face and lips, or painful swollen joints.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/hives

 

 

 

Laceration (staples)

 

Have the staples removed by your child's regular doctor in 7 days.  See a doctor if the wound appears infected, (redness, swelling, pain, pus, or fever).

 

Laceration (stitches)

 

Have the stitches removed by your child's regular doctor in [x] days.  See a doctor if the wound appears infected, (redness, swelling, pain, pus, or fever).

 

 

 

Migraine headache

 

Treat with pain medication, and rest or sleep in a dark, quiet room.  Avoid stimulation from noise, lights and physical activities. Avoid TV and computer use.  Follow-up with your regular doctor for further care as needed.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/headache

 

 

 

 

Nasal congestion

 

Can use steamy showers, humidifier or vaporizer, saline nasal drops, or a nasal suction aspirator to reduce nasal congestion.  See doctor if having fever, facial swelling, difficulty breathing, excessive crying, or other new concerns.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/congestedbaby


 

 

 

New onset afebrile seizure

 

Follow-up with your regular doctor to arrange an outpatient EEG, and to consider referral to a neurologist as needed.  Return to Emergency if your child has another seizure, abnormal behaviour, irritability, vomiting, weakness, neck stiffness, high fever, or other new concerns.  Call 911 if a seizure is lasting more than 5 minutes, or if lips appear pale or blue.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/seizuresymptoms


 

 

 

Otitis media

 

See doctor if still having pain or fever in 2 or 3 days, or if fluid is draining from the ear.  Return to Emergency if too much pain, excessive crying, repeated vomiting, redness and swelling behind the ear, lethargy or weakness.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/earinfection

​


 

Pain control (acetaminophen)

 

Use acetaminophen (Tylenol or Tempra) around-the-clock every 4 to 6 hours for the next few days (maximum 5 doses in 24 hours), then as needed for pain control.

 

Pain control (ibuprofen)

 

Use ibuprofen (Motrin or Advil) around-the-clock every 6 to 8 hours for the next few days, then as needed for pain control.  Give with food or snacks.



 

Pneumonia

 

Return to Emergency if the fever does not go away in 2-3 days, or sooner if trouble breathing, repeated vomiting, lethargic, weak, or otherwise more unwell.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/pneumonia



 

Emergency Point of Care Ultrasound

 

A *** emergency point of care ultrasound scan was performed in the Emergency Department today by ***.  Results of this emergency ultrasound examination appear in your medical record.



 

Educational Point of Care Ultrasound

 

The point of care ultrasound you had today in our Emergency Department was for educational purposes. This scan did not influence how your doctor took care of you/your child. If a clinical ultrasound was necessary for the care of you/your child, it would have been done in addition to the educational ultrasound.


 

Pulled elbow

 

Resume regular activities.  Avoid pulling on the arm. Return to Emergency tomorrow if your child still having pain or is not using the arm properly.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/pulledelbow

 

 

 

Rapid strep test NEGATIVE

 

Your child's rapid strep test did NOT show a bacterial throat infection.  A throat culture was sent to the lab to confirm this negative result, and we will call you if the culture turns positive within the next couple days.  Your child likely has a virus that should be treated with fluids, rest, and medications for fever and pain. See your child's regular doctor if still having fever or not feeling better after 2-3 days, or if other concerns.  Return to Emergency if severe sore throat, refusing to drink, cannot swallow, trouble breathing, neck stiffness, or appears more unwell, lethargic or weak.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/strepthroat


 

 

 

Rapid strep test POSITIVE

 

Your child’s rapid strep test was positive for a streptococcal throat infection.  Please start the antibiotics today, in addition to the medications for fever and pain.  Your child should feel better after 2-3 days of taking antibiotics, but must complete the full 10 days of antibiotics to ensure the infection is treated.  See your child's regular doctor if still having fever or not feeling better after 2-3 days, or if other concerns. Return to Emergency if severe sore throat, refusing to drink, cannot swallow, trouble breathing, neck stiffness, or appears more unwell, lethargic or weak.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/strepthroat


 

 

 

Sickle cell pain crisis

 

Treat with pain medications as prescribed, and encourage drinking plenty of fluids.  Call the Sickle Cell clinic nurse or your regular doctor for further discussion around ongoing pain management if symptoms are lasting longer than 2-3 more days.  Return to Emergency if you are not able to manage your child’s pain at home with oral medications, or if fevers, vomiting, difficulty breathing, becoming weak or sleepy, or other new concerns.

 

 

 

Sickle cell with fever

 

You may use fever medications as directed and please start antibiotic as prescribed. Encourage your child to drink plenty of fluids. If fevers are ongoing beyond tonight, then please follow-up with your regular doctor or call the Sickle Cell clinic nurse.  We will call you if the blood culture is positive. Please help us ensure we have your correct contact phone number on file. Return to Emergency if fevers are ongoing for another 24 hours and you were not able to arrange urgent follow-up, or return sooner if having significant pain, neck stiffness, new rash, repeated vomiting, difficulty breathing, weakness, or your child appears generally more unwell.

 

 

 

 

Soft tissue infection

 

Use warm soaks or apply warm compresses several times daily to the affected area.  Use ibuprofen (Motrin/Advil) or acetaminophen (Tylenol/Tempra) as needed for pain control.  Use the antibiotic as prescribed, and see your regular doctor for reassessment in a few days.  Return to Emergency sooner if worsening pain, increasing redness and swelling, fevers, or other new concerns.


 

 

 

 

Soft tissue injury

 

Rest and elevate the affected area.  May apply ice (wrapped in cloth) several times daily as tolerated to reduce swelling.  Let pain be the guide of your child's activity level. See your regular doctor if not getting better in a few days.  Return to Emergency if increasing pain, redness, or fever.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/softtissueinjuries


 

Sore throat

 

See your child's doctor if not better within the next few days.  Return to Emergency if your child has a severe sore throat and cannot swallow or open their mouth, severe headache, neck stiffness, or appears unwell or lethargic/weak.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/sorethroat


 

 

 

Syncope (fainting)

 

Drink plenty of fluids.  Follow-up with your regular doctor as needed.  Return to Emergency if your child is fainting repeatedly, feeling their heart beating fast or racing, having chest pain, trouble breathing, confusion, appears weak or pale, or other new concerns.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/fainting




 

Testicular pain

 

An ultrasound today revealed normal testicular blood flow.  Treat the pain with ibuprofen (Motrin/Advil) as an anti-inflammatory every 6-8 hours as needed, and wear briefs underwear for scrotal support.  See your regular doctor in 2-3 days if not better. Return to Emergency immediately if sudden worsening of pain, increasing scrotal redness or swelling, high fevers, vomiting, or other new concerns.



 

Ultrasound

 

An outpatient ultrasound scan has been booked.  Your doctor should advise you regarding the need to have an empty stomach or a full bladder depending on the scan being done.  Re-register in the Emergency Department and see the triage nurse prior to the booked ultrasound time, then go to the ultrasound area.  After the scan is completed, return to the Emergency to see the doctor for the results and plan.



 

Urinary tract infection

 

See doctor if still having fevers after 2 days of taking antibiotics.  Return to Emergency if having too much pain, vomiting repeatedly and cannot keep down any fluids or medications, becoming lethargic or weak, or seems more unwell.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/UTI


 

Ventolin (salbutamol)

 

Ventolin (blue puffer) is a rescue medication that works immediately for wheezing.  Give [x] puffs of Ventolin every 4 hours for the next 1-2 days, then every 4 hours as needed for wheezing, chest tightness, or excessive coughing.

 

Further information about this and other conditions may be found at: www.aboutkidshealth.ca/asthma

www.aboutkidshealth.ca/asthmaspacer



 

Viral illness


See your doctor in the next 2-3 days if not better.  Return to Emergency if trouble breathing, frequent vomiting, persistent pain, becoming lethargic or weak, or seems more unwell.
 

 

Vomiting

 

Give small amounts of fluids often, and if tolerating, then may give more fluids and start feeding slowly.  See your regular doctor in 2-3 days if still not better. Return to Emergency if vomiting repeatedly despite small amounts of fluids, vomiting blood, persistent or worsening abdominal pain, bloody diarrhea, becoming lethargic or weak, dizzy, pale, sunken eyes, or dry mouth.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/vomiting



 

Vomiting

 

If breastfeeding, continue to breastfeed.  Otherwise, give small amounts of fluids often, preferably starting with Pedialyte.  If not vomiting, then continue to encourage fluids and may start feeding slowly. See your regular doctor within 2 days if still not better.  Return to Emergency if vomiting repeatedly despite small amounts of fluids, vomiting blood, severe abdominal pain, bloody diarrhea, becoming lethargic or weak, crying too much, no tears, sunken eyes, or dry mouth.

 

Further information about this and other conditions may be found at www.aboutkidshealth.ca/vomiting

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