When Vomiting Requires the ER
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Comment| Wednesday, April 9th, 2008 | Emily Halevy | CWK Producer |
“Any time your vomiting is green or bloody, you need to seek immediate medical treatment. It may be related to an ulcer, a tear in your esophagus, some inflammation of your stomach or something serious going on.”
– Dr. David Goo, M.D., Children’s Healthcare of Atlanta
Babies and young children get sick all the time. Runny nose, coughing, vomiting … but how do you know when it’s serious enough to take your child to the emergency room?
“How many times would you say she threw up since 7 o’clock this morning?” asks the doctor.
“Over 20 times,” says the patient’s mother.
Theresa Puckett has been throwing up all day and it’s dark green and bloody.
“Green vomiting, or what we call bilious vomiting, is very serious. That means that you have some obstruction that’s backing up the small intestine. The bile normally comes out in the small intestine,” says Dr. David Goo, M.D., Children’s Healthcare of Atlanta.
Theresa also has a G-Tube, which provides food directly into her stomach.
“Why does she have that?” asks Goo.
“She has failure to thrive, she’s not growing as well as she needs to,” says her mom.
“Theresa was very small and her doctors decided to put a tube inside of her stomach. That tube was to be used during the night, so that they could give her continuous feeds while she slept, and so all during the night when she was sleeping she would get food and that would help her grow,” says Goo.
Why is she throwing up? The doctor thinks the problem may be a blockage in her digestive system, so he orders X-rays.
“The X-ray did not show obstruction in the lower part of the abdomen, but the child continued to have vomiting and green substance coming out of the tube, so we knew that there was a continued problem. So we’re still very concerned about her and will probably admit her to the hospital,” says Goo.
In fact, Theresa was admitted to the hospital and with further testing, the doctors found the blockage.
“They ended up taking a special tube with a light -- called an endoscope -- and they looked down into her mouth and into her stomach and what they saw was the G-Tube actually blocking the exit of the stomach and blocking part of the small intestine, and that’s why everything was backing up and becoming green. They pulled the tube back and everything got better and Theresa was able to go home,” says Goo.
The doctor says Theresa’s case was special, but there is a lesson here.
“Anytime your vomiting is green or bloody you need to seek immediate medical treatment. It may be related to an ulcer, a tear in your esophagus, some inflammation of your stomach or something serious going on that we’d have to do special tests to look for,” says Goo.
Tips for Parents
- If your child has had a tube placed in his/her stomach, it’s probably a gastrostomy tube or G-tube. This tube provides an alternate way to offer food or medicine. It also can be used to vent your child's stomach for air or drainage. (Cincinnati Children's Hospital Medical Center)
- Your health care provider will give you specific instructions regarding the importance of flushing your child's G-tube before and after any tube feedings. (Cincinnati Children's Hospital Medical Center)
- Giving medicines via a G-tube: (Cincinnati Children's Hospital Medical Center)
- Liquid medications may be injected directly into the tube after the tube has been flushed.
- For pills, first check with your doctor or pharmacist before crushing any medications. Crush the medicines into a powder and mix with enough water to make a liquid (1-10 mls).
- For capsules, first check with your doctor or pharmacist before opening the capsule. Open and dissolve the powder with enough water to make a liquid (1-10 mls).
- Remember: do not mix medicines unless directed by your health care team.
- Venting the tube: (Cincinnati Children's Hospital Medical Center)
- You may need to vent your child's tube to remove excess air or fluid in your child's stomach. Your doctor or nurse will tell you if this is needed and how to best accomplish the venting.
- Do not allow your child to pull on the tube. Keep the tube secured beneath the child's clothing. You may be asked to measure and record any drainage and frequency. (Cincinnati Children's Hospital Medical Center)
References
- Cincinnati Children's Hospital Medical Center
- Children’s Healthcare of Atlanta
