this is what scares me at work

[Dave]

this has to be one of an ER nurse's worst nightmares.

http://southofboston.com/articles/2004/06/05/headlines/news/news01.txt

South Shore Hospital's emergency room chief acknowledged that the hospital failed to provide proper care to a Rockland woman whose family says her appendix burst while she waited for six hours to be seen.

this hospital is about 3 or 4 towns north of the one i work at. they service approximately the same size community as mine. they are just as busy, if not busier, than where i work. both places see about 60-70,000 patients per year in the ER. the staffs in the Boston hospitals would probably come work in the suburbs for the slower pace. they see considerably more people.

i can understand exactly how this can happen. for instance:
you've got a waiting room full of people with more coming in regularly. you have a kid in one seat with a knee the size of a grapfruit from wiping out on a skateboard, you have an older guy in the next seat with crushing chest pain, the woman in the next seat is there to be seen because she thinks she may have been scratched by a mouse but cant see where the injury is, you have someone start throwing up in the wait area and the girl on the desk just tells you that there is a 5 month old with a 104 fever in the last seat. this is usually when some irate family member starts to make a scene because they need to be seen NOW. then to add to the stress level, you glance at the computer and see that you are now 1.5 hours behind in just seeing patients before they get to wait for a bed.
this would be a day from hell because this is what it will be like the entire shift. these days can happen 3 or 4 times a week. it says something about the staff that it doesnt happen regularly. it shouldnt happen, but it does.
for anyone that cant understand how something like that can happen, come play with me at work someday.

we were talking about this at work today and all the nursing staff had pretty much the same reaction, a combo of "there but for the grace of god..." and "glad it wasnt me."

...just thought i'd give you a quick peek into my world ....

 

[unclehobart]

Whose malpractice insurance is going to be on the chopping block when the dust settles?

 

[tonksy]

dave, you guys are awesome...the stress is probably killer and i know that shit happens from time to time but i genuinely respect you for the job you do.

 

[Dave]

Whose malpractice insurance is going to be on the chopping block when the dust settles?

probably the nursing staff. my guess is the error started in triage.

dave, you guys are awesome...the stress is probably killer and i know that shit happens from time to time but i genuinely respect you for the job you do.

thanks tonks

 

[unclehobart]

Was the woman triaged at all? ... temp and all that good stuff... before this went down? ... or was she still being pushed back in the cattle call all the way to the end?

What are the triage level symptoms that would be indicative of appendicitis? What confirms? Bloodtest?

 

[Dave]

Was the woman triaged at all? ... temp and all that good stuff... before this went down? ... or was she still being pushed back in the cattle call all the way to the end?

What are the triage level symptoms that would be indicative of appendicitis? What confirms? Bloodtest?

she must have been triaged as she did get the surgery.
the symptoms would be Right Lower Quadrant pain with rebound tenderness (hurts when the doctor lets up instead of when pressing down), spiking a fever and an elevated white count. usually confirmed by CT scan. sometimes the appys arent obvious at first. pain might not be a major issue, might not be a temp, the patient may not "look sick".
the abdominal pains are the trickiest ones out in triage. could be anything from gastritis to appendicitis to an aneurisym.
i had appendicitis as a kid. my pediatrician missed it entirely. an ER surgeon caught it a couple days later.

 

[Inkara1]

How much of the ER load is people like Brandi? Explanation: people like Brandi go to the ER every time they get a headache to get a pain shot, since years of drowning pain in acetaminophen, aspirin, ibuprofen, excedrin, acetaminophen with codiene, and so forth have built up an astonishing tolerance to pain killers... until the husband starts getting the bills in the mail and puts a stop to that practice, much to the detriment to the quality of his life for the next few days.

 

[tonksy]

How much of the ER load is people like Brandi? Explanation: people like Brandi go to the ER every time they get a headache to get a pain shot, since years of drowning pain in acetaminophen, aspirin, ibuprofen, excedrin, acetaminophen with codiene, and so forth have built up an astonishing tolerance to pain killers... until the husband starts getting the bills in the mail and puts a stop to that practice, much to the detriment to the quality of his life for the next few days.

hey man...it's over...it won't happen anymore...you're free dude....take a deep breath and relax

 

[Dave]

we get people like that all the time.

 

[unclehobart]

So if I chip a nail and I scamper into your clinic, I can get a 30 day script for demerol?


pretty please?...

 

[Dave]

So if I chip a nail and I scamper into your clinic, I can get a 30 day script for demerol?


pretty please?...

no...we'll give you a painful shot in the ass of an NSAID, then make you cool your heels for 3 hours sitting on a stretcher in the hallway down in the back till we get a chance to discharge you. and no, you cant get anything to eat.

 

[unclehobart]

Good. Hospital food blows ass anyway.

I remember being in the vortex when I was in Hilo last year. My ankle had gone off the deep end enough to warrant the emergency room. Of course it was the first weekday after Chistmas weekend... so the place was packed beyond packed. It took me 7~ hours to get processed. It kinda scared me to note that I was about 6th in line for the walking wounded lobby and it took 3 hours for the first person to be let past the doors. What I didn't see was ambulance after ambulance being stacked up out the back letting in a steady cha cha line of diabetics who couldn't resist a little XMas cheer. When I did get in, I was given a chair next to the nurses station as the 15 rooms were packed and the gurneys were double parked in the hallway; broken limbs, surfing injuries, and this poor baby with some kind of nasty skin disease/infection/viral whatzit.

 

[Oz]

I remember the last time I was in ER.....

I got stung by a wasp. Didn't think anything special about it until a few hours later when my hand started swelling. Spent a rather annoying ten mins cutting a ring off my finger 'cos it was gettin' painfull but when my hand had doubled in size I thought I better toddle off to the hospital, in case the bloody thing exploded or summit.

I was seen pretty quickly, within' 30 mins or so. The doxy examined my hand, asked me what had happened etc. Then I was given an injection and told I have had an allergic reaction to wasp stings.

Then, the doxy called on his seven years of medical training and umpteen hours of medical practice to give the best advice he could to me.

He said "Try not to get stung on the neck, if you do it'll swell and kill you".

Ain't education a marvellous thing? As if I ever walked around encouraging wasps to get close to me neck !

 

[Dave]

It took me 7~ hours to get processed. It kinda scared me to note that I was about 6th in line for the walking wounded lobby and it took 3 hours for the first person to be let past the doors. What I didn't see was ambulance after ambulance being stacked up out the back letting in a steady cha cha line of diabetics who couldn't resist a little XMas cheer. When I did get in, I was given a chair next to the nurses station as the 15 rooms were packed and the gurneys were double parked in the hallway; broken limbs, surfing injuries, and this poor baby with some kind of nasty skin disease/infection/viral whatzit.

sounds like an average day. we have 32 rooms and lots of hallway space.

I have had an allergic reaction to wasp stings.

you keep anything with you? epi pen? benadryl?

 

[catocom]

So if I chip a nail and I scamper into your clinic, I can get a 30 day script for demerol?


pretty please?...

Unc, you'd have a better chance here if you drink about 10 cases of
Yahoo chocolate drink, or maybe a gallon of milk, and take some calcium
pillls, and get yourself a kiney stone. then you might get some demerol,
dilata, or morphine. *doesn't know how to spell dylatta*

 

[unclehobart]

Unc, you'd have a better chance here if you drink about 10 cases of
Yahoo chocolate drink, or maybe a gallon of milk, and take some calcium
pillls, and get yourself a kiney stone. then you might get some demerol,
dilata, or morphine. *doesn't know how to spell dylatta*

I had a kidney stone back when I was 19. The thing was a shard covered mass the size of a fat pea... which is to say that it was 50x larger than your normal record needle sized stone. All I can say is that it was the worst pain by far that I have ever felt in my life. There is no drug outside of a .45 slug to the temple that can start to mask that kind of pain. It took me 25~ days to pass it. It was exaggerated by the fact that I only have one kidney; ergo one ureter for which to pass waste; the same ureter blocked up by the mondo stone; forcing that constant flow of urine to somehow find a way to get around that stone and flow throughout the lacerated tissues and most likely partly back into the bloodstream. I was a seriously unhappy camper. I would just assume not get another one.

 

[Dave]

how long were you in the hospital for?

 

[Oz]

you keep anything with you? epi pen? benadryl?

Nah, a rolled up newspaper seems to work ok. I'm workin' on the theory that prevention is easier than the cure.

 

[unclehobart]

how long were you in the hospital for?

Not one minute. My dad took me to the family practitioner since at the time we didn't rightly know what ailed me. It took me 3 hours to be seen. My pee was about 50/50 urine/blood, went into shock 3 times ... and they told me to go home and rest and drink fluids and report back for an xray to locate the stone for a possible ultrasound to break it up if it got worse. At no point did anyone say... 'Jesus! Get your ass to an emergency room!' I might have suggested it if I would have been in my right mind ... but several rounds of shock tends to shake one off of their game. I didn't make it to a hospital for three days. They seemed to care less and sent me packing. I didn't get so much as a darvocet. I was only 19 and hadn't been near a doc since I was like 9 years old ... so I had clue as to options, second opinons, patient rights... all that good stuff. I just assumed that I was fucked. The only medicine I had was a few cranberry vodkas to try and flush it quicker. 11 days of dire pain. 13~ days of off again/on again pain. 2 months of that healing itch. My treatment was pretty much 14th century. All that was missing was the leeches. Fuckers.

I hate doctors. I hate insurance companies. I hate bureaucracies.

 

[Thulsa Doom]

I had a kidney stone back when I was 19. The thing was a shard covered mass the size of a fat pea... which is to say that it was 50x larger than your normal record needle sized stone. All I can say is that it was the worst pain by far that I have ever felt in my life. There is no drug outside of a .45 slug to the temple that can start to mask that kind of pain. It took me 25~ days to pass it. It was exaggerated by the fact that I only have one kidney; ergo one ureter for which to pass waste; the same ureter blocked up by the mondo stone; forcing that constant flow of urine to somehow find a way to get around that stone and flow throughout the lacerated tissues and most likely partly back into the bloodstream. I was a seriously unhappy camper. I would just assume not get another one.

oh thank you so much. I just spent the last hour and a half holding my groin and squinting thanks to this post. Several years ago i had a bad reaction to a um spemicide a girl I was with was using (yeah go ahead laugh it up ) and the end result was the constriction of my urethra and the inhability to pass any urine at all. for three days... let me tell you everything just simply fades into the background when you cant pee and your WHOLE focus is getting relief at any cost. you forget about food. you forget about work. you forget about sex (sex!! ah!!!). you forget about everything. the whole freaking world can crash and burn for all you care. the animal survival robot personality takes over and its all about doing whatever it takes at any cost to get relief. which for me meant finally going to the emergency room one morning after three days of this. to be told well to determine whats wrog with you we will need a urine sample.... *twitch*....

me: what? thats the whole reason im HERE. what about the burning horrific mind numbing pain in the worst place possible for a male? how do i avoid this? cant you stick a pipate into my bladder or something??

doc: well theres not much we can do. we can stick a needle down there and try to numb the urethra if you want but...

me: GET THE FUCK AWAY FROM MY URETHEBA WITH YOUR NEEDLES!!!

Anyway to make a long story short... i had to resort to just forcing it out. And let me tell you I can now handle most of the tortures Ive heard about after forcing myself to try to aim a stream of pee into a little plastic cup while i felt like electric charges where attached to each gonad as i opened the stream and then like lava was errupting from my hole. ok I realize im getting way too graphic here but ive been needing to get this out for years... Ill stop now...


*sob*