Posted on 10/26/2008 5:34:19 AM PDT by 60Gunner
Okay, I know this is a bit of a chronological jump, considering I was last writing about my recent odyssey. I'll get back to that soon.
I am back at work now, and since returning I have encountered an unusually-long parade of ER patients who have displayed, shall we say, less-than-sound judgment with regard to the way they chose to conduct themselves in ER Triage.
I am a man of great forbearance and restraint. I have never told any patient that he/she was a slack-jawed, mouth-breathing idiot before- even when the patient's actions clearly proved such to be the case. But some people make it very difficult to restrain the urge. Happily, only a rare few have ever caused me to fervently wish that dope-slapping was approved as a therapeutic nursing intervention.
For the sake of brevity, I'll cut to the chase:
To all of the exasperation-inducing patients described in Paragraph Two of this entry, and to all potentially-exasperating patients, I offer the following pearls of advice. If you follow these maxims, I guarantee that your name and the word "idiot" will never be uttered in the same sentence when you are mentioned in verbal handoff report by your Triage Nurse.
1: Do not come into the ER with a chief complaint of "high blood sugar" and then sit, in full view of the Triage Nurse, gulping down a can of Coca Cola and eating a candy bar.
2: Do not use "I have (insert disease name here)," "Googled," and "My symptoms" in the same sentence.
3: Do not sprint full-tilt boogie into the ER from the parking lot (having been observed by the Triage Nurse for the entire 100 feet of your medal-winning dash), burst into the waiting area, and yell at the registration clerk in a full sentence that you are having a heart attack and need morphine.
4: Do not ask the Triage Nurse for any sample packets of Tylenol, Ibuprofen, antibiotics, the "Morning After Pill," Valium, Ativan, Zanax, Methodone, Oxycontin, Surgi-Lube, or medicinal marijuana.
5: Do not tell the Triage Nurse that you don't want to see a doctor but just want to have your blood pressure, blood glucose, lung sounds, or that "icky lump" in your bikini area (I am not kidding) checked by the Triage Nurse. You have to be registered before the Triage Nurse will listen to you say anything about that "icky lump" in your bikini area. Otherwise, go to the fire station or your clinic. And wash your "icky" frigging hands.
6: Do not get out of your car, walk ten feet to the wheelchair your relative provides for you, sit down in the wheelchair, and then go limp and pretend to be unconscious the remaining twenty feet to the Triage Desk. (Yes, I did see you peeking, you rascal!)
7: Do not ask for a five-gallon barf bag, be given one, pull your face out of it to spew all over the Triage Room, Triage Computer, Triage Floor, Triage Tech, and Triage Nurse- and then say, "Sorry, I missed."
8: Do not refuse to wear a mask if you are coughing or sneezing. If you do refuse, then do not take offense when you are thus held in that special regard reserved for all mindless, disease-carrying vermin.
9: Do not talk on your cell phone while being triaged and tell the Triage Nurse to "shush!" for interrupting when you are asked about your migraine. And do not get angry when you are ushered out of Triage to finish your phone call and the Triage Nurse moves on to the asthmatic 3-year-old who just came through the door.
10: Do not walk in and tell the Triage Nurse you were involved in a rollover motor vehicle crash an hour ago when all you are really looking for are narcotics. You will be slapped into a cervical collar and duct-taped onto a very uncomfortable backboard faster than you can say "I'm never using this frigging story again." Just tell the truth. Honesty serves two purposes: 1) We can deny your request for narcotics without you having to go through all that unnecessary discomfort, and 2) You can haul your drug-seeking carcass over to the neighboring ER without any telltale patches of tape-induced depiliation on your head.
11: Please be sure to leave the ID bracelet from the neighboring ER that you just left on your wrist when you arrive at our Triage. This enables us to contact that ER and find out why you were dissatisfied with the service they provided and which medication they refused to give you.
There you go. Have a safe Halloween, think before you drink, avoid anyone who says "Hey, watch this!," and stay inside any moving automobiles.
ROTFL...this is great. I’m going to print this out for my instructors.
omg you poor things people are such losers
the only times I’ve gone in are with my kids for broken things and once for myself when I fell over while seated in a lawn chair at my kid’s ball game holding a newborn and a baseball headed right for us so I jerked us out of the way, used my arms to protect the baby and injured my elbow
Very cute! :-)
Funny, funny! Thanks for posting that!
Do you always whine this much?
I was in the ER triage after getting about a gallon of JP-4 (jet fuel) spilled over my head and in my eyes. After waiting about 25 minutes, the nurse walks in and looks at the chart and says “Fuel spill? Was it hydrazine (a very dangerous rocket fuel that we used for Emergency Power Units on the F-16)?”
I answered, “No, it was just JP-4.”
When she answered “Oh, “just JP-4...aren’t we being macho!”
Was I wrong in cussing her out? :)
I am so guilty of saying that. Never to a triage nurse, but to an ophthalmologist.
10: Do not walk in and tell the Triage Nurse you were involved in a rollover motor vehicle crash an hour ago when all you are really looking for are narcotics. You will be slapped into a cervical collar and duct-taped onto a very uncomfortable backboard faster than you can say "I'm never using this frigging story again." Just tell the truth.
I was hit, by a jackass in a truck, while riding a bike when I was a kid. I remember being strapped to one of those boards. Ugh. Not fun. I kept trying to tell everyone it hurt and I didn't need it.
avoid anyone who says "Hey, watch this!,"
But what if it's really cool? ;)
ER Nursing Stories Ping.
If you have been in a motor vehicle accident, make sure that you are actually injured before you listen to your lawyer and call 911. He doesn't care about your condition, he's just trying to get rid of you.
When the emergency services professionals arrive and observe a thumb sized scrape on your bumper, they will know that you are faking an insurance claim. Don't act surprised when they strap you to a backboard and leave you there all day. You asked for it.
If your cell phone is impaled in the side of your head because you turned sideways just before impact, expect the emergency services professionals to take an interest. If the phone is still working and you are still talking to your friend while they cut the doors and roof off of your car, expect the professionals to be very interested. They will want to know what kind of phone could survive such an impact because they will want to get one. Emergency service is rough work. They need good, quality cell phones.
If you collide with another object and are visited by the emergency services professionals a second time, try some friendly banter to ease the tension when they recognize you. Look and see if any of them are carrying the same brand phone that you have. If they are, remind them that you told them it was a good phone. They will still chop your car into little pieces, but they will be nice to you.
Don’t make out with your boyfriend in the waiting room.
Don’t copulate in the exam room, your wait will not be that long.
Don’t threaten the triage nurse with calling the police and having them arrested. The triage nurse has their own policeman and he is bored.
Don’t deficate in the UA cup.
And my personal favorite is, if you are faking a seizure, the triage nurse is only testing you by saying “if it were a real seizure, they’d wet themselves” At this point urinating in your pants will get you nowhere.
I had one where I limped into an ER. I told them I had fell and struck my leg on a concrete edge, and I thought I just needed some motrin.
The nurse took one look at my left leg and saw it was literally twice the size of my right leg.
I was in a bed so fast my head was spinning.
From the other side - treat your patients and get them out. Four years ago it took 8 hours to diagnose my son with appendicitis. My husband threatened everyone in sight to get him some pain medication. That hospital is closing this year. The surgeon actually taught the doctor how to press in the right place to do the old pain test for appendicitis AFTER the CT scan.
In August my son was at another ER after a car crash. $23,000 for four hours which included a tetanus shot, pain pill,urine test for sugar levels and total spine CT. I was there, I know. If he had Medicare or employee based insurance there would have been a HUGE write off. Instead he owes $13,000. I was office manager for a group in 1980 who raised their prices to increase Medicare reimbursements for the future.
The ER culture of making people wait when they get into one of those little rooms in the back is so wrong, I would love to see them run with a little efficiency and sense.
You have just listed 11 of the 20 reasons I will not go to the ER unless I have visible blood loss or an appendage unintentionally disconnected from the rest of my body (i.e., techniques to bypass the triage nurse as quickly as possible)
This is really informative! I haven’t had to go to an emergency room since “critical care” clinics were invented, thank God. They can put a baby with croup to the head of the line, while a real ER has accident victims, gunshot wounds, and drug addicts looking for a fix.
My son is an E.R. Doc. I think he wrote this thing. LOL I will pass it on. Thanks
These are all good. But, please tell me, how does one really get taken care of by the triage team. I went in with a body temp that went up and down, pain in my abdomen, nausea, headache and weakness. I was obviously cold. In August in Alabama I walked in wrapped in a quilt! I was not sitting up, but did everything I could to lay down. It was 21 HOURS LATER before the ER began diagnosing me.
It turns out I had a serious kidney infection with possible appendicitis. I was finally admitted for 48 hours.
How can I communicate to the triage nurse that I was really sick? Obviously I said something wrong.
On the happy side- in a country with socialized medicine, a patient with appendicitis would have to wait a much, much longer period of time- days, even- just to get into a room, much less be treated. You may fault American ER care all you wish- but I have been to multiple countries to study emergency care and I would still take my kid to an American ER first, bar none.
Regarding waiting after being taken back: the pace of the ER treatment is driven to a very large extent by the pace at which the diagnostic studies go. It's frustrating as a nurse as well to have to wait for the lab to process a blood test, or for the Radiologist to get around to posting his findings, or for a room to open up on a patient care unit. We can't change that. But any nurse/MD worth his/her salt will do everything possible to keep the patient/family informed and comfortable.
I cannot really say any fairer than that. I am sorry that your experiences were unpleasant ones.
I’m a pathologist now but in my ER days the thing that would annoy me the most were the people coming to the ER complaining about back pain they’ve had for years. Sometimes they would show up at 3 AM. When I’d ask them what there was about the pain that prompted them to come in now they’d say “It hurts”. Not that it hurt any worse, just that it hurts.
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