How to Be Taken Seriously by Your Triage Nurse

10/26/2008 | 60Gunner

[TASMANIANRED]

Rattle snake bite can be as bad as getting hit by a train.

[NoLibZone]

Simply add “and I have chest pains” to move to the front of the line.

For example a man with a broken arm in the waiting room will be trumped by a man saying he has a tooth ache and chest pains.

[JDoutrider]

LOL!

Thanks for the laughs and memory jump! I spent seven years teching in a major metropolitan ER... Your list rings true!

I thank my lucky stars I "retired" from the profession in the late seventies... I could never tolerate the new ER scene of today, especially with the illegal aspect of abuse of services. Back then, they would have been shown the door and sent to the County clinic if it wasn't a "true" emergency.

[Judith Anne]

Thank you. He was there.

[McLynnan]

Ditto to the illegal alien abuse here too. Tomorrow morning I know when I walk through the ER waiting room at 6:30 AM I will see rows of Hispanic women with several children with upper respiratory infections, a few with barf buckets, etc. They will be waiting for free care with their usual sense of entitlement. They don’t even offer to pay part of the bill. This goes on all day every day. On the one hand the sick children are innocent, but on the other hand I am absolutely po’d at the parasitic parents by the time I make it through the waiting room.

[Judith Anne]

That’s what I did. I didn’t realize I really WAS having a heart attack, no symptoms of it, and no chest pain.

[Vicki]

Good advice. That said I have only been to an emergency room twice in my live. I do have heart condition and take medication every day. I had been having chest pains (for 2 days). I finally called my cardiologist and he advised me to go to the ER. I didn't want to, but I thought I should follow his suggestion.

I had been under a lot of stress and attributed my chest pains to that. Long story short. I was treated horribly by the ER doctor. I told him straight off that I was under a lot of stress and felt that all it was. He demeaned me so bad that I almost got up and left in the middle of the exam. He injected me with some ativan and sent me on my way. I told him the only reason I came in is my cardiologist told me to.

I don't think I'll ever go in again.

[MoochPooch]

Thanks again muchly!

[gardengirl]

I’ve told you before how much I enjoy your stories and insights, and I do. Thank God for decent, caring nurses like you.

Have to agree with pretty much everyone else said. We don’t go to the dr., much less the er, unless it’s bad.

A few years ago, hubby broke his neck. We didn’t know it, he was complaining about his shoulder—also broke his collarbone. As soon as we told them he fell out of a tree, they had him strapped to a board in a back room. This was about 6pm. About 1am, they had me helping move him onto the xray table because everyone—read techs— had “gone home”.

While we were waiting in the little room, they put a colicky toddler next door. I know—I had one who was the same way and I recognize that scream. He screamed, not cried, screamed, for 3-4 hours. Nurse finally came in and gave him a shot. He was out in 20 seconds. After that bit of fun, the hosp decided they couldn’t help hubby so they sent us to another hosp. Guess what? They’d sent all the ambulance drivers home, so we had to wait some more.

They took hubby, I swung by home to let the kids/inlaws know what was going on, and drove to the other er. I sat there for another 5-6 hours. There were kids, looked to be 4-5 years old running around the er at 4 in the morning, no parents in sight, begging for money because they were hungry.

We spent 4 days at that hosp, and the nurses were angels. Docs decided they couldn’t help and sent hubby to Duke. He got to ride in the ambulance, I got to drive. Almost a week with no sleep, and driving stresses me anyway. Then I had to sit in the er waiting room from Hell. Couldn’t even take my 2” pocket knife in, had to go back and put it in the car. There were armed guards at the door and some truly scary people in that waiting room, and if ever i needed a knife, it was then. When I finally got to hubby’s room hours later, he blew me out for not being there when the doc was.

Funny thing is, you can go in and out any other door in that hosp outfitted like a suicide bomber and nobody blinks.

Spent a week there, and I have nothing but the highest praise for the nurses. There’s just so much going on, and nobody has a clue. Sigh

OTOH, Daddy cut his hand badly with a power tool and he was in and getting stitches in a matter of moments. Blood everywhere might have had something to do with their speed. LOL

[dalereed]

What’s a Triage Nurse?

As far as that goes, what’s a triage anything?

[MarkL]

I've got an interesting ER story... I guess I'm a typical guy, meaning that I normally won't go seek medical attention until I'm bleeding profusely or something's fallen off...

Anyway, I had something in my eye, and I just couldn't get it out. It felt like there was a boulder in my eye, and no number of times pulling my eyelid out, or washing out my eye seemed to help. After about three days of this, two girls where I work finally went up to me and said that my eye (which was completely red by this time) was making them sick to their stomachs, and they demanded that I go to one of those quick care places to have it looked at. I checked with my boss, and he told me that my eye was making HIM sick too, and to just go. So, I go to a quick care clinic, tell the receptionist my story and sit down until it's my turn. I'm called into the exam room, and while the nurse is getting my initial info and takes my blood pressure, her eyes get real big, does it again, and then just turns and walks out of the room. A doctor comes in takes my blood pressure, and asks me how I'm feeling, and if I realized that my blood pressure was REALLY high (I can't remember what the numbers were at this point). Anyway, I told her that I felt fine, except for my eye. They told me that they were going to call an ambulance to take me to the ER at a local hospital, since I could have a stroke at any moment. I couldn't believe it. Anyway, I asked them if it were really that serious, and they said yes. Well, my father had uncontrolled high blood pressure for a long time, and he did die of a stroke, so I told them that I'd go to the hospital, but I wasn't going to pay for an ambulance, and besides, I didn't want to leave my car at the mall. I had to sign an AMA form before they'd let me leave, but they gave me an envelope to give to the triage nurse, and told me that they'd alert the ER that I was on my way. This didn't make me feel very good... Anyway, I did drive myself there, thinking that they were going to put me to the front of the line, and hook me up to all these monitors and a drip and all...

When I got to the ER, I told the nurse who I was and that they should have gotten a call from the clinic, and they had. She took the envelope, and told me to have a seat, and that they'd be right with me.

Three hours later, they finally called my name, took me back, and put me on a gurney, took my blood pressure, hooked me up to a monitor, and drew some blood. Two hours later, a doctor came in, took my blood pressure again, and told me that I had high blood pressure, and that I needed to see my regular doctor immediately, and she gave me a blood pressure medication - Toporol I think. They kept me in the ER until it took effect, and my blood pressure was better, but still quite high.

Anyway, I guess I just had these ideas that if I was going to "stroke out" (as I had been told at the clinic) at any moment, waiting 5 hours to see a doctor seems a bit long. The ER didn't seem that busy to me, but then I'm not a medical professional, so I really couldn't say for sure. But I tried not to be a pain in triage.

Oh, and as the doctor was writing up my discharge, I remembered the reason that I had gone to the clinic in the first place. I told the doctor, and she put some dye in my eye and didn't see any foreign object, but told me that I had a tear in my cornea, and that it was starting to heal. She did give me some eyedrops, and it helped.

Mark

[Gay State Conservative]

I worked for 20+ years in a major Boston hospital....about 18 of them in the ER.I,too,have many stories...many of them funny beyond all description.Our patient population was a strange mix of inner city welfare types,rich snots from the rich 'burbs (you know,John Kerry Country) and people who have flown in from the four corners of the world wanting to be treated like royalty (which,fairly often,they were).

I don't know about you but bloom came off the ER "rose" for me after a while and I'm glad to be out.Too much death....too much suffering....**AND** too many clowns just like the ones you've described.But someone's gotta do it!

[Gay State Conservative]

What’s a Triage Nurse?

A triage nurse is an ER nurse whose job it is to determine (or at least get a sense of) what your problem is,how serious and urgent your problem is (so that it can be decided how long you can safely wait to be seen)and what service should be seeing you initially (medicine,surgery,OB/GYN,etc).

[Titan Magroyne]

LOL! You truly are one of FR’s many treasures, 60Gunner!

(And bless ya for your understanding of all the horror stories vented on this thread.)

[fr_freak]

2: Do not use "I have (insert disease name here)," "Googled," and "My symptoms" in the same sentence.

I once had what I knew to be a lung infection (3 or 4 months of straight coughing, and it just felt like an infection, plus I had no history of allergies whatsoever). I made an appointment with my regular doc, told him the history, and he said "allergy-induced asthma" and threw some steroid inhalant sample pack from some major pharmaceutical at me and said he'll see me again in 2-3 weeks. I argued with him about the diagnosis, and he got pissy with me, as if he were offended that anyone would dare question his diagnosis. The only problem was that I could tell that he had put absolutely zero thought into his diagnosis, and I was in serious pain and discomfort at this point, had been for weeks. He told me if I didn't like his diagnosis, I could find another doctor.

So I did. A week or two later I visited a walk-in clinic attached to a large hospital on the recommendation of a friend. After a couple hours waiting, I finally saw the doctor. She put a stethoscope to my chest, took my pulse, and walked out before I could even say a word. Another hour later, some intern-type comes in with a rig for administering - guess what? - a steroid inhalant. I refused and asked to talk to the doctor. I couldn't believe she went the asthma route without even hearing me speak. After another hour, I left the room and found the doc out in the hall BSing with the rest of the lollygagging staff, so I went up to her and asked why the inhalant, and could I please describe the situation to her. She got EXTREMELY pissy with me and stomped off in a huff. Then, the lollygaggers who had been so nice before all took her lead and got pissy with me. I left.

Another month later I was at my wit's end, still hacking, my lungs feeling like they were completely inflamed. I knew it was an infection, so out of desperation I drove 3 hours to a walk-in emergency clinic that I had dealt with years ago (unrelated to this, obviously), talked to a physician's assistant, and told him that I wanted to try anti-biotics because I was sure it was an infection. Thankfully, he agreed, perhaps because he was not a full-fledged doctor and thus had not been annointed with his godhood yet. He prescribed me a strong one, and within 3 days I had coughed up a giant loogie and the pain was gone. All better, after 4 months and two doctors whose arrogance made them incompetent.

I was never one to go to doctors for much, but after this experience, I wouldn't go to the ER or even a regular doctor without doing a damn good amount of research first, because a doctor is just as likely to mess you up or kill you as cure you, either through incompetence or apathy, or because some pharmaceutical company is pushing the latest fad cure for the latest fad diagnosis and the doctor laps it up like a pig in a trough. Maybe a lot of people do get silly ideas from the internet, but for those of us who need to see a doctor but don't want to get killed or maimed by some yahoo with a medical degree, it is a godsend.

[60Gunner]

I really have no answer to your situation. The system in which in ER belongs treats open fractures (the bone is sticking out) as a medical emergency. There is no wait for a person like that. An elbow injury like your son's would have been 'fast-tracked' and you likely would have been out the door in maybe two hours, tops.

Then again, our ER docs can base their diagnoses on preliminary x-ray reports (not yet confirmed by a certified radiologist) if there is either an obvious fracture that needs no orthopedist intervention or if no fracture is evident. If the radiologist does find something, we call the patient and instruct them to follow up with an orthopedist. It works well this way.

If there is a fracture that requires orthopedist intervention, the wait can extend. But we also keep the patient comfortable and informed.

[Volunteer]

I had to go to the ER this week. I was on my best behavior, despite the fact that I was scared to death.

My ER nurse was an Army vet and we ended up trading stories.

[60Gunner]

What I meant by that particular entry was that we occasionally get a person in Triage who marches into the room, sits down, shoves a stack of internet printings in the nurse's face, and flatly tells the nurse that he/she has researched his/her symptoms and determined that he/she has such-and-such disease, and thus demands such-and-such treatment.

Sometimes people get lucky and a batter of tests confirms their suspicions. But bear in mind that the vast majority of potentially-lethal illnesses start off with 'flu-like symptoms.' All it takes is one wrong self-diagnosis. We don't go to school for a decade to just 'google' somebody's symptoms and hope we are right. People can be wrong. But blood doesn'lie.

[mplsconservative]

Thanks for your stories, 60Gunner. I’ve been to the ER myself and with family a few times in the past couple of years.

I appreciate all that you do for us in some very scary times. It’s a comfort to know people like you are out there when we need you. You have my utmost respect.

[fightinJAG]

I wasn’t in the medical field in the military, but in the general studies we all had to take at various command schools, my recollection of triage on the battlefield was that it required sorting by seriousness/potential seriousness of the medical condition AND ALSO by nature of the steps necessary to address the condition.

IOW, after addressing true emergencies . . . if the condition wasn’t as serious as some others, but was very easily or quickly addressed, then that went into a separate track. This was to balance the needs of the person who could be on his way if just given an ace bandage with the people who were in line for extensive medical care. You can see how this works to get everyone taken care of more quickly.

That doesn’t seem to happen in most ERs. For example, the person who just needs an x-ray read and then he will leave sits there for hours, clogging up the system, because people with symptoms that need to be evaluated extensively are slowly being visited by various doctors and sent for various tests and waiting for various results.

Or the babies, the vast majority of which will be given NO treatment for their colds, runny noses, etc. Can they not be evaluated quickly, not because they have a potentially more serious problem in triage, but because they likely don’t have a serious problem and, therefore, the vast majority could be gotten out of the system quickly?

Let’s assume your basic ER situation. In the case of a potentially broken bone, the only service needed to determine how to treat the patient is x-ray. Probably the vast majority of these x-rays are not ambiguous at all: the bone is broken or not. The x-ray takes minutes, reading the preliminary report takes minutes. IOW, the ultimate decision of whether this patient needs to continue through the ER process or can go home takes minutes to accomplish and is not complicated.

Wouldn’t it be better for everyone involved if those patients could simply go right in for x-ray, get those x-rays read, and then they and their families can GO HOME if there is no broken bone? And those with a break can go back and sit there however many hours it takes to get it fixed. But at least the people with NO PROBLEM could be “discharged” quickly and out of the way.

This is not a situation where someone comes in with stomach pain and there are a hundred things that need to be considered and examined/tested for.

I would pay money to have access to a streamlined “ER” service for conditions that are very easy to screen for, such as most broken bones.

There are a lot of ways in which ER triage could become more efficient. However, the more efficient the ER becomes, the more people would abuse it. Believe me,as it stands now, the people who don’t abuse the ER are the very ones who don’t want to go there AT ALL, for ANY REASON.

Most people who do not use the ER as a health clinic avoid going there at almost any cost!

I see they are now running ads about how important it is to go to the ER “at the first sign of stroke.” Why is that? Because most people with signs of stroke would rather “wait and see” than put themselves through the hell that is the ER, usually for nothing.

Most people WILL NOT put themselves through the ER experience unless they become truly scared. Unfortunately, many of the early warning signs of stroke and heart attack, for example, are not all that scary.

And why should they? Obviously, the person feels terrible in some kind of way-—why would they want to sit at the ER for hours and hours if they don’t have to? So this means the person has to decide as best he can if he is having a stroke or heart attack. I have been in on many discussions about “should we take her/him to the ER,” trying to balance the hell the entire family (remember, you have to take the kids with you if they’re too young to be home alone), including the sick or hurting person, is likely to go through there for 10 hours or so v. trying to gauge the likelihood that true emergency care is needed.

That is a terrible situation to be in.

Sorry to unload my rant on you, but this is a serious problem. And it will only get worse as our health care system becomes more and more socialized.

It seems to me that hospitals and insurers could find ways to work together to peel off certain types of cases and direct them to private clinics rather than the ER. Such as broken bones. You should be able to get in and out on screening for a broken bone in a very short time. I would gladly pay a co-pay for the option to go to a private ER, say, 3 times a year.