A previous commenter wondered what we do when we aren't in triage so I thought hey, I bet a lot of people really don't know much about the ER other than what they see on TV, which aren't very accurate.
In my ER when you come in the front door you see a 'greeter' who takes some basic info to get you into the computer - name, date of birth, social security number and why you are there. Then you see the triage nurse, this may be right away if the ER isn't busy but more likely you will have to sit and wait a bit.
Triage means to 'sort.' We use a 5 level triage system but what it boils down to is: can go to fast track or not. for the 'or not's' they can either wait or need a bed now. The triage nurse is very important, they need to have the experience to sort through all the extraneous information people give to figure out what might be going on with the patient and how sick they really are. In my ER we don't even think about putting you in triage until you have at least a full year of ER experience.
Once you go to a room you get into a patient gown and the nurse will probably put you on the monitor to monitor at least your blood pressure, oxygen level and pulse. Often we will often put your heart leads on also - especially if you are complaining of chest pain, dizziness, weakness, shortness of breath, seizures, abdominal pain or any problem that can be related to your heart. The nurse will probably start an IV and draw some blood either now or after the doctor sees you. Then you will wait for a while until seen by the doctor.
The doctor will come in and talk to you, do an exam and then order some tests to try to figure out why you are ill. If you need IV fluid, pain meds, anti-nausea meds those will get ordered also.
Then the nurse will come in and complete any of the Dr.'s orders that aren't already completed. The nurse may will be caring for several other patients at the same time and it may take awhile to get back to you, they are doing the best they can but some of the other patients may be critical. Then you wait for results, depending on what is done that can take one hour or several.
When the results are back the ER doc will re-evaluate them when he has time, the ER doctor is often juggling ten or twenty patients some of which are critical. Depending on the situation it make take awhile for the ER doc to get to you. Remember, they are doing the best they can - it is not like your doctors office where you have an appointment and he sees patients one at a time.
When you get re-evaluated you may need more tests, you may need to be admitted or you may be discharged home.
That is sort of a brief over-view of the organized chaos that is the ER.
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- A hardworking ER nurse trying to survive until retirement and if I can have little fun or have a positive impact on someone's life, all the better!
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7 comments:
Hi, I'm not in the medical field, but enjoy your blog along with other medical blogs for my education. Just a question about the difference between walking into the ER vs. being brought in by ambulance.
While visiting with my neighbor one day, I noticed her speech blurring, plus a slight mouth droop. I brought this to her attention. She dismissed it at first, then later asked me to take her to the hospital to check it out. I drove her to the closest ER which is connected to a big teaching hospital. Long story short, 5 hours had gone by before she was finally placed in a bed in the hallway for examination saying she would be spending the night when a room opened. Said she felt fine. Then I left.
The next day when I went to visit her, she had full blown stroke symptoms. Completely paralyzed on the right side, and blind in one eye. She never improved.
My question is, did I make a mistake by not insisting on calling an ambulance whereby the crew might have made an early judgment that she was pre-stroke and administered appropriate care before even getting to the hospital. This is really haunting me.
Sorry, I meant to add another question to the above situation. Would this patient have been checked out sooner by ER personnel if brought in by ambulance vs. walk-in? Thanks.
I would say yes you should have called an ambulance. As far as your friend being "pre-stroke", sorry there is no such thing. If she was symptomatic (slurred speech and facial drooping) then she was already having a stroke. The important thing is how long had she been symptomatic. In the ER we only have 3 hours (and this is from the time of symptom onset not from time of arrival) to determine if the patient is having an ischemic stroke vs. a bleed. If we can diagnose in less than that time frame we can give thrombolytics in some cases to decrease amount of damage done.
Any patient with those symptoms should have been checked out immediately regardless of how she arrived to the hospital. At least that's how it would be in a perfect world. However, just because you show up in an ambulance doesn't mean you get immediate treatment. Unfortunately 99% of the people that call EMS do so for nonemergent reasons (ie. think they will be seen sooner, don't have a ride, dont want to drive, etc...). I have recieved many EMS patients before, triaged them for a nonemergent complaint, and escorted them to the waiting room where they can wait their turn like everyone else. That allows us to get the higher acuity patients seen first as it shoulb be, (and as a bonus it pisses the people that abuse the ER and EMS off so hopefully they will go somewhere else next time:) )
I would like to offer a small clarification to anon's comment that the ambulance patient won't necessarily get seen faster. That is true as a generalization, HOWEVER if the paramedic radios in and says he thinks his patient is having a stroke (having a heart attack, in symptomatic shock, etc.) they will get attention when they come in the door.
I work both ends as a paramedic and an ER nurse. When I radio the ER that I have a stroke (heart attack, shock) patient and am treating them as such in the ambulance, I always get full attention on my initial arrival.
So yes, if you have an apparent emergency call 911. The paramedics can initiate care already during the transport, and the ER will know sooner what to expect.
I went to an ER over the holiday weekend because no regular doctors were open. It was busy, crowded, and unpleasant. Kids were crying all over the place and the whole process was wearying on my patience.
But it was obvious that the hospital staff, from the greeter all the way up to the attending doctor, were all working very hard, they kept up uniformly professional attitudes, and no one, but no one, stopped for a break the entire four and a half hours I was there. I assume that I was there as long as I was because that was how the triage nurse classified me and I don't resent people with more emergent problems cutting in line ahead of me at all.
So although I can't say I enjoyed my trip to the ER, I can say I was very impressed with the staff. My guess and hope is that most ERs around the country are like that. Thanks, ERNurse and everyone like you, for being there on days you'd rather be relaxing with your families and instead giving so much of yourselves for the rest of us.
Thank you. :) That is interesting. The idea of "going to the hospital" is a scary thing, so if I ever have to go, knowing the typical procedures will probably help.
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