It always amazes me how the people with a cold will call an ambulance but the really sick people will make their own way to the ER and sit patiently in the lobby until they are called for triage. They often give a vague, non-specific complaint when they sign in so the greeter doesn't catch that they need immediate attention.
We were short staffed one morning so we didn't have a triage nurse, we were all busy with patients in the back so when they called from up front for a lady with "weakness for a week" it took a minute for one of us to break away and get out front.
It happened to be me. The lobby was already full, when I called her name no one got up. I was about to give up when someone mentioned casually that they thought she was sitting next to them. I went over to check it out and found a woman slumped over minimally conscious, pale and diaphoretic with no palpable pulse. (Gives you an idea of the usual ER clientele that no one out there was worried about how she looked.)
We quickly got a gurney and rushed her to the back where she was found to be in V-tach, with a blood pressure of 48 by doppler. We quickly applied some electrical therapy in the form of cardioversion which converted her to sinus rhythm. Anti-arrhythmics, vasopressors, fluid boluses and eventually a trip to the cath lab which led to a 4 vessel CABG. She made a full recovery and made it home two weeks later.
Her story eventually filtered back to us. She had probably had an MI earlier in the week which was why she had been feeling bad, ischemia and necrosis made the heart irritable. She was feeling worse and worse but didn't want to be a bother to anyone. She called her doctor but couldn't get an appointment so she stayed at home until she couldn't take it any more and decided to drive herself to the ER. (In V-tach with no blood pressure!)
We had gotten three ambulances prior to her arrival, a 44 year old with nausea and vomiting for an hour, a chronic back pain and a sprained ankle. Ironic, isn't it.
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10 comments:
Why would you even bother with the doppler, or any blood pressure, on this patient?
Too many people in the room, have to give them something to do to keep them out of the way?
I suspect that when she drove to the hospital, it was between episodes of NSVT or before this episode of VT.
If she walked in and signed in on her own, later is found unconscious, then it is likely that there has been a change in presentation from when she walked in.
Nice job with the electricity. :-)
This is why we would close an area before we have no triage nurse. Good Save.
Just the same in the UK. Older people (in particular) apologise when their chest pain turns out to be non-cardiac and they don't need hospital. They even apologise when it is and they do!
They don't seem to get it when we say "No problem - it's what we do" and that we'd rather get called 10 times for non-cardiac chest pain than miss one that is.
Good Save! The sick ones are also the least "demanding" where the cough and colds try to call someone to the room every 5 minutes for something.
I had s/s of a kidney stone the other evening (while working, no less), but opted to go home and take two vicodin. I figured, going to the ER would mean IV fluid and IV narcs, I can just do PO narcs at home. Pain finally passed by morning, but it was a loooooong night. Still haven't passed the darn stone.
For a different spin on this: I took care of a patient in rhabdo last week-she "slid" from the toilet to the floor and laid there NEXT to the phone for 36 hours. She didn't want to bother her daughter (a nurse.) Laid until the daughter found her. Interesting personality-passive/aggressive. I think she enjoyed "punishing" her daughter. Sometimes, there's more behind what they mean when saying they don't want to bother anyone. More than once this lady told me how disappointed she was in her daughter for leaving to go to work instead of caring for her at the bedside. My patient's daughter couldn't find anyone to do what she does at the last minute. Kind of sad and definitely a no win for all-the patient's daughter and the patient with her kidney failure all because she was angry with her kid and was longing for any attention.
I will try to make this short...had a woman and her daughter call an ambulance for SOB and med refill, her daughter had an ear ache for many weeks.
She did have an hx of COPD and smoked. Basically she wanted her meds. The charge, bless her heart, put them out to me in triage. I triaged them right out to the lobby. When they found out they would have a wait they went to the cafeteria to EAT. What an abuse of the system...of course they had a ride home.
I have a question. I'm trying to find out the role of an NP in the ER or ICU setting. No one seems to be able to tell me anything about them. Do you have them in your ER? Do you know of any trauma/acute care role for an NP?
Thanks
If im in the situation of the owner of this blog. I dont know how to post this kind of topic. he has a nice idea.
PO2 of 64, in the waiting room for 1 and a half hours.
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