Just a question to understand the ER better - page 7

so a quick run down. just wanted opinions. 59 yr old male patient in ESRF comes into the ER. wife signs him in and describes that he is "finishing dialysis (home hemodialysis), rapid heart rate,... Read More

  1. Visit  ecerrn profile page
    0
    Please also keep in mind, how you respond to a patient with any complaint. Whatever the level, or reason they are there, they don't need to be talked down to, if you've ever had some one speak to you in that dismissive way you'll know how obnoxious it is, and it makes the rest of us look bad. Always be kind and professional. (Studies show you are then less likely to be sued) not you personally, I meant the dismissive one, we can learn what not to do in triage as well.
  2. Visit  DC Collins profile page
    1
    Quote from samadams8
    People with afib have a good chance of having a stroke, among other serious/critical problems. Some folks don't tolerate rapid Afib for very long.

    Sorry guys. Unless there were mass casualties going on, I'd get that pt at the least on a monitor ASAP. Call me crazy.
    I won't call you crazy, but I will say that there are MANY times in my ED where there just isn't a monitor available. Every room is taken and every hallway bed as well so there is no place to move anyone out of a room. /shrug Still would have had him sit in a w/c near the triage desk.

    But the triage nurse with the bad attitude needs to go!

    DC
    canoehead likes this.
  3. Visit  DC Collins profile page
    1
    Quote from samadams8
    Put them in the freaking hall on a monitor near the nurse's station,

    DC==If the hall beds are full? Plus where I work there are no monitors in the halls. No room for such things.

    or better yet, listen for an apical rhythm and get an EKG.

    DC==Okay, still no beds - maybe, *maybe* someone can be moved out of a room to sit in a chair somewhere. That still takes time.

    [Triage begins with a general assessment of the patient. The nurse must look at the patient and take note of the patient's condition as he or she approaches the triage desk.

    DC==Much deleted for brevity. All true! Now the question still remains, not a single bed available. If a less critical patient is in a room, sure they can be moved out, *if* there is some place to move them. In our ED *every* possible bed is often occupied. But as for triage itself, we are one of the many hospitals that are moving toward immediate bedding (when one is available). No actual triage occurs until the primary nurse gets to the room. Which sometimes takes a while. Do I think this is the safest policy? No. Do I know that with Medicare paying based on pt satisfaction, rooming every pt immediately when a bed is available is the way of the future.

    My BP is going up just thinking about it.
    I don't deny your points have merit. But the reality is that the ED is 'the best of our resources'. Just knowing someone is having a-fib with rvr doesn't mean there is a resource available the minute the pt hits the door, whether brought in by family to the triage desk or by ambulance.

    DC :-)
    Daisy Doodle likes this.
  4. Visit  samadams8 profile page
    0
    Quote from DC Collins
    I don't deny your points have merit. But the reality is that the ED is 'the best of our resources'. Just knowing someone is having a-fib with rvr doesn't mean there is a resource available the minute the pt hits the door, whether brought in by family to the triage desk or by ambulance.

    DC :-)
    First, 99% of what you quoted was from someone else and not me.
    Second, surely you are correct. My point was that such patients need to be, at the very least, closely observed and not just made to go back to being mixed in with those in the waiting area. And yes there are times when thus and such occur; but there are also plenty of times when the "thus and suches" do not. Be real about the situation at the time. People that should be taken or at least put as close to observation as possible are too often just put right back out in the waiting area--mixed in with the crowd. Certainly exceptional circumstances may be one thing--and in some ED's they can almost become the norm. Nonetheless, brushing aside something that could become a life-threatening problem in a heart beat (no pun intended), well that should not become the routine and standard of practice. Your ED may be excellent and go above and beyond--through all the normal rushes of hell and high water--such that other EDs may not even have a clue about. Yep, I have seen the functional and realistic differences between one kind of ED over another. But I have seen operations of EDs, plenty of times, where more close attention to things was needed--and these EDs tended to be the not so high acuity/volume kind of EDs. So I am also saying, don't let the necessary exceptions, due to uncontrollable circumstances, become the routine or standard of practice. The exceptional situations are what they are for a reason, and they sure as heck should be truly exceptional if such situations caused a bypass a standard of practice, and then, good grief, someone decides filing suit is a good idea b/c something important was blown off or missed. Other than that, why miss the opportunity to help someone as soon as possible, especially if it is a condition as changeable or potentially dangerous as the OP 's situation was with her father?

    When you come to play on the field, come to play, and give it all you got, every game. Of course if your clavicle gets broken, you must be wise about the situation. Once it heals, however, go back to really playing. Don't let the exception become the new rule. That's really all I was saying.
  5. Visit  DC Collins profile page
    0
    Quote from samadams8

    When you come to play on the field, come to play, and give it all you got, every game. Of course if your clavicle gets broken, you must be wise about the situation. Once it heals, however, go back to really playing. Don't let the exception become the new rule. That's really all I was saying.
    Hear, hear!

    DC :-)
  6. Visit  RNFiona profile page
    0
    15 minutes? That's pretty darned good. In some of the crapholes I have worked, you are lucky to see a doctor before Christmas.
  7. Visit  RNFiona profile page
    0
    That being said, I would have seen that particular pt right away.But that's just me.

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