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Originally Posted by rjflyn

Yeah its not too late for a CT but why. The purpose would be to rule out serious internal injury, of which its Wed now and the injury occurred on Sat. More than likely he would have shown outward signs of it by now, so only spending needless $$.

Definitely second rate care. What social worker, some ER's may not have one, as far as referrals its common to refer pts to their PCP. Also some facilities may not have referral services either.

Now from the sounds of it this pt should have never even been transported to the facility he ended up at. He as a trauma pt and should have went to a trauma center. You need to be talking with EMS as well. Sounds like they were over their head and just were winging it.

Rj

Some cities have protocols where EMS takes an injured person to the closest ER and it is their responsibility (the ER physician) to decide if that person has injuries that warrant transfer for a higher level of care. It sounds as though this patient was where he needed to be (perfectly appropriate) - I worked at a smaller ER and everyone came to us and we sent out what needed to and kept those that could be managed.

CT's way after the fact for internal injuries are useless - and if there was no indication during the physician's assessment after the injury that warranted a CT, then they did the right thing by not ordering one. I'm sure a CXR was done, as were all of the trauma series xrays. Sounds like protocol to me. Did he complain of abdominal pain? If so, maybe a bedside u/s was done?

Also when discharged from an ER there are on-call physicians for follow ups and they are obligated to see an ER patient for follow up. If there is an issue on the follow up doctors end saying they're not accepting new patients, clarify to them he is not a new patient, but an ER referral for follow up (they are obligated to see the patient since that is part of a contract for taking call). If there is issue with that, call the ER physician director to complain - you'll get a referral quickly.

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Originally Posted by mwboswell

...Not all NPs only work Fast Track....

True true! We have a NP that works all patients.... so do our PA's!!!!! Aghhhhh!

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Originally Posted by openheartmary

Thank you all for your input. My son's wounds look like they are getting better. He is still in severe pain, but now is manifesting other s/s.

Our hospital is not designated a trauma center as you all have figured out. However, they do have an emergency department and accept patients.Appropriate emergency care should have, but was not, provided. I'll deal with those things after we are on the upswing in recovery.

This town has two hospitals. I intend to take him to the other ED this morning to be examined by a doctor. I am not convinced there isn't something else going on. Severe pain in left kidney area, extreme bruising, mild swelling. I now do not believe he was even given a physical exam by the doctor in ED. (I was not with him the whole time, they had to have their paperwork, you know). X-rays included flat plate of cervical, thoracic, lumbar and sacral spine, abdomen. My son does not remember being examined.

he was also medicated... and you wrote yourself that you were not there the whole time (just being devil's advocate...)

Glad you're getting him checked out - bruised Kidney, bladder issues are my first thought.... maybe a CT now.

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Originally Posted by mwboswell

...how about FAST exams?
You could use that instead of all the radiation as a first level screening tool....plus less risk for complication during intrafacility xport.

Question: Do you do your Trauma CT's with or without oral contrast???
-if you do them "with" how do you justify giving a pt PO contrast who might have a perforation or internal disruption???
-if you do them "without" oral contrast, how do they see hollow organs on the scans???

...how about angio for vascular integrity?

at my previous ER (in NC), trauma CT's were with and without contrast, using IV contrast and PO Gastrograffin (via NG if needed, if able).

Where I work now gastrograffin is not used.... and I'm pretty sure any PO contrast is not used for trauma.... but I'll look into that.

[openheartmary]

I want to thank you all for your insight and encouragement. I still beat myself up over this, but I hope and pray should I ever be in this type of situation again I will remember, and be able to fight for what I feel in my gut is right.

To update you, my son has recovered. He has a lot of scarring and some embedded gravel that may or may not eventually work out. We are so thankful he is alive. By the way, he was wearing his helmet, and is most definitely very verbal to everyone about the need to always wear a helmet.

Again, THANK YOU VERY MUCH.