When is a situation considered an Emergency?

Nurses General Nursing

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:D Hi, I am not a nurse yet, so I would like to ask ya'll a question. This post is a little long, so just try to bare with me. What makes a situation an Emergency??? I will explain myself:

Yesterday, my husband had a slight stomach ache all day. He took some pepto thinking that would help, but at about 10:00 PM, he came wake me up and told me I needed to bring him to the hospital. Since we don't have any insurance, we drove about 30 minutes to the Charity Hospital. At this point he is in a good amount of pain. He is having trouble walking and every 2 minutes is seems like he needs to urinate but only a little comes out at a time. We get into the ER and they must have had about 100 people in their. He and I both knew their would be a bunch of people. Well he picks his # and goes sit down, and asks me to go talk to someone to see if they can give him some pain medication. So I went ask a lady (I'm assuming she was a nurse) and she asked if he went through triage yet (I think that is what it is called) and I told her no. She walked away and came back and said that there was nothing they could do, that he had to wait to be called and they would be starting to call #'s soon. :stone He was #9. I could tell she really sympathized for him, but there was nothing she could do.

We sit down for a few minutes and my husband asks me to take him to another hospital. We will just pay the bill, just get me to that hospital, (hoping it would be a little faster since it isn't charity) It is about 15 minutes away. So he gets in this ER and by this time he is obvious pain. :scrying: The lady at the desk looks like she is in NO hurry at all to try to help him. He went to the bathroom again, came out and basically begs the lady at the desk to let him talk to someone. So she says in the rudest, most hateful way, Sure, Go knock at that door. :flamesonb It was the way she said it, with a hateful smirk on her face like she knew the woman behind this door would make him feel like it didn't matter what he was feeling, and that is exactly what this lady did. He knocked on the door, knocked and knocked, and finally just opened the door to try to talk to her; she yells at him and tells him he needs to knock and this & that. He told her that he did knock and that he can't take the pain anymore, then she tells him he needs to wait like everyone else. He is almost in tears. :scrying:

So he tells me to bring him to the other hospital, about 25 minutes away. :confused: I didn't know what to do, I wanted him to just wait but he couldn't. So the whole way to the hospital (which is about 10 minutes from my house in the first place) he is yelling in agonizing pain. :sniff: I feel like crying, he is scaring me to death, & he is also scared to death because he had no idea what was going on, he's never felt pain like this before. I almost wanted to pull over and call 911 but I might have been at the hospital by the time they got their. We finally got to the hospital and I drop him at the door. The nurse looks at him and immediately takes him into triage and into a room. I was so HAPPY :roll .

We eventually found out it was a kidney stone and he did pass it before we left the hospital. So I ask... Do ya'll think this should have been considered an Emergency??? The whole time I kept thinking that he's having an Appendix attack and it is going to rupture or has ruptured and will poison his body while WAITING for someone to acknowledge that he is desperate need to some kind of comfort. Obviously this wasn't the case, but what if it was???

Am I overreacting? Should we have called an ambulance in the first place??? Is their any way that I can complain to someone that will really listen about the hospital's lack of urgency?

If you got this far, thanks for reading.

Maya

Actually, yes , you can die from pain. Pain causes the body to loose blood to non vital organs, to shunt blood to the place of pain. Pain also causes stress to the body, can have an MI etc. Not to say that ks pain is that kind of pain, but, ks's are worth getting back to ER asap if possible. Ever see a ks pt come in pale , diaphoretic , low bp. It happens. If they can't get back they are most certainly a pt that is worth keeping an eye on and evaluating as much as possible in triage. Ks can cause pylo, that can lead to sepsis.:nono:

I have never started a dopamine drip for someone with pain the only symptom, or coded someone because they were in pain only. Pain is a symptom not a disease process. Please explain to me the physiological process that pain shunts blood to "non vital organs." Yes the ks is painful and they can be very sick and have low blood pressures etc.

but the OP and her husband did not even stay at one hospital long enough to be triaged.

Specializes in Education, Acute, Med/Surg, Tele, etc.

Hey guys...remember, the patient did not have a dx yet...so sudden onset of pain like that, even if very typcial of a kidney stone...still needs to be Dx'd before we can rule out life threatening or loss of organ/limb...while this was occuring no one really knew what was going on...talk about fear factor!

Naaaa pain won't kill you, but pain indicates a probelm that might (unless you stroke/MI out from the high blood pressure pain causes!) be life threatening. We don't just get pain when there isn't a probelm...so we have to go through the motions of rule out and what not to find the solution.

But I agree full heartedly...you can't tell what pain is indicating by a persons account because it is so varied from person to person. One person may feel sharp shooting pressure chest pain 10/10 for heartburn or a gall stone and not an MI...but the little old lady in the corner just feeling "uncomfortable" in the chest with no other pain than perhaps "well....4/10 sweety, I have felt this before but it scares me"...could indeed be having an MI!

Or headaches..dont' you love these! Could be a migraine, could be meningitis, could be stroke! Even at a 10/10 pain level...these three can't be Dx'd without testing...and all of these dependant on situation can be life threatening (yes even the migraine untill we find out why it is occuring...I had a pt with a migraine that was severely DKA and almost died because it was triaged as a migraine, and in a triage room with the story the pt gave..that is what it was..female in her 20's with Hx of migraines pre menses..but this one was what she said as "different"...okay can't triage any other way besides migraine and can wait over more emergent cases).

So basically pain doesn't kill ya (for the most part), but till you know what and why it is there...woooooo hooooooo it is a bumpy scary ride!

Specializes in Case Management.

I picked my 4 yr old son up at daycare the other day, he was sleeping when I came in. (which was not usual) After working to get him in a standing position for about 20 minutes, he finally woke up enough to put his coat on. By the time we got to the front door, He said his leg hurt a lot. 2 more steps and he said he could not walk on that leg. I tried to get him to walk down the 5 steps from the front door at daycare and he was screaming that he could not walk down the steps. This is a kid who jumps from one piece of furniture, who takes swan dives off the couch and throws himself to the floor playing superhero. He is the toughest kid I know and he would not walk.

By the time we got home he was screaming in pain. I made him take his pants off (a feat in itself, I had to literally lay him on the floor and take the pants off myself) I observed both legs and did not see anything wrong. He screamed in pain when the pants came off and on again. At this point I am sure he had jumped off something at daycare and broke his leg. I called the pediatrician office after hearing him screaming in the background they said take him to the ER! Off we went, with him screaming all the way, getting him into his booster seat was difficult, he did not want to bend the leg. He would not point to the pain, just said it hurt so bad. He screamed and cried, "I don't want them to cut off my leg, I just know they are going to cut off my leg!" I was trying to console him, telling him they will probably only have to put it in a cast, dont worry etc. We get to about 3 blocks from the ER and he became strangely quiet. By the time we got to the ER parking lot. He looked at me and said, Mom my leg is fine now. I made him get out and he started running around kicking his leg and acting like himself. He was fine, the pain was gone. I think his leg just fell asleep.

The point I am trying to make, is even as a veteran nurse, I still fall apart in emergencies dealing with my kids. And when your loved one is in pain, all you want to do is make it go away. You did your best to help your husband and you wanted to make the pain go away. You did good. Any time a loved one is in pain, it is an emergency to you.

We left the ER without being seen. but if he had still been in pain, I would have brought him in only to have the drs and nurses tell me his leg fellasleep. My bad, but at least they can't say I don't care about my little boy.

Specializes in Corrections, Cardiac, Hospice.

I am going out on a limb here and disagreeing with everyone, I think. I feel the way that she and hubby were treated was deplorable. If someone is very obviously in pain, that needs to be addressed. We don't have pain without reason. To be in such awful pain and to be treated like you were less than human in INEXCUSABLE to me. To say pain has never killed anyone is a cop-out. Tell that to the MI patient, tell that to the cancer patient, tell that to the patient with a DVT. No that pain won't kill them, but the REASON THEY ARE HAVING PAIN WILL!!!! I wonder if the scenero would have been different if they knew someone at the hospital or were friends of the board.

No, I am not naive, I worked at an inner city jail for 18 months and was lied to daily. HOWEVER, I was also on the other side. My husband c/o pain twice in his life to me, to the point I took him to ER. Once they found a tumor the size of a grapefruit in his lung. (This after the ER doctor told us we should have stayed home with some Advil.) The second time the surgeon told me he was within 24 hours of his appendix exploding. Luckily, the second time I was a nurse at the hospital and they didn't think my husband was drug seeking. I AM NOT THE JUDGE and JURY! It isn't my job to decide if someone just wants drugs. If you have lost your compassion in the ER, maybe its time to move on. SORRY, just my :twocents: :chair:

I picked my 4 yr old son up at daycare the other day, he was sleeping when I came in. (which was not usual) After working to get him in a standing position for about 20 minutes, he finally woke up enough to put his coat on. By the time we got to the front door, He said his leg hurt a lot. 2 more steps and he said he could not walk on that leg. I tried to get him to walk down the 5 steps from the front door at daycare and he was screaming that he could not walk down the steps. This is a kid who jumps from one piece of furniture, who takes swan dives off the couch and throws himself to the floor playing superhero. He is the toughest kid I know and he would not walk.

By the time we got home he was screaming in pain. I made him take his pants off (a feat in itself, I had to literally lay him on the floor and take the pants off myself) I observed both legs and did not see anything wrong. He screamed in pain when the pants came off and on again. At this point I am sure he had jumped off something at daycare and broke his leg. I called the pediatrician office after hearing him screaming in the background they said take him to the ER! Off we went, with him screaming all the way, getting him into his booster seat was difficult, he did not want to bend the leg. He would not point to the pain, just said it hurt so bad. He screamed and cried, "I don't want them to cut off my leg, I just know they are going to cut off my leg!" I was trying to console him, telling him they will probably only have to put it in a cast, dont worry etc. We get to about 3 blocks from the ER and he became strangely quiet. By the time we got to the ER parking lot. He looked at me and said, Mom my leg is fine now. I made him get out and he started running around kicking his leg and acting like himself. He was fine, the pain was gone. I think his leg just fell asleep.

The point I am trying to make, is even as a veteran nurse, I still fall apart in emergencies dealing with my kids. And when your loved one is in pain, all you want to do is make it go away. You did your best to help your husband and you wanted to make the pain go away. You did good. Any time a loved one is in pain, it is an emergency to you.

We left the ER without being seen. but if he had still been in pain, I would have brought him in only to have the drs and nurses tell me his leg fellasleep. My bad, but at least they can't say I don't care about my little boy.

OMG!!! Thank you so much for understanding!!! And everyone else for that matter who understands just how scared we were! We didn't know what to do, for all we knew, it would be another 30 minutes before we would be seen, and he kept saying he couldn't take it. :(

But I agree full heartedly...you can't tell what pain is indicating by a persons account because it is so varied from person to person. One person may feel sharp shooting pressure chest pain 10/10 for heartburn or a gall stone and not an MI...but the little old lady in the corner just feeling "uncomfortable" in the chest with no other pain than perhaps "well....4/10 sweety, I have felt this before but it scares me"...could indeed be having an MI!

I totally understand this. When we were in the ER, I kept thinking, look at all these people just sitting here in no pain (or so I assumed), and my DH is here in OBVIOUS PAIN and no one is coming out to even talk to him. But how did I know that those people weren't in pain or something. You Know??? I was in panic mode just like my DH. I hope that when I am an RN, I learn how to not panic in situations, but I'm sure I will. ;)

And there is no indication the OP's husband wasn't being eyeballed by the triage nurse while in the WR.

At the first hospital, there may have been a nurse seeing the discomfort he was in that we didn't notice. But at the second Hospital, (let me explain exactly how it was), we walk in, there is a little desk to the right, I fill out a sheet of paper with all of his info, and put EXCRUTIATING pain on his right side as his symptom. The receptionist took her good old time walking to a drop box and slipped the paper into the room (that had its shades down) that the lady who started yelling at my DH was in. There were no nurses in the waiting room seeing him or his discomfort. We waited for a few minutes (must have felt like forever to him) and then he went knock/open the door to the room. I know he shouldn't have opened the door, he should have waited for her to answer it.:nono:

Thanks to everyone for explaining to me how the ER process goes down. Just for the record, I hope I am never in the position to have to tell someone they have to wait when they are in pain. I am sure it is a very tough position to be in.

Maya

I am going out on a limb here and disagreeing with everyone, I think. I feel the way that she and hubby were treated was deplorable. If someone is very obviously in pain, that needs to be addressed. We don't have pain without reason. To be in such awful pain and to be treated like you were less than human in INEXCUSABLE to me. To say pain has never killed anyone is a cop-out. Tell that to the MI patient, tell that to the cancer patient, tell that to the patient with a DVT. No that pain won't kill them, but the REASON THEY ARE HAVING PAIN WILL!!!! I wonder if the scenero would have been different if they knew someone at the hospital or were friends of the board.

No, I am not naive, I worked at an inner city jail for 18 months and was lied to daily. HOWEVER, I was also on the other side. My husband c/o pain twice in his life to me, to the point I took him to ER. Once they found a tumor the size of a grapefruit in his lung. (This after the ER doctor told us we should have stayed home with some Advil.) The second time the surgeon told me he was within 24 hours of his appendix exploding. Luckily, the second time I was a nurse at the hospital and they didn't think my husband was drug seeking. I AM NOT THE JUDGE and JURY! It isn't my job to decide if someone just wants drugs. If you have lost your compassion in the ER, maybe its time to move on. SORRY, just my :twocents: :chair:

Thank you for your message.

If we would have know that it was a Kidney Stone that was causing this, and known that it would have passed, I'm sure he wouldn't have been so scared and persistant. But he didn't know what was going on, he thought something really bad was happening. I had never seen him like this before, in the 7 years we have been together. I could see the fear in his eyes.

But it's over now and he's fine, just hoping that he never has to experience that again.:uhoh3:

Thanks again for your understanding.

Maya

Specializes in ER.

Another problem I see is that even if the triage nurse knows it fits the symptoms of a kidney stone, and that the patient won't die in the next few minutes, he/she can't communicate that to the patient because they can't officially diagnose. We all know that is part of what the triage nurse does- makes a mental list of all the things it could be and thinks about the possible consequences of waiting. Just knowing the findings of the triage nurse would have helped this couple.

Another problem I see is that even if the triage nurse knows it fits the symptoms of a kidney stone, and that the patient won't die in the next few minutes, he/she can't communicate that to the patient because they can't officially diagnose. We all know that is part of what the triage nurse does- makes a mental list of all the things it could be and thinks about the possible consequences of waiting. Just knowing the findings of the triage nurse would have helped this couple.

When we got to the last hospital, and the nurse took him into triage, she was asking him if he still has his appendix, we said yeah, blah blah blah and then we said that he kept felling like he needed to urinate alot and only a little bit would come out. She said, Oh that sounds like it might be a Kidney Stone. Just hearing her say that calmed my nerves.

Thanks for the reply

Maya

Specializes in Brain injury,vent,peds ,geriatrics,home.

Im sorry about your horrible,scary situation.I think I wouldve called 911.They at least would have assessed him,and got medical assistance quicker.What ashame.also on behalf of the ER,they might see lots of persons who overreact or are drug seeking on a daily basis.Remember your ABCs.That is usually the precedence.Try C/O of difficulty breathing,youll have a better chance of getting to see the DR more quickly.

Specializes in Brain injury,vent,peds ,geriatrics,home.
I am going out on a limb here and disagreeing with everyone, I think. I feel the way that she and hubby were treated was deplorable. If someone is very obviously in pain, that needs to be addressed. We don't have pain without reason. To be in such awful pain and to be treated like you were less than human in INEXCUSABLE to me. To say pain has never killed anyone is a cop-out. Tell that to the MI patient, tell that to the cancer patient, tell that to the patient with a DVT. No that pain won't kill them, but the REASON THEY ARE HAVING PAIN WILL!!!! I wonder if the scenero would have been different if they knew someone at the hospital or were friends of the board.

No, I am not naive, I worked at an inner city jail for 18 months and was lied to daily. HOWEVER, I was also on the other side. My husband c/o pain twice in his life to me, to the point I took him to ER. Once they found a tumor the size of a grapefruit in his lung. (This after the ER doctor told us we should have stayed home with some Advil.) The second time the surgeon told me he was within 24 hours of his appendix exploding. Luckily, the second time I was a nurse at the hospital and they didn't think my husband was drug seeking. I AM NOT THE JUDGE and JURY! It isn't my job to decide if someone just wants drugs. If you have lost your compassion in the ER, maybe its time to move on. SORRY, just my :twocents: :chair:

Very well said!!

Specializes in Education, Acute, Med/Surg, Tele, etc.
When we got to the last hospital, and the nurse took him into triage, she was asking him if he still has his appendix, we said yeah, blah blah blah and then we said that he kept felling like he needed to urinate alot and only a little bit would come out. She said, Oh that sounds like it might be a Kidney Stone. Just hearing her say that calmed my nerves.

Thanks for the reply

Maya

Actually Maya...when you told of this story I wondered about appendix rupture or kidney stones before I got to the end of the story! You described the story so very well!!!!!!!

I agree with you, with pointed out mistakes of going hospital jumping and all (and if your hubby says so...heck...you do it, you love him and want to do things for him!!!! I let my hubby drive himself during a heart attack to the hospital totally white nuckled waiting to take over the wheel because he wouldn't let me drive! I know...very much so I know!!!!!!!!!!).

But it was the fact that you had no clue..hubby had no clue...and you had pleanty of time to wonder of the worse....and well...nurses and their compassion should be consistant..but human beings are not...especially in emergencies! SO no matter where you go...I think it is a Murphys law..you will encounter someone that will not share your feelings in the way you do! (medically speaking or not)...

It would be a great world if nurses in ER could have the chance to share their love and compassion..but ER isn't that place! You have to deal with here and now...put your emmotions aside (IE the burn out potential, and the feeling you did so much, maybe saved someone but you feel empty!)... But rest assured...they do care! Trust me..they do!

Sadly your hubby came in for good reason...but the system...gives ER an open ticket to help anything...and it stalls those that need it! And someone somewhere will come up with a better idea for how to handle it...and more than likely will be ignored...LOL!

Huggles to you and your hubby....even with the hospital jumping you did...you tried your best to do what was right for your loved one! And well....loved ones can have you doing whatever to help them! Including letting a man drive when you knew he was having a heart attack!!!

Specializes in ER, ICU, Infusion, peds, informatics.
i am going out on a limb here and disagreeing with everyone, i think. i feel the way that she and hubby were treated was deplorable. if someone is very obviously in pain, that needs to be addressed. we don't have pain without reason. to be in such awful pain and to be treated like you were less than human in inexcusable to me. to say pain has never killed anyone is a cop-out. tell that to the mi patient, tell that to the cancer patient, tell that to the patient with a dvt. no that pain won't kill them, but the reason they are having pain will!!!! i wonder if the scenero would have been different if they knew someone at the hospital or were friends of the board.

no, i am not naive, i worked at an inner city jail for 18 months and was lied to daily. however, i was also on the other side. my husband c/o pain twice in his life to me, to the point i took him to er. once they found a tumor the size of a grapefruit in his lung. (this after the er doctor told us we should have stayed home with some advil.) the second time the surgeon told me he was within 24 hours of his appendix exploding. luckily, the second time i was a nurse at the hospital and they didn't think my husband was drug seeking. i am not the judge and jury! it isn't my job to decide if someone just wants drugs. if you have lost your compassion in the er, maybe its time to move on. sorry, just my :twocents: :chair:

i think we all agree that pain needs to be addressed.

in the op, maya stated that there were about "100 people" waiting at the first hospital. many of them were probably in pain. it isn't as though the waiting room was empty and they just left him out there to suffer. i don't blame her for asking for pain meds (and maya, it may have been a nurse but was probably a clerk), but of course they couldn't give him anything yet. (i hear that some hospitals are starting to give pain meds in triage -- scary, scary -- but there is no way anyone would be given as much as a tylenol without going through triage first).

as for the attitude encountered at the second hospital, i'm really sorry you were treated that way. however, the clerk (i'm assuming it was a clerk) never should have told you to knock on the triage nurse's door. she is in there trying to see to a patient, and it really isn't acceptable to interrupt. had i been the triage nurse, i would have been ticked, too. (though more at the clerk than you). i get mad at my co-workers when they interrupt triage, too. it is really a privacy issue and a respect issue for the patient in the triage chair. i try to be nice about it, but if you were the 50th person to interrupt me that night, it would be hard to keep the irritation out of my voice.

another thing, sometimes it is easy to misinterpret someone's attitude. i tend to be fairly laid-back. i don't get excited all that easily. i try to be calm and even. it doesn't matter if your toe is stubbed or if you are turning several different shades of blue due to hypoxia. i have found that getting anxious and excited doesn't do anyone any good. the patient and their family are already all worked up. if i get worked up, too, it makes the situation worse. generally, it works well. sometimes, though, i get accused of being cold and indifferent. it is especially easy to misinterpret attitude when you are upset/concerned.

i'm not really trying to tell you that you are wrong about how you were treated, because i wasn't there. you may be dead-on, they may have been completely inappropriate and rude. there are people like that, and some of them are (unfortunatly) nurses. but i wanted to give you something to think about.

by the way, i wanted to thank you on how you approached this here. it is so nice to have someone ask why things went the way they did, rather than outright blasting er nurses for being such horrible, mean, uncaring people. we appreciate the opportunity to explain ourselves without having to get defensive.

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