When is a situation considered an Emergency?

  1. 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. 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.

    So he tells me to bring him to the other hospital, about 25 minutes away. 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. 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
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  2. 49 Comments

  3. by   snowfreeze
    Keep this posting and reassess it after you have 2 years of nursing experience. My comment about your hospital treatment is that maybe if someone had more time they could have assessed your pain better. Also time seems so much longer when you are uncomfortable.
  4. by   TazziRN
    The definition of a true emergency is any condition with which the life/limb of the pt is threatened if not treated immediately. Urgent is anything that could deteriorate into an emergent situation if not treated with 2 hours.

    That said, new treatment guidelines say that pain is considered an emergency. He should have been at the very least checked out by a nurse at the first places you went to, and it sounds like they didn't do that.

    HOWEVER: if the treatment area is full and/or there is something that truly is emergent going on, pain takes a back seat.
  5. by   Antikigirl
    I absolutely agree with the definition as given by Tazzi! That is right on!

    I would not have gone hospital jumping though, I would have stayed at that hospital till treated. Why? What if all the sudden as you are driving around heck and back he lost consciousness? What would you have done? In the ER they could have treated that STAT in the waiting room...or anything else that may have occured (vomiting blood, seizure, etc).

    Severe pain is an emergency in my book, especially with sudden onset and nothing quells it (not even body positions). And a kidney stone...OUCH, the worse pain of all!!!!! (I hear it is akin to giving birth to twins sideways). Men have told me it is like having a vice grip on their privates twisting each second and a hammer at their flanks! Without knowing what it is, sudden onset pain...I would have called the ambulance so that whatever happens, there is a trained medic there watching them and treating what they can (they have protocols and some may not be able to give pain meds because they can't have the pt's pain masked for the ER doc to examine...sounds mean but if you mask symptoms, you mask the probelm. And some medications like morpine, which is a typical pain med in ambulances, is contra indicated in abdominal pain till examination..can cause more damage...I hate abdominal pain...such a mystery as to what, and you have to wait till they know before they can try good pain management...it is just they way it goes...believe me, I know it well...I suffer from adhesions attached to my overies and bowel they can't operate on without making it worse...I move wrong and 10/10 screaming pain...and each time, uhhhhgggggg the wait is way to long even if immediately taken back in the ER).

    When it comes to medical situations/emergencies NEVER think of the money...money doesn't mean anything against the life and loved one! A loved one comes first...you typically can get payment plans or help for the money situation somehow...but if the life is lost, what do you have...no loved one, and a big ol bill you still have to pay...and funeral expenses sadly. Nope, the hospital bill is nothing compaired to that financially or emotionally/spiritually! Don't consider that in an emergency...typically that mindset leads to nothing but more serious consequences or even death.

    Hope your hubby is doing well!
  6. by   Altra
    Quote from TazziRN
    The definition of a true emergency is any condition with which the life/limb of the pt is threatened if not treated immediately. Urgent is anything that could deteriorate into an emergent situation if not treated with 2 hours.
    Agree - this is a standard definition.

    Some things to think about: if you thought there was a possibility of a life-threatening emergency, why the jumping from hospital to hospital?

    As you gain assessment skills you'll understand why pain needs to be assessed before it is treated. Triage protocols frequently include the administration of Tylenol/Motrin, but those probably weren't going to be effective in this case.

    When triage is backed up, believe me, that triage nurse is still constantly scanning the waiting room for anyone who may be truly emergent.

    I sympathize with the situation - the pain from kidney stones can be awful, and if your s/o has never experienced one before it is easy to understand how the 2 of you could have been very frightened. But as has been said before here in various discussions, if you are triaged in the ER and then asked to wait - BE GLAD -- it's when we're rushing you right back and you have several people initiating treatment all at once that you need to worry.

    Hope he is now feeling better.
  7. by   I want to be a nurse
    I thank you all for your responses.

    I know we shouldn't have been going from hospital to hospital, but it just seemed like there was nothing else to do (at least to my DH). I felt like all the time we spent going from hospital to hospital, we could have maybe already been seen by a nurse. But he said he just couldn't wait; what if something is going on really bad in there?

    He is doing fine now, he is still a little sore in his abdominal and private area but he said that this is a piece of cake compared to the pain he had.

    I don't know what I would have done if he had passed out on the way to another hospital. I was praying that nothing like that would happen on the way. I can tell you though, I will never do this again. We are going to the closest hospital, 10 minutes away, and he is staying there until someone can see him.

    I just couldn't get over the way these two people made him feel. At least at the first hospital, the nurse looked like she really wished she could do something, you know???

    Oh well, it's all over with now, and I kind of feel like what is the point of complaining anyway about these two people, I don't think it would do any good.

    Thanks again everyone.
  8. by   Altra
    Quote from I want to be a nurse
    I just couldn't get over the way these two people made him feel. At least at the first hospital, the nurse looked like she really wished she could do something, you know???

    Oh well, it's all over with now, and I kind of feel like what is the point of complaining anyway about these two people, I don't think it would do any good.
    I wasn't there ... but if I had to guess, it was the frustrated/sympathetic look of an RN who can easily spot (and diagnose) the classic "kidney stone dance" ... recognizing it does not change its urgency in relation to other patients in the ER. In other words ... if I have an empty ER (in my dreams) I'd whisk your hubby back & start an IV line immediately so that I could relieve his pain w/some IV pain meds as soon as he was seen. But in the real world, where the ER is not empty and waiting for your *emergency*, a patient presenting with kidney stone symptoms will probably wait.

    The other nurse ... again, I wasn't there. But just for a moment try to think about your husband's insistence that he be seen now, and multiply it by 50 ... every ... single ... day. As you progress through school you will learn to incorporate the patient's reporting of symptoms into your overall assessment, but also learn that it's only part of the picture. If it is my clinical judgement that patient A can wait and patient B needs to be seen now, well, that's my function as a nurse.

    Just food for thought. Glad to hear that hubby's doing better (make sure he follows up with the urologist and/or PCP!) and good luck to you in school.
  9. by   TazziRN
    Well said, MLOS
  10. by   EmerNurse
    Have to agree with the above. If he gave the symptoms just as you stated in your post, I know I thought KS the second I read the s/s. While it IS probably the most painful thing a guy can feel (my dad suffered with them for years), he won't die from it even if he feels like he might. Other, sicker, patients WILL be seen first. It's just a fact of triage, and every ER will do the same thing (which is why I discourage hospital-hopping). The cold-seeming treatment you got at one hospital is unfortunate. You may simply have run into a grouchy nurse (they exist) but more likely your husband was the 100th patient who had to be seen right this minute NOW that she'd seen that day. Wasn't there, just speculating.

    I always try to get an obvious KS back quick if I can. I've even been known to throw a particularly severe one in my triage stretcher so I can get a line and get him hydrated - docs are usually good about letting me give a shot of Toradol in there, if no contraindications. BUT, my triage bed is often already occupied by the asthma attack that we're treating from my triage bed because the back is full up swamped beyond belief and that patient could not wait with sats in the 80's. Or some other life-threatening issue. So most times I can't do that. When that happens, pain waits ;(

    Wish I could say something better, but ERs are overburdened by BS - cold symptoms x 2 days, ETOH use (no more drunk tanks in the PD, sigh), etc.

    Hope your hubby does well and follows up appropriately. Just please know that we ER nurses really DO care and don't want anyone to hurt, but we can only do what we can do. I'm sorry.
  11. by   Soup Turtle
    I can sympathize with you. I went through something similar with my husband at the emergency room. I really thought he was about to drop dead, but we just waited and waited for 7 hours before he left to "die at home". There were a lot of people there and if you were breathing and your heart was beating, there just wasn't any room.
  12. by   AnnieOaklyRN
    Unfortunatly in the ER one has to look at the BIG picture, and that big picture includes how many patients are in the E.D. already, how sick they are, how many others are waiting before you and how sick they are, how much staffing do they have. If they have no beds than unfortunatly if you are not emergenct or urgent then you have to wait. They cannot just give out pain meds to people waiting in the waiting room either. Most E.D.s will take a person right in if they are in absolute agony, but again if they have not beds...
    Technically a kidney stone is not an emergency (it is not going to kill him) although VERY painful. You have to remeber that in the waiting room every other person may also be suffering something painful and may be in the same situation as your husband.

    I am glad he did finally get help though.

    swtooth
  13. by   TazziRN
    A year or two ago my MIL suffered a cat bite, which segued into cat bite cellulitis. I took her to the ER at midnight because she couldn't take the pain anymore. Waited in the WR for about an hour, waited in the back for about an hour and a half.......and she complained the whole time. After trying to soothe and explain and cajole, I'd had enough. I stood up beside her gurney and yelled "DO YOU THINK YOU ARE THE ONLY ONE WHO IS MISERABLE HERE??? THESE PEOPLE ARE NOT HERE AT 2 IN THE MORNING BECAUSE THEY HAVE NOTHING BETTER TO DO!!!"



    Not another peep...........
  14. by   caroladybelle
    Agree with many of the posters. Emergency is impending loss of life ora major limb. Pain is important but life threatening emergencies trump it every time.

    Another thing to remember is most patients must be thoroughly assessed before safely being medicated. This cannot occur until after triage and being taken back. The other is that especially when abdominal/back/flank discomfort is present, many MDs WILL NOT MEDICATE FOR PAIN, until some tests are done and completed. Masking the pain can seriously impair ability to diagnose situations. And administeration of some pain meds can interfere with some tests.

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