Wow, we weren't expecting that!

Nurses General Nursing

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Specializes in Emergency, Haematology/Oncology.

What's your most surprising clinical find? A few of my colleagues and I were chatting about epic triage fails the other day and decided that there should be a "Waiting room to ICU plaque" somewhere in the department especially for patients triaged to sit in the waiting room who end up in ICU, I am sure this happens in wards as often. Also, we were trying to figure out the best "VS" triages. Not just ED but all nurses, please add your biggest unexpected surprise diagnoses / discoveries.

Here's mine- not my triages thankfully but no doubt I'll have one eventually.

Triage- "Lateral muscular neck pain post excercising yesterday" CAT 5, waiting room.

Diagnosis- dodgy sex injury resulting in dislocation of several cervical spine- straight to ICU.

Triage- "Epigastric pain / syncope while doing situps (25yM)" CAT 3, ramped for 3 hours in acute (anxious young man and a bit um, snobbish and a little bit rude).

Diagnosis- Aortic dissection- straight to theatre, survived.

Triage- "Requesting prescription for endone, L) leg pain drowsy" CAT 5, waiting room.

Diagnosis- Rhabdomyolysis- fasciotomies, renal failure straight to ICU, had injected endone and been lying in same position for 2/7.

Triage- "High speed MVA, sternal pain" (19yM) CAT 3, seated in acute with his aunty, patiently waiting for half an hour for team leader to read his chart. Four of his friends from the same accident brought in with ambulance service 1/12 hours earlier, all being admitted for various injuries. Pt. was driver- team leader almost had her own MI.

Diagnosis- Sternal fracture and cardiac contusions, HDU.

Triage- "Onset headache post sneezing" CAT 4, waiting room.

Diagnosis- Some sort of intracranial bleed which ended in burr holes.

Now for the VS

Face VS Concrete, Shampoo bottle VS Rectum, Alcohol VS Oesophagus, Lawnmower VS Foot, Tablesaw VS Hand, Tree branch VS Eyesocket, Cat VS Testicles, Flu VS Wimp, Pseudo seizure VS Trainee paramedic, Demented pt. VS Sundown, New intern VS Sensible, come up with something better for us.

Specializes in PICU, ICU, Hospice, Mgmt, DON.

My favorite "we weren't expecting that" came on a relatively busy Saturday ER night a number of years ago. (this is in a inner city hospital)

A quiet middle aged Latino man who spoke very little english came in to triage with what was acertained as chief complaint...back ache- but he was alert and oriented and appeared to be in no distress. The initial paperwork was started and he was asked to take a seat.

He sat quietly for about 30 minutes and then approached the nurse who was in the middle of the usual crazy stuff.

Since he seemed fine and didn't complain, except to ask in broken English when he could be seen, again for his "back ache"....

He was reasurred that he would be seen as soon as possible, but there were many very sick patients ahead of him.

He went back to his seat without any questions where he again sat quietly watching everything around him.

About 20 minutes went by and the third time he approached the nurse he turned around to say something to another person....and as he did she could see the reason for his "back ache"......

He had a 4 inch KNIFE sticking out of his back!!!!!!

Um, he got moved right up on the list...and sent to the trauma bay.

You can't fix that with anti inflammatories and muscle relaxants!

Like I said, this was many years ago and only a few personnel spoke spanish...now in the ER many do. The triage nurse is a friend of mine and she never forgot that night.....she also takes the complaint of "back ache" much more seriously now.

What's your most surprising clinical find? A few of my colleagues and I were chatting about epic triage fails the other day and decided that there should be a "Waiting room to ICU plaque" somewhere in the department especially for patients triaged to sit in the waiting room who end up in ICU, I am sure this happens in wards as often. Also, we were trying to figure out the best "VS" triages. Not just ED but all nurses, please add your biggest unexpected surprise diagnoses / discoveries.

Here's mine- not my triages thankfully but no doubt I'll have one eventually.

Triage- "Lateral muscular neck pain post excercising yesterday" CAT 5, waiting room.

Diagnosis- dodgy sex injury resulting in dislocation of several cervical spine- straight to ICU.

Triage- "Epigastric pain / syncope while doing situps (25yM)" CAT 3, ramped for 3 hours in acute (anxious young man and a bit um, snobbish and a little bit rude).

Diagnosis- Aortic dissection- straight to theatre, survived.

Triage- "Requesting prescription for endone, L) leg pain drowsy" CAT 5, waiting room.

Diagnosis- Rhabdomyolysis- fasciotomies, renal failure straight to ICU, had injected endone and been lying in same position for 2/7.

Triage- "High speed MVA, sternal pain" (19yM) CAT 3, seated in acute with his aunty, patiently waiting for half an hour for team leader to read his chart. Four of his friends from the same accident brought in with ambulance service 1/12 hours earlier, all being admitted for various injuries. Pt. was driver- team leader almost had her own MI.

Diagnosis- Sternal fracture and cardiac contusions, HDU.

Triage- "Onset headache post sneezing" CAT 4, waiting room.

Diagnosis- Some sort of intracranial bleed which ended in burr holes.

Now for the VS

Face VS Concrete, Shampoo bottle VS Rectum, Alcohol VS Oesophagus, Lawnmower VS Foot, Tablesaw VS Hand, Tree branch VS Eyesocket, Cat VS Testicles, Flu VS Wimp, Pseudo seizure VS Trainee paramedic, Demented pt. VS Sundown, New intern VS Sensible, come up with something better for us.

Holey smokes!!! Sounds like you've got it covered. :eek:

Specializes in Trauma, ER, ICU, CCU, PACU, GI, Cardiology, OR.

he had a 4 inch knife sticking out of his back!!!!!!

unquestionably, your story brought back memories of a female pt. that came into ed on a very hectic saturday night. we were swamp since the nearest hospital went on diversion. she literally walked in as one of my colleagues noticed her, she told her that she had to wait in the waiting room. as the female turned we both looked at her and noticed that she had a knife stuck between her shoulder blades. we immediately brought her back to a room, the pt. was coherent and didn't present any c/o other than a slight pain. as we asked her who did this, she stated that her boyfriend did it and then she added "but he's not the violent type" i couldn't help myself and i said "aren't you lucky that his not". true story.

Specializes in Trauma, Teaching.

Fellow in Fast Track with abd pain. Work up about done, but FT was closing so was asked to move him to an ER bed, while waiting for the CT results just in case. So, I have him get up, he is in a lot of pain, walks down the hall to another room, kind of leaning and clutching.

Doc looks at the CT and says "OH ****", dissecting AAA, to OR in nothing flat.

Specializes in Emergency, Telemetry, Transplant.

30-something seen one morning in the AM. Had some umm...'vigorous' love making with his wife the night before. Discharge with ibuprofen and flexeril. Came back that evening in SVT. After several interventions he had to be cardioverted (sp?). He went to the ICU. Next day, the attending goes back to dictate on that pt. Turns out he by then had an intraventricular drain. Turned out that all along he had a subarachnoid hemorrhage. All around weird.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

my best friend's hubby was working in er one night -- standing out at the reception desk watching a thunderstorm and probably waiting for a pizza delivery . . . .

he sees this apparition approaching the er from across the parking lot, and as he says, "my first thought was that i've been on call a lot this week -- when exactly was halloween?"

lightning flashes, thunder booms, and the sliding glass doors of the er slide open to admit a man carrying an unconscious woman in his arms, and what looked like an axe protruding from his head.

turns out the guy was splitting wood when the axe got away from him. he went into the house to get his wife to drive him to the er, and she took one look at him and fainted. he couldn't just leave her there, so he brought her with him and drove himself to the hospital. the blade went right down between the lobes of his brain and didn't seem to damage anything he couldn't live without.

the wife was fine, too.

Specializes in Urgent Care, Oncology.

I have a story, but I was the patient. I was a student and had been going to the infirmary for about 12 weeks on and off. Just a case of the sniffles that would not go away! I thought it was just allergies. Finally, a NP gave me the time of the day and ordered a chest x-ray, thinking I might have pneumonia. From the x-ray she ordered a CT, and that's when she confirmed my PE. From there I was rushed to the ER and straight into surgery. They drained about a 2 liter of soda from around my heart. It ended up being lymph fluid, and 10 days later I was diagnosed with Hodgkin Lymphoma 2B. The NP came to visit me in the hospital and we're still in contact to this day. She even wrote a paper about my case :) It's what made me want to become a nurse... and that's what I'm doing. Two weeks shy of finishing my first semester!

Specializes in LTC, assisted living, med-surg, psych.

Incredible stories, y'all.........keep 'em coming!!

I have only this one to offer: 9mm Glock vs. Testicles. X 2.

Specializes in Emergency, Haematology/Oncology.
Incredible stories, y'all.........keep 'em coming!!

I have only this one to offer: 9mm Glock vs. Testicles. X 2.

Was the Glock VS testicles one shot VS two testicles or two shots taking care of it- and did he deserve it?

Specializes in LTC, assisted living, med-surg, psych.

Actually, it was two shots vs. two testicles on TWO SEPARATE OCCASIONS. The dipstick apparently didn't learn the first time he stuck his gun in his waistband....nope, he did it again a few months later, effectively ending any possibility he might have had to pass his IQ to a new generation.

Specializes in OR, Nursing Professional Development.

The sad thing is that this isn't an isolated occurrence- it's happened here too! And for strike three, 9mm vs femoral artery. Not a good outcome. And yes, all three were while shoving the gun into the waistband. Didn't learn after two good lessons.

Another shooting incident- rifle vs future SIL hand vs future FIL thigh. Same bullet, two people. Can't remember which of the two was holding the rifle.

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