Is the ER supposed to stablize the Patient before transferring to the unit?

[indapinda]

I have had 2 scarey situations 2 nights in a row. The first night an Acetominophen overdose was sent up with just a saline lock, when we took her first b/p it was 68 systolic, got an order to bolus her and the iv didnt' work, got worse from there, we think she is now brain dead. The next night I got report for a patient with COPD and biventricular failure with a pulse in the 160's and a sys of 80 on a dopa gtt at 5 mcgs. I called the supervisor about them stabilizing the patient before transferring them up and was told that was not their job. I know of another night were a patient was sent up who was in 3rd degree HB wasn't paced nothing, and this was an extra patient for them so their resources were spread very thin. According to ACLS protocol, these symptoms should be treated when the present themselves. Does anyone have any experience to the contrary?

[Dixielee, BSN, RN]

I have been on both sides of the wall in this, ICU and ER. Yes, the ER initially is to try to stabalize the patient, but as another poster mentioned, some patients are never going to stabalize, so we get them to the point where we can get them to the ICU who generally has better staffing. If I get a one to one unstable patient in the ER for any length of time, then who is going to watch my other 4-5 patients?

Many good points have already been made. The comment about keeping death stats down, made me laugh. I have never heard such a thing ever in my career. I suppose someone somewhere keeps those stats, but they are certainly NEVER an issue of whether we keep a patient or not.

I can't address each issue you brought up...the non functional saline lock was a no no, they should have had fluids anyway, but I don't know the situation.

I will say though.....how many of you ICU and floor nurses have ever dreaded bathing a patient and turning them over, because you were afraid they were going to decompensate and die? I have had many situations like that when I worked in ICU. I have had patients in the ER who WERE stable enough to transfer when we left the ER, but in the process of moving to the unit, they became unstable. That is why we send them with an RN, a transporter and a cardiac monitor, O2, defib, etc. Just in case there is a problem.

The ER receives the same kind of patients as transfers from other hospitals. They were stable enough to transfer, but became unstable during the ride to the hospital. That is the nature of critical care. If they remained stable all the time, they would never need critical care! I received a patient who has 99% third degree burns. Of course he should have never been transfered, but allowed to die at the outlying hospital. I once received a baby who arrested on the way to the helicopter and had CPR in progress the whole way. Neither of these patients should have been transferred, but what do you do? You deal with the cards you are dealt.

If you do not want to deal with the possibility of unstable patients, then maybe you should re think where you are working.