A Headache is not an emergency

OrganizedChaos, LVN · Jun 20, 2016

That actually made me LOL. Seriously. Could you imagine a world with walk-in ORs? We could open a chain, call it Jiffy OR or Speedy-ectomy.

I hafta say, I'm partial to Speedy-ectomy. [emoji4]

emtb2rn, BSN, RN, EMT-B · Jun 20, 2016

There are walk-in ORs. Off the grid, just need to know who to ask....

Editorial Team / Moderator · Jun 20, 2016

There are walk-in ORs. Off the grid, just need to know who to ask....

LMAO! What, like Mafia surgeons? "Hey, Jimmy, I got dis here GSW, do you know a guy?"

Guest219794 · Jun 20, 2016

Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.

Well, not so much.

ER docs regularly give medications that fall on the wrong side of the risk/benefit ratio. They give out drugs for reasons they would never allow in their own family.

There are a number of reasons for this- Path of least resistance, as mentioned earlier. And, of course patient satisfaction.

If you have to identical presentations dealt with in 2 different ways, who do you think is more satisfied, and takes up less time:

1- You have ____________. (bonus points if it has a Latin name.) Here is a pill you can take, and this problem should resolve in ____________ days. (Best to put the amount of time it generally takes for self resolution.)

2. You have ____________. This will most likely resolve on it's own. The most recent research shows that the risks of pharmacological treatment outweigh the potential benefits. This is very lucky, as there is no expense for the medicine, and your body is an amazing creation, with the ability to heal itself. And I am sorry you had to wait 3 hours to see me, I was tied up in an emergency. And yes, it does only take me 2 minutes to diagnose this- I see it all the time.

In the ER we regularly treat things in a way that defies current recommendations - ABX for viruses, narcotics for chronic pain, IVF for pt's who are mildly dehydrated and tolerate PO, etc. Starting to see a lot of steroids for minor inflammation- run of the mill poison ivy for example. People love being given drugs.

So, I wouldn't read too much into the fact that a doc prescribed drugs for something in the ER. Trust me when I tell you it is often something they often wouldn't consider for themselves, friends or family.

Oh- and as somebody pointed out- the OP was not real. First post, poorly written, inflammatory subject and factually incorrect. The hallmarks of a bored AN member creating an alias.

FurBabyMom, MSN, RN · Jun 20, 2016

I just want to say, as someone who suffers from migraines, I have been to the ED twice with them. The first time, I woke up with the most horrible headache I have ever had (my migraines but worse somehow). I think a large part of what made that worse was the panic I had about whether I'd woke up with it or it woke me up. Because I didn't know the answer to that - I bought myself a stat head CT. No aneurysm, no bleed, no tumor. I went to the ED a second time for my migraines after *four* days of trying to get rid of the pain using all my normal meds and sleep with no relief.

I didn't really enjoy paying what I ended up paying for my migraine-related ED visits. Yeah, it costs money even with really good insurance to be seen in the ED. But you get to a point where you have to get *some* relief. I am also generally nauseous (either from my migraines or the meds for it) that I do not eat well nor do I manage to stay hydrated if it's really bad. I didn't enjoy being a patient in the ED (I hate it actually). I really hate when providers treat me the way you've expressed in your original post.

I just, very recently, had a fall where I broke *THREE* bones in my foot (in other news I'm clumsy as all get out). While that hurt, it is a different kind of pain, and far more tolerable than what my migraines are like. I actually managed to keep walking (I was out for a fancy dinner) and waited probably 4 hours to take anything at all for the pain (that's what I get for not taking my purse (I just took a small clutch) with me - not having Tylenol or ibuprofen). For the pain I've had with my foot, I've only taken NSAIDs because when I don't put weight on it it doesn't hurt. I *didn't* take my happy butt into the ED at work for my foot when I was concerned sprain of the joints vs broken. Why? I assessed the situation: my foot and my toes were fine - I had good cap refill, and was able to move all of my toes.

As an adult, I've been a patient in the ED four times (five times if you count the work injury after employee health closed that got me sent to the ED). Migraine, migraine, appendicitis and an anaphylactic reaction to something I was using to clean my house (getting rid of the product has meant I've never had a repeat reaction - but it was bad, super high heart rate, hives, swelling of my lips and tongue - that was the *one* time I have considered calling 911 on myself). I don't think those are "bad" reasons to go to the ED.

The reality is I would never go to the ED for a run of the mill headache. But the headaches I get - yes, depending on the situation. Headaches can be very serious and the causes can be life threatening. Is that always the case? No. But some people probably come in for abdominal pain and it's gas or constipation, but other times it can be things like appendicitis or ectopic pregnancy.

I pay for my health insurance too. I should be able to use it when I feel like I have exhausted all other options. Our insurance company has assigned penalties (co-pays due at time of service) to entice people to only go to the ED when necessary, and to use primary care for most things. There *are* certainly people who abuse the system but not everyone does.

klone, MSN, RN · Jun 20, 2016

I don't work in the ED, but as part of my job of conducting the first OB appointment/history of newly pregnant patients, I would always scrub the patients' charts before their appointment. I have seen some pretty ridiculous abuses of the ED. I saw a woman who had called the ambulance and went to the ED for "lady partsl itching/yeast infection". And MANY women who think it's appropriate to go to the ED because she had a +home pregnancy test and "wanted to make sure everything was all right/wanted an ultrasound". IMO people need a serious re-education on appropriate use of ED services.

klone, MSN, RN · Jun 20, 2016

I have gone to the same ER when I had an ovarian cyst, was in so much pain I could barely walk but the cyst didn't rupture & was slightly too small to take out. I was discharged with nothing, not a pain med or anything. Not that I wanted pain meds, I wanted the damn cyst out.
That may be true for the doctors you know, but they haven't done that here. This hospital is known to do as very little as they can.

We typically do not remove ovarian cysts. Women of child bearing age get cysts on their ovaries every month. Sometimes they are quite painful. 99% of the time they go away on their own.

missyumee · Jun 20, 2016

Well, not so much.
ER docs regularly give medications that fall on the wrong side of the risk/benefit ratio. They give out drugs for reasons they would never allow in their own family.
There are a number of reasons for this- Path of least resistance, as mentioned earlier. And, of course patient satisfaction.
If you have to identical presentations dealt with in 2 different ways, who do you think is more satisfied, and takes up less time:
1- You have ____________. (bonus points if it has a Latin name.) Here is a pill you can take, and this problem should resolve in ____________ days. (Best to put the amount of time it generally takes for self resolution.)
2. You have ____________. This will most likely resolve on it's own. The most recent research shows that the risks of pharmacological treatment outweigh the potential benefits. This is very lucky, as there is no expense for the medicine, and your body is an amazing creation, with the ability to heal itself. And I am sorry you had to wait 3 hours to see me, I was tied up in an emergency. And yes, it does only take me 2 minutes to diagnose this- I see it all the time.

Exactly. Just finished my FNP program. Most MDs and NPs I followed in clinicals gave out antibiotics like candy. No one wants to hear option #2 after they've been waiting for awhile. Unfortunate.

OrganizedChaos, LVN · Jun 20, 2016

Well, not so much.
ER docs regularly give medications that fall on the wrong side of the risk/benefit ratio. They give out drugs for reasons they would never allow in their own family.
There are a number of reasons for this- Path of least resistance, as mentioned earlier. And, of course patient satisfaction.
If you have to identical presentations dealt with in 2 different ways, who do you think is more satisfied, and takes up less time:
1- You have ____________. (bonus points if it has a Latin name.) Here is a pill you can take, and this problem should resolve in ____________ days. (Best to put the amount of time it generally takes for self resolution.)
2. You have ____________. This will most likely resolve on it's own. The most recent research shows that the risks of pharmacological treatment outweigh the potential benefits. This is very lucky, as there is no expense for the medicine, and your body is an amazing creation, with the ability to heal itself. And I am sorry you had to wait 3 hours to see me, I was tied up in an emergency. And yes, it does only take me 2 minutes to diagnose this- I see it all the time.
In the ER we regularly treat things in a way that defies current recommendations - ABX for viruses, narcotics for chronic pain, IVF for pt's who are mildly dehydrated and tolerate PO, etc. Starting to see a lot of steroids for minor inflammation- run of the mill poison ivy for example. People love being given drugs.
So, I wouldn't read too much into the fact that a doc prescribed drugs for something in the ER. Trust me when I tell you it is often something they often wouldn't consider for themselves, friends or family.
Oh- and as somebody pointed out- the OP was not real. First post, poorly written, inflammatory subject and factually incorrect. The hallmarks of a bored AN member creating an alias.

I could see most people getting upset. But I just wanted an answer for my ear pain. If that meant pain pills, antibiotics or nothing I just wanted an answer because the pain was so bad.

lifelearningrn, BSN, RN · Jun 20, 2016

I took my husband directly to the ER with a migraine. He was vomiting out the window the entire way there and kept a jacket over his head in the waiting room because the lights hurt so bad. We'd tried everything. Tylenol, ibuprofen, immitrex....you name it
IV dilaudid (which he had never had before) took it away and I was so thankful for that ER staff for taking him seriously.
He said it feels like brain freeze, only for hours and hours on end. Ugh! Can't imagine.

This sounds like an emergency. Like I said before, some headaches ARE emergencies.

anon456, BSN, RN · Jun 20, 2016

I saved my neighbor's life by taking her to ER for a headache. She was in a hypertensive emergency, and my only clue was that she was complaining of an awful headache. My nurse instinct led me to ask more questions and we diverted from me driving her home to lie down, to the ER where her BP was 100s/200s. She had some heart damage but had not stroked out (yet). Was credited with saving her life.

My little one-- she was c/o headaches and I finally took her to ER to get her head scanned one night when it was so bad she was in tears. I have seen enough pediatric brain tumors to scare me for life. Her scan was normal but her pain was real. She got IV headache protocol, and a referral to a neurologist.

Editorial Team / Moderator · Jun 20, 2016

I hafta say, I'm partial to Speedy-ectomy.

QuickCuts! Though that might be confused with a hair salon. :) QuickSnips? (Sounds like vasectomies.)