A Headache is not an emergency

ixchel · Jun 20, 2016

Just think if all of the "non-emergent" cases were to stop, staffing would decrease, people could and probably would be laid off or just lose their job all together...hmmm...job stability would be one good reason for me to take a Pt with a headache and smile about it. Breaking up the acuity would seem to be a good thing too...
I get it, it can clog the ED up when traumas, ROMI's, CVA's, etc come through but I would much rather get my hours in and have a paycheck with differentials and have paid leave for when I want a vacation instead of needing to job hunt to get my hours somewhere else.
If my Level I didn't see all of the non-emergent cases it does every year then the staff would probably be cut in half simply because the daily census wouldn't justify the current amount of staffing. More hands on deck when it really hits the fan seems like a win-win situation to me. To each their own though.

I wont go into details here, because I'm honestly not wanting to get my butt dragged through the mud if someone in management at my tiny 60-something bed facility follows me like a creepy little weirdo.

Being a person who stands waiting for my last step-down bed to be filled while you are thankful to receive an ear infection or uncomplicated headache....

If we can't fill our last hospital beds because all of your patients are unadmittable, you can't go on divert.

When you can't go on divert, you'll get all of the headaches, school notes for fevers, and work notes for a head cold, in addition to the "I needed an ambulance because it hurts RIGHT HERE! on my nose!" patients, and guess what? Legit emergencies that require admission.

So in an ED that becomes standing room only, the ED docs/PAs/NPs figure, "lets get the patient upstairs, they can take care of this." Only apparently somewhere in the transfer of care, a ton of stuff isn't done, and it gets noticed by the receiving nurse.

Or worse yet, the next shift. Night shift. After the specialties have gone home. After the hospitalists dwindle down to bare minimum. And now I'm left with a half-dead, should very much survive, patient that I am responsible with EXTREMELY few (if any) resources to take care of.

Uncomplicated headaches and ear infections do not offer a nice break or job security. Forgive me, because I, in no way, wish your job to be any harder. Consider, though, how limited your own resources would be in anything less than a level 1. My level 3 has limited staff, limited diagnostics, limited specialties, and very limited space in a small community that is rural. Headaches aren't at all job security or an easily, quickly turned bed.

AS FOR THE OP, good grief.

Two headache related emergencies pop in my brain at the moment - stroke and increased ICP.

My kid just started doxycycline last week and you better BELIEVE a strong headache would have sent us to wherever his doctor said to go. Immediately. Even (especially) if he said ED.

I'm pretty sure you're just trolling us, though. At least I hope so.

(And before anyone calls me a fence hopper, my problem with the above comment was specifically what I responded to (the idea that headaches are nice occurrences for ED nurses, keeping people employed), and I would have requested guidance before going into an ED for my son. His present medical condition could possibly warrant that, and if it was ED worthy, he might be admitted or transferred out to a higher level.)

floridaRN38 · Jun 20, 2016

It is not the people with headaches that bother me coming into my ER. It is the people who call 911 are 20 years old and have tooth pain for 2 weeks! Why can't they drive themselves or take an UBER?

ixchel · Jun 20, 2016

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

Meanwhile, my recurrent ear infection spouse takes WEEKS of snoring and me staring in his ears before he'll FINALLY LISTEN TO ME to go get seen. He literally just now came back from his doctor for this very thing. lol Honestly, the ways his ears are so filled with fluid right now (cone of light? PFFFFFT!), I wonder how his hearing is so good. Though, he's been shouting more, and then insisting he isn't shouting when I mention it. *sigh* Steroids and decongestants. I'll be able to sleep through the night soon.

OrganizedChaos, LVN · Jun 20, 2016

Meanwhile, my recurrent ear infection spouse takes WEEKS of snoring and me staring in his ears before he'll FINALLY LISTEN TO ME to go get seen. He literally just now came back from his doctor for this very thing. lol Honestly, the ways his ears are so filled with fluid right now (cone of light? PFFFFFT!), I wonder how his hearing is so good. Though, he's been shouting more, and then insisting he isn't shouting when I mention it. *sigh* Steroids and decongestants. I'll be able to sleep through the night soon.

My poor son has fluid behind his ears too & isn't hearing as well either. Why are men so stubborn sometimes? I'm glad you will be able to sleep well now. [emoji42]

PNM2600 · Jun 20, 2016

The symptoms of a stroke are similar to a migraine. If there's a family history or personal risk factors one can never be too careful with headaches. If it was severe enough, I'd go to the ED.

ixchel · Jun 20, 2016

I never knew there were rules to use the ER. If you don't like your job, I'm sorry & maybe you should look into a different one.
When I went the other night there wasn't anyone in the ER & I wasn't taking up valuable time.
Yes I had the pain for awhile but it wasn't worth addressing until last night, on a Friday when my doctor was closed. I thought I just had a sore throat & it would go away, I was wrong.

Cheerios, I know this thread has taken a frustrating turn.

The anecdote about the burden we see at my hospital... Let me share something a bit more detailed.

One night, when our ICU was completely full, I got a shift change shuffle patient. Our ED had been standing room only the entire afternoon, and because of afternoon discharges, there was no ability to go on divert. The waiting room was full of not quite or not at all emergent patients, and ambulances kept bringing non-emergent and emergent patients.

We had an emergent GI bleed with dementia. He was vomiting coffee ground emesis. By the time he got to me, it was bright red. I was so wrapped up in keeping him stable, I had no time or chance to look through diagnostics except Hgb, which I watched like a hawk q4h. I also had to track down an accurate code status on this guy as daytime hospitalist didn't know and family wasn't there. It was a flippin' mess. He was a flippin' mess. It was a struggle to keep his BP over 85 by the end of my shift. His Hgb had dropped 4 points during my shift, probably largely due to hemodilution since the vomiting did stop and he had no bloody stools. God knows how my other patients were, and thank the gods old and new my unit had a good team on that shift. GI doc got to the hospital early AM to scope him.

When I gave report, though, I didn't have any answers to two HORRIBLE things: why is there no abdominal imaging on him? And why isn't GI consulted?

Daytime hospitalist was under the impression ED doc took care of both these things. THANKFULLY, night hospitalist found the lack of GI consult and got him in early. The CT was missed by every single one of us. Honest to god I left believing completely that guy wasn't going to survive. His progress during my shift was that bad.

And it all began with an ED overwhelmed by way too many non-emergent cases.

I'm glad you do report that it was empty there. What I wonder is what your decision would be if it was busy?

Does your PCP have an on call line? That really is the best place to begin.

ixchel · Jun 20, 2016

Or even worse...it feels like having a stroke; my worst migraines have facial droop, slurring blurred vision and aphasia; I have seen it in the pts that come through as well; we take migraines seriously enough that they are Level 3s-they are never classified as urgent when they have serious symptoms.

I've had patients who were admitted for possible CVA from headaches like this. It drives me bonkers when nurses scoff at that after the stroke-like symptoms pass.

ixchel · Jun 20, 2016

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

I was thinking it might be nice to visit Mexico in the near future. Send me a list of names.

OrganizedChaos, LVN · Jun 20, 2016

Cheerios, I know this thread has taken a frustrating turn.
The anecdote about the burden we see at my hospital... Let me share something a bit more detailed.
One night, when our ICU was completely full, I got a shift change shuffle patient. Our ED had been standing room only the entire afternoon, and because of afternoon discharges, there was no ability to go on divert. The waiting room was full of not quite or not at all emergent patients, and ambulances kept bringing non-emergent and emergent patients.
We had an emergent GI bleed with dementia. He was vomiting coffee ground emesis. By the time he got to me, it was bright red. I was so wrapped up in keeping him stable, I had no time or chance to look through diagnostics except Hgb, which I watched like a hawk q4h. I also had to track down an accurate code status on this guy as daytime hospitalist didn't know and family wasn't there. It was a flippin' mess. He was a flippin' mess. It was a struggle to keep his BP over 85 by the end of my shift. His Hgb had dropped 4 points during my shift, probably largely due to hemodilution since the vomiting did stop and he had no bloody stools. God knows how my other patients were, and thank the gods old and new my unit had a good team on that shift. GI doc got to the hospital early AM to scope him.
When I gave report, though, I didn't have any answers to two HORRIBLE things: why is there no abdominal imaging on him? And why isn't GI consulted?
Daytime hospitalist was under the impression ED doc took care of both these things. THANKFULLY, night hospitalist found the lack of GI consult and got him in early. The CT was missed by every single one of us. Honest to god I left believing completely that guy wasn't going to survive. His progress during my shift was that bad.
And it all began with an ED overwhelmed by way too many non-emergent cases.
I'm glad you do report that it was empty there. What I wonder is what your decision would be if it was busy?
Does your PCP have an on call line? That really is the best place to begin.

If it was busy I would've gone home since as a nurse I know better than to clog up an already busy ER. But since there was no one in the waiting room & only 1 person in the ER, I was not as concerned.

No, my PCP does not have an on call line. [emoji107]ðŸ¼ I wish I was joking about how horrible the doctors in my area are. My son had an appointment today & the wait was 3 hours. Since there are so few doctors but so many patients, it's hard to get in the same day unless someone cancels.

ETA: When I had real insurance I use to go to the walk in clinic for minor things. But since I have Medicaid because my husband lost his job, it's not that simple any more. Thankfully I haven't needed to see a doctor this whole time, until now.

ixchel · 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.

Gotta love it when you see "STI exposure" on the CC list.

ixchel · Jun 20, 2016

Hmmm... Christmas Eve many years ago, I worked in HR for a global Fortune 500 company, I drew the short straw... had to work. As I am doing my thing, I felt a terrible pressure inside my ear, and then a "Swoosh" sound and suddenly I had blood dripping out of my ear. I was a hard worker, and even though I woke with a fever and an earache, I went to work. So, the blood thing changed my mind. Guess what? I WENT TO THE LOCAL ED. Yep, I went to the Emergency Dept on Christmas Eve with essentially, a horrific earache and a ruptured membrane. I hope that is ok with those of whom are the "Guardians of All that is Right and OK with Living Based on the Rules of the Righteous".
FWIW, the ER MD was very clear that coming in ASAP was THE CORRECT CHOICE. I certainly, once again, hope that is ok with the Guardians.
If someone feels the need to go to the ER, we deal with it. THAT'S LIFE. I would expect the same level of compassion for that patient as I would a patient suffering from something more gruesome. There are things happening in a persons life that you might not understand, and you might not even consider... So, just be the amazing nurse you always imagined you would be.
JMHO.

You had BLOOD coming out of your EAR, after experiencing what sounds like a bit of an explosion. I would HOPE you'd go to an ED for that.

ixchel · Jun 20, 2016

My poor son has fluid behind his ears too & isn't hearing as well either. Why are men so stubborn sometimes? I'm glad you will be able to sleep well now. [emoji42]

No clue. I wish I knew!

My best theory is he's used to feeling like crap. (Isn't that awful?) His frequent infections result from allergies and his stupid Vape. (Guess I should be glad he's stopped cigarettes, although the Vape hasn't decreased his ear infections any.) He's also tired of being told, "you're fine, it'll go away on its own." They seem to be 50/50 on that prognosis. Today's I agree with because the fluid is clear, and the inflammation is so minor.