Hello all-I found your site while doing a search for standard of care in the ER. I'm going to be the first to say, the only nursing experience I have is as a patient as I have just been accepted to a program. I will introduce myself more later, but currently typing this with one hand do to surgery yesterday (which is how I found this site)
Anyway, on Sunday I was getting ready to make dinner & handed my husband a sharp knife by handing it handle out. You can probably guess what happened next. I wanted to wait & see since I'm not one to head to the ER unless I think I need to go by medic. But this time, I knew the cut on my index finger was DEEP (arterial blood was squirting out). We have several major hospitals near us, we chose the closest because the bleeding was so heavy (soaked 3 bath towels in 15 mins)
So we arrive at the ER, lots of blood, taken immediately to a room, BP check and questioned by a few different people (a nurse and some others, not sure what they were, never saw them again). Nurse hands me a gauze pad and tells me to hold my hand over my head and keep the pressure on it. She goes over my medical history and then leaves. The clerk comes in to collect my $150 copay. About 20 mins have now passed with me spurting blood & everyone that comes into the room saying "wow, you're making a mess". 30 mins, doc comes in, pours saline on the cut and say "holy crap, we need a hand surgeon, I'm not touching that" and leaves, saying he will go page one. Now we've been there an hour, I've soaked my entire sheet, gown (they removed my shirt). I'm doing the best I can to keep my arm above my head and hold pressure, but I'm feeling sick, clammy and very dizzy. A radiology tech comes and when I get to the xray area, she tells me to take the pressure off and remove the gauze pad. I warn her I am bleeding a lot she says "I have to xray without the pad" so I remove it and blood immediately sprays all over the room. her clothes, etc. She gets upset, takes the xray while yelling at the other tech that "she made a huge mess, ugh I guess I will clean it up"
Then she wheels me back to the exam room. The ER is practically empty except for me, another guy who cut his hand and a teen with a sore throat, an ENORMOUS woman who wants pain meds because her knees & hips hurt and a bunch of toddlers crying and screaming (they are there with the "sick" people who bring the entire family) The nurse ONLY comes to check on me when my husband, who sees the large pile of bloody towels and then she finally says "I guess you want something for pain" to which I say "No, I want to stop bleeding!!". She sends in an aide who can only say "no, must keep pressure" and grabs my injured hand trying to twist it to put a new gauze bad, more blood squirts on HIM and he ends up scraping my leg with something in his pocket (leaving a 16cm cut on my thigh) and I yell in pain & he runs out of the room. Noone comes to check
Now we have been there for 3.5 hours and the bleeding has not stopped, even with pressure & holding it above my head (I can't do it forever I am getting weak). I feel like I'm going to pass out, I'm very thirsty and the nurse comes in with a percocet & a cup of water. My husband asks how much longer & what are we waiting on. She says "Oh, they're just working through the others (sore throat, hip/knee pain and other cut finger - they are treated first because they are there first, she says. He says "even with all of this bleeding?" and she shrugs, checks my BP again (which has dropped to 85/56 from 142/90 when I arrived) and leaves. My husband goes back out to the desk & is told they took the OTHER guy to surgery so it'll probably be 12+ hours longer wait for me. A physcian's assistant overhears and says "I'll sew her up but you need to have a surgeon come check her first" So I've gone from emergency, to ignored, to a dr afraid to sew me up because it's too deep to a PA saying she will do it.
My husband finds someone else who pages the surgeon, who leaves surgery to come check me. He asks how long I've been bleeding like that and everyone makes excuses. He VERY annoyed. He checks my cut & says "you've cut an artery, a bunch of nerves and the tendon, you have to have surgery but I'm in the middle of sewing the other guys thumb on, you should have been first!" and gives me a nerve block and instructs the PA how to put loose sutures in and tells me to be in his office at 8 the next morning (Monday), I'm immediately booked for surgery which has been done.
Is this the standard of care for an emergency? Should I have gone to urgent care instead? We went to the ER because it was 5 pm on Sunday and everyone else was closed. I thought bleeding like that IS an emergency, not a sore throat or something. I feel really traumatized. I was in HORRIBLE pain the entire 5 hours we were there, the surgeon said I lost A LOT of blood (the only way he knows is because I just had a CBC a week ago at a checkup and I guess he is able to figure it out from the blood he took from me?) He is SO upset that I wasn't given any pain med to take home, no IV, no blanket and wasn't kept warm with the blood loss, no antibiotics, nothing in the ER) The surgery took nearly 4 hours to repair because it was such a mess. I feel REALLY terrible and sudden lost my hearing in my left ear when I felt like I was fainting (and did lose conciousness for 2-3 mins until the PA came in and flicked me or something, it is all a nightmare to me.
I don't want to be a nurse if this is the standard of care (which I am pretty sure it is not, I have been in other ER's for bleeding kidney cyst and was cared for VERY well in the ER and as an inpatient, this was a different hospital, a foofy suburban hospital. I am still feeling a sense of shock over all that happend
Mmmmm....something about this is just not adding up. don't want to fight or debate but as a ER/ICU vet in three major hospitals, remember, perception is not always reality.
You don't lose A THIRD 30% of your blood volume and walk out without a transfusion.
I believe the OP, mainly because as I said in a previous post, the same thing happened to my husband in an ER. Also, you CAN lose a third of your blood and walk out without a transfusion... I walked out once (separate incident, obviously... different hospital) with my H&H halved with a script for some iron pills. It was AWFUL and I WISH I had been given a transfusion!
The other thing, not from a medical sense, but from a customer service sense: the MD, 2 or 3 nurses (plus the triage nurse) and a few aides (plus some other nurses who were, alledgedly, on Facebook) are all at the worst at the same time on the same night toward one patient....at least accoding to the original story with followups.
Plus, as much as I like AN, it is one of the last places I would visit not too long after I was "going into shock."
Your circulating blood volume consists of components. Hemoglobin and hematocrit are only indicative of the part of the rbc count that binds to oxygen, and not reflective of total blood volume. After a traumatic injury or blood loss, you produce new immature RBC's that weigh less and are smaller, so while your hgb and hct counts may be low, as long as you are producing them many docs esp trauma prefer not to transfuse, as your RBCs mature your hgb and hct will go up on their own. There are risks with transfusion. Not trying to make anyone mad, just stating facts.
I understand that... and that's exactly what my provider told me, AFTER admitting that they should have given me a transfusion. And it was a long road to recovery for me, weeks of being excessively tired, not to mention painfully constipated from the iron. I do know there are risks with transfusion, my own mother died of complications of Hepatitis that she contracted from a transfusion she received when she was 19. And hypersensitivity reactions, compatibility reactions, etc, etc, etc...
But, to bring the focus back to the OP, I was merely stating that I believe that someone can leave a hospital without a transfusion after losing a lot of blood. Your post seems to agree with that statement as well.
everyone is entitled to their opinion. I have seen a lot and been around the block a few times. Perception is reality. What's real to you as a person in one room in pain and afraid may not be the same perception of the people involved. I have witnessed two people involved in the exact same incident describe it two totally different ways. So, yeah, you want to know point blank? I think much was exaggerated. An outright lie? No, again, a different perception from someone who was undergoing pain and anxiety. And you can believe what you want. Either way, good luck to you in your future endeavors. Same to the OP.
To follow up on the perception vs. reality post....I had a pt (age 70s or 80s) who had a bloody nose. No anticoagulant use. Controlled with pressure, but still a "steady trickle" of blood when the tissue was removed from her nose. Busy day, after an hr or so in the room, dtr calls me in asking what is taking so long. Politely explain that we are busy, her mother will be seen in turn. The condition is not serious and we will get the bleeding stopped before we go home. After the MD puts the "rhino rocket" up the nostril to apply direct pressure and stop the bleeding, we draw CBC and coags. All WNL. Pt given referral to ENT and d/c without incident. Week goes by, dtr writes to complain that we sat around and did nothing (I'd like to see the dtr last for a 12 hr shift on a busy day) "while her mother was bleeding to death." On one hand I shrugged it off as no big deal (and it was not a big deal), on the other hand I got kinda upset that she would make such a ridiculous allegation (I was fairly new in the ED so I took said complaints too personally). Anyway, just how a lay person perceives a situation versus how the ED nurse perceives it.
Had a patient's daughter complain to director nurse "ignored her mother's cries of pain all night while she sat on the Internet all night and only checked on her twice." Thankfully we wear Big Brother tags that you can run a report on....SHOCKINGLY I was in her room evey hour for at least fifteen minutes, had placed four pages to the anesthesia on call managing her epidural, two calls to the surgeon, had multiple coworkes who had assisted turning her every hour and who had observed said pt sleeping while daughter cried about how much pain she was in.
Lawsuit???
keikei
28 Posts
Really? Do you mean walk out of that one, when I've been bleeding for hours and I'm so dizzy I can barely stand?