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
A tech came in and took your BP and it was 85/40 (or something like that) from the 145/90 when you first arrived.
Then the husband took pics of the monitor the OP was connected to.
If a tech is coming in taking the BP with a Dinamap, why are you hooked up to a monitor? The monitor should be automatically taking your BP as often as it is set (example every 30 minutes).
There would be no need for a tech to come in to take your BP. The RN would be able to monitor your vital signs from the nursing station if you are indeed hooked up to a monitor.
And I find it hard to believe NOTHING was done for a BP that low.
Specializes in Pediatric Emergency Medicine/Trauma.
This is absolutely not the standard of care. Patients are triaged based upon seriousness of condition and THEN by time. It's never the other way around. Unfortunately, sometimes things get out of control - paging different specialties, waiting on them to call back/show up, other patients/families yelling for various things - - it's a chaos unlike any other when you work in an ER. Because of this - you have to be your own advocate or have someone with you to do this. I would hope that a situation like this would never, ever happen - and I'm so very sorry it happened to you. Please trust that it is almost never like that. It can be insanely busy but the sickest are seen first - period. Always remember that you are in charge of your care - - you make decisions, you make choices, and you always have the right to demand the supervisor in charge at that time or leave and go else-where. I don't advocate leaving - only because you can get worse - but remember you have the control. Again, I'm so sorry this happened - - it's really unacceptable and I would be calling the medical director of the ER and the nursing supervisor.
I ROUTINELY drive over an hour to the next decent one for ANY and EVERY thing.
This hospital in my neighborhood?
Kept my son in law in an open, unrestricted access room for over a week about nine years ago. Finally the day they discharged him, told him he had SARS. Now, granted he had been travelling and had been in the right place at the right time to get SARS. But to not keep him in isolation? Ever? To casually mention that on the day of discharge? Really?
My dtr went to this same ER with a 3 day migraine. (This was just last year). The doc told her that because she was "too heavy, it makes your troat (sic) small. You not breathe well because of small troat (sic) and make your head hurt. Breathe deep, exercise, take Tylenol, you feel better." Not making fun of his accent or broken English, just stating the facts of what he said - yes I was there with her.
Took her to that ER an hour away? She got a ct scan, Morphine and Demerol, rest in a darkened room, careful, attentive care by concerned professionals and a non-narcotic pain reliever to take home.
There really are hospitals and ERs as bad as the one the OP presents. I have lived it and seen it. And feel bad for people who are stuck going there. My other DD worked there prn for a few months - she said she was scared for her license every time she walked in the door.
I ROUTINELY drive over an hour to the next decent one for ANY and EVERY thing.
This hospital in my neighborhood?
Kept my son in law in an open, unrestricted access room for over a week about nine years ago. Finally the day they discharged him, told him he had SARS. Now, granted he had been travelling and had been in the right place at the right time to get SARS. But to not keep him in isolation? Ever? To casually mention that on the day of discharge? Really?
My dtr went to this same ER with a 3 day migraine. (This was just last year). The doc told her that because she was "too heavy, it makes your troat (sic) small. You not breathe well because of small troat (sic) and make your head hurt. Breathe deep, exercise, take Tylenol, you feel better." Not making fun of his accent or broken English, just stating the facts of what he said - yes I was there with her.
Took her to that ER an hour away? She got a ct scan, Morphine and Demerol, rest in a darkened room, careful, attentive care by concerned professionals and a non-narcotic pain reliever to take home.
There really are hospitals and ERs as bad as the one the OP presents. I have lived it and seen it. And feel bad for people who are stuck going there. My other DD worked there prn for a few months - she said she was scared for her license every time she walked in the door.
Well, I believe that their are EDs that are that bad. I don't believe the OP beacuse with each post, the story got more and more sensational. First she was bleeding profusely, then spurting blood with each heart beat, next time she was practically in shock, and, finally, she has friends in that ER (which she never mentioned in the other 5 rants). Every time someone points out an inconsistency, she adds something else to make her side of the story "more right."
Also, I honestly believe your story involving your dtr (and I know that when I get a migraine, I can't take any PO meds or else I will throw them back up)....and this is more of a comment in general, not really a response to that situation...anyway, why is it that an ED must give IV narcotics or it did not do its job?
How many here have ever held pressure on a large artery? How about with anticoagulants on board? I do not believe for a second that bleeding from small digital arteries cannot be controlled with adequate direct pressure.
How many here have ever held pressure on a large artery? How about with anticoagulants on board? I do not believe for a second that bleeding from small digital arteries cannot be controlled with adequate direct pressure.
Good point. Try holding pressure on a fem line gone wrong....or a bleeding cath site.
That's all pretty accurate. Except I was not oozing, it was squirting out with each heart beat unless I kept pressure on it.
Which is exactly why your nurse instructed you to hold pressure on your wound. Direct pressure is what you do in order to control bleeding. Direct pressure with a gauze pad is totally appropriate. If the patient is alert and oriented and there is no medical reason that they cannot hold pressure on their own wound, then it is reasonable to ask them to hold pressure on their own wound. A staff member is not going to sit at your bedside and hold pressure for you unless you are a demented little old lady who doesn't even know she's bleeding, or an unconscious head injury patient with a dangling flap of skin for a scalp.
Well, I believe that their are EDs that are that bad.
Also, I honestly believe your story involving your dtr (and I know that when I get a migraine, I can't take any PO meds or else I will throw them back up)....and this is more of a comment in general, not really a response to that situation...anyway, why is it that an ED must give IV narcotics or it did not do its job?
Oh, no we didn't mind it was a non-narc, that wasn't the point. Just pointing out that the second ER did all they thought they could do and did it quickly and non-judgementally, and that the new meds were given as a follow up. I always tell the ER for myself, I don't care what you give me as long as I stop hurting. If it works, I don't care if its a placebo-- just hand it over!!!
Did I miss something, or has the OP not posted since this direct question?
She hasn't been back. She had pictures, names, times of care, and a copy of the chart from medical records or at least she said she did. Trying to figure out why she posted left me puzzled. I narrowed it down to 3 of the most likely.
1) Was going to sue and wanted validation.
2) Was going to sue and wanted info about the ER only nurses could give. Which we all provided by telling her the parts of her story that were unbelievable.
3) Psych is not my thing, but if the first two are negative then that only leaves psych. Normal healthy people do not make up wild stories and post them on the internet for no reason. At least in my world they don't.
Specializes in Mental Health, Medical Research, Periop.
She hasn't been back. She had pictures, names, times of care, and a copy of the chart from medical records or at least she said she did. Trying to figure out why she posted left me puzzled. I narrowed it down to 3 of the most likely.
1) Was going to sue and wanted validation.
2) Was going to sue and wanted info about the ER only nurses could give. Which we all provided by telling her the parts of her story that were unbelievable.
3) Psych is not my thing, but if the first two are negative then that only leaves psych. Normal healthy people do not make up wild stories and post them on the internet for no reason. At least in my world they don't.
:up:OMG! You totally hit the nail on the head. I think this makes 100% sense. She is probably fixing every inch of her story now so she can sue the ER. I sure hope the defense finds this post and busts her bubble. She changed her story with every post when someone pointed out something did not make sense...... Hope this isnt the case. Check in a few months via AN Nursing News.
shoegalRN, RN
1,338 Posts
One change in the story:
A tech came in and took your BP and it was 85/40 (or something like that) from the 145/90 when you first arrived.
Then the husband took pics of the monitor the OP was connected to.
If a tech is coming in taking the BP with a Dinamap, why are you hooked up to a monitor? The monitor should be automatically taking your BP as often as it is set (example every 30 minutes).
There would be no need for a tech to come in to take your BP. The RN would be able to monitor your vital signs from the nursing station if you are indeed hooked up to a monitor.
And I find it hard to believe NOTHING was done for a BP that low.
Just my opinion, don't shot me.