ED given a bad rap

Published

ENA posted this on an online social networking site: Hospital's ER sign a farce

This article quite upset me, and I'm planning a response to the writer. Ironically, I had meeting on EMTALA at work today. It reminded me why proper triage is so incredibly important to ensure those proper medical screenings. Also reminded me, not surprisingly, why dental pain (unless airway obstruction is of concern) is triaged so low.

Thoughts?

why don't ER docs give a shot of Novocain or lidaine? It gives immediate short-term relief and no pills involved. I have seen ER pts who over-dosed on Tylenol trying to get pain relief from a tooth ache.

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Specializes in ER, Trauma.

You could inspire the patient to not get their antibiotics filled, or followup as instructed to save $ now that they're comfortable. They come back 2 days later much worse.

I've seen marcaine given, but the patients are carefully chosen.

Had a patient I was discharging get mad because the doc only gave her 6 vicodin. She explained that 3 months ago she was in for the same tooth and they gave her 10 vicodin! Grrrrrr!!

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Dentists need to address weekend tooth aches. It's their specialty and why should they always get weekends off?

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Specializes in ED/trauma.
I also had to go to the ER for an abscessed tooth. Being an RN I know the bad feelings ER staff have for people with tooth complaints. Drug seekers frequently present to the ER with similar complaints. On Saturday afternoon after calling every dentist in the phone book, I broke down and went to the ER. I didn't have to wait 5 hours, but I was treated with disdain by everyone I came in contact with. I deliberately refused pain meds. I repeatedly said, "I just need some antibiotics." Not one person believed my story, even though my face was obviously swollen. I'm a nurse, and I was shocked at the way I was treated.

If my face had not been swollen the bad treatment may have been understandable.

If I had demanded pain meds, and been specific about my drug of choice, the bad treatment may have been understandable.

I have a mouth full of crowns, bridges, fillings. I obviously go for routine dental exams. And yet I was treated like a scummy drug addict.

My complaint is not that I was seen last. Or even that I was made to wait. I expected that. I just never expected to be treated with that level of disrespect from a fellow nurse.

Agreed. My ED deals with a population that routinely does not get preventive care - including dental issues. I'm not grouping you into this category, simply saying that you should have been given something. We routinely give abx - at least a Rx, IM if it's bad enough + a Rx. I had one pt yesterday AM who developed a golf ball on his face in 1 day. Gave him IV abx. You deserved AT LEAST a Rx!

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Specializes in ED/trauma.
What I took away from that article was that the author really didn't have a clue why the other people were there, which is as it should be ... HIPPA HIPPA hooray. Ha ha. If I got upset over every single complaint/article about nonemergent patients made to wait, I'd never smile again. He's also no so bright for insinuating that somehow, ERs earn more money if we keep patients in the ER longer ("overnight admission$"). Ummmm ... quite the opposite. Why else would ERs be trying to reduce door-to-discharge times? I know! So we can free up beds to see more patients. Durrrr. :D

Good call. I'm newer to ER (than nursing overall), and I've yet to read an article this insulting. My hope was to knock *some* sense into that fool. That said, yes... HIPPA hooray :yeah:

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Specializes in ED/trauma.
I don't know how many times someone has walked to me at triage and said "I've been waiting for 2 hours now,.and I've seen people go back who are no sicker than I am." Really? and just how do you know that? This statement always infuriates me.

That's when I want to say "Well, remember that sweet little lady with the red dress? She kept her scheduled appointment with her doc today and they just called to say her INR is 6.2. Do you know what can happen to a person with an INR that high? No, I didn't think so. And that sweet little blonde baby that came in,..her temp was 105.4, she was moving no air in her right lung and her room air O2 sat was 68%. That big burly guy in the blue jeans,..his heart rate was in the 250's. That guy in the suit and tie,..he was at meeting at work when he suddenly couldn't move his R arm and his speech became slurred. Do you know the cut off time to safely give the drugs that can restore his neurological function? No,.I didn't think so. That's why I'm behind the triage desk and you are sitting in the waiting room!"

I'm in no way familiar with the ER in the article,.but at my hospital the ambulance bay is in the back,.past four sets of double doors and there is no way you can see what's coming in from the waiting room. I will never understand why people think we leave them in the waiting roomer longer than we have to. Do they think we get some pleasure or benifit from leaving people just sitting out there? We will often place our dental pain, earache, spider bites, in our "eye" room. This room doesn't have a place to lay down,.just a chair. It's fine for the real simple pts but not appropiate for a full exam. Patients often get upset when they see the toothache go back before them, then I explain about the room situation,..they assure me that they would be happy sitting in a chair if they could just be seen,...I have to explain that the doc can't assess a belly pain in a chair,.............etc,.etc,...it's a no win situation. I just wish people would believe us when we say we are doing the best we can and we really are trying to get the sickest people back first!

This is just one more article from someone who really doesn't have a clue what goes on day in and day out in the ER.

I was planning an elaborate response to the article's author, chock full 'o sarcasm. I like all of what you said though :yeah:

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Specializes in ED/trauma.
RN Cardiac, you've said it quite eloquently. Maybe we've worked the same ER's. Has anybody ever had the top of his head blown off at your ER entrance? If not, we've worked different but very similar places.

ER nurses have trouble not being judgemental. We want to get the beds empty and give great care, but we get the anger of people who are healthy enough to complain, while others will sit there quietly and die. The hardest part of the job is to forgive the patients.

Drug seekers, people wanting prescriptions for OTC meds, people trying to get ongoing care when they actually need a primary doc, and a million others that are inappropriate for the ER, still need our care in some way. They are still displaying needs not being met otherwise. They are part of the job.

When I start getting mad about it all, I just start keeping a mental list of in what order I'm going to shoot patients and staff when I finally flip and give them all the high velocity hot lead enema, and retroactive abortions. It helps me to refocus and reduces my stress.

I'd like to give those in Rx form :yeah:

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
why don't ER docs give a shot of Novocain or lidaine? It gives immediate short-term relief and no pills involved. I have seen ER pts who over-dosed on Tylenol trying to get pain relief from a tooth ache.

It might be because knowing where to inject the lidocaine in the patient's mouth to block specific nerve pathways isn't something most MDs know how to do, but I agree there should be on call coverage for dental emergencies!! On a related note, since dental coverage isn't something routinely paid for my Medicaid in my state, systemic problems related to untreated dental problems do often end up arriving to the ER and costing thousands of dollars and ensuing pain to the patient. It's just a bad system in that regard.

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Specializes in Med/Surge, Psych, LTC, Home Health.

I can only relate to the poor guy that the author was writing about... I went to the ER one Sunday after not being able to get a hold of my dentist, or any dentist for that matter... the left side of my face was swollen to twice its normal size and I was in ten kinds of pain. I was in the *process* of having a root canal done in one of my bottom left teeth and that tooth/area became infected.

I just wanted some kind of relief, that's all. =) I can't remember what they did for me... I think they gave me some sort of topical anesthetic to dull the pain for awhile, but I think that's it.

I do wonder if it is some sort of insurance issue; that hospitals don't get reimbursed for providing dental care? I don't know.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Our providers typically offer dental blocks to the dental pain patients; generally speaking, the offer is accepted about 50% of the time.

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Specializes in Med Surg/Tele/ER.
why don't ER docs give a shot of Novocain or lidaine? It gives immediate short-term relief and no pills involved. I have seen ER pts who over-dosed on Tylenol trying to get pain relief from a tooth ache.

We have one doc that does!! The real dental pain pts appreciate it.....the drug seekers :eek:. Toothaches usually don't just happen out of the blue. Most of the time you will have warning signs over a peroid of time that something is wrong. :idea: Take care of it then and you won't be sitting in the ER waiting...............

I just love it when you hear "I cant go to the dentist yet....I am waiting on my medical card, or I don't have insurance, and I can't afford to go to the dentist". How much do you think an ER visit cost??? oh wait you don't care do you???? because your not paying anyway!!! :devil:

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Specializes in ER, Trauma.

After many years in the ER I could write a book on the complicated interaction between the patients, medical resources outside the ER, and the medical care reimbursement system which is always penny wise and pound foolish. I've had to limit myself to thi board with a paragraph or 2. It amazes and delights me as others post insightful remarks about so many of the things I'd write, like dentists not being on call (in my area dentists offices are only open 4 days/week). You are all so right on that you're expressing my frustration for me. Thank you, thank you, thank you.

NOW, if we could only get "retroactive abortion" accepted as a nursing order.........

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