I work in the operating room. Have previous ICU experience. Never floated to ER, so here's what I need to know:
Saturday afternoon a 24 yr. old male transported to ER by ambulance, involved in motorcycle crash (approx. 50mph), wearing helmet,no other riding gear. Patient flipped 6-8 times after having ridden motorcycle through sideways slide. No loss of consciousness. Spine stabilization in place. Alert and oriented x 3. NP evaluates patient, RN gives 10mg Morphine. X-rays are ordered (flat plate, no CT scan). Patient given another 10 mg Morphine (approx 30 min. later, before radiology visit and because of no pain relief). Patient comes back from radiology, still no pain relief, minus C Collar, radiology cleared spine.
ER MD comes in states no broken bones. Road rash 2nd and 3rd degree burns. Dress the wounds and will be allowed home. ER RN starts dry wiping debris from back (rocks, gravel, sand, dirt). Patient screams, begs her to stop, request made for additional pain medication. She stops, shrugs her shoulders and states she'll just have to apply the dressing over the wounds and patient will just have to clean it off when he takes a shower, the doctor didn't order any more medicine. (Wounds on both shoulders (most severe), full back, bilateral kidney areas around to sides (most severe). Both knees with less severe wounds, both arms, hands with scrapes, cuts. Left ankle sprained, no skin wound. Open wounds covered with tubes of Bacitrain ointment, adaptic sheets applied, wrapped in kerlex rolls. Discharged with Rx Tylenol IV, orders to see primary care physician in 2-3 days (patient has no primary care physician).
This patient is my son. I'm ashamed to say I was not an RN or advocate for him in the ER. I was just a mom, thankful her son was alive. My nursing knowledge was not a benefit for him or me at this time. :bluecry1::bluecry1:
Later Saturday night my nursing knowledge kind of kicked in enough to make me realize I needed to be monitoring him for internal injuries, etc.
Monday, unable to find a doctor to see my son, no one accepting new patients. My charge nurse at work contacts a surgeon who indicates he will see my son in his office the next morning (he is in operating room all this day).
Tuesday, the surgeon's first response was to take my son to O.R. to debride and clean out the wounds (I could not get it all out, pain too severe). (My son refused, not understanding that he would be put to sleep for this procedure, and I did not know that he didn't realize that. The doctor decided we would continue with wound treatment with Silvadene, abdominal pads and kerlex wrap, and appropriate pain medicine an hour before dressing changes. Concern with possibly needing skin grafts later. Come back in one week.
I am thankful to say the dressing changes have been going much better.
At least now I am not skinning my son with every dressing change.
I guess I am just venting, now that I feel my son will be getting better.
I am disappointed in my hospital's care delivered to my son. I feel that he should have been CT scanned, I feel he should have had a trip to the OR, I feel that he should have been admitted at least overnight, or transferred somewhere else, I feel that the dressing was inappropriate (no silvadene applied or prescribed, adaptic dressing stuck and pulled skin off when being removed), no dressing supplies were supplied or suggested where they could be purchased in bulk.
Do you all think this was appropriate standard of care? Am I just being an upset Mom? As a RN myself, I am horrified at how things were handled and ashamed of myself!
Fast exams have become a standard assesment tool during a work-up in our ER. And the MOI of speed, and becoming thrown from vehicle would make him a trauma ALERT!
We do not give oral contrast for abd/pelvic trauma CT's . Non-trauma yes, and sometimes rectal contrast....a ER favorite!! Any decent CT scanner can give enough of a clear image that they can see abnormal vs normal.
a CT wouldve taken all but 10 minutes just to make sure nothing is cooking. I know we do abuse radiology at times, but if this isnt a need for a cat scan then what is?
im really surprised that they were so lax with his treatment, i work in a level 2-3 and we see silly mva accidents where people come out without a scratch yet they dont even remove the collar until the cat scan is back.
While I do think he probably should have gotten a CT'ed from head to pelvis due to MOI, not every road rash wound needs to go to OR for debridement. Most do just fine with a scrub. Yeah they hurt like hell but I've been on both sides of this and when I was on the side of the pt is when I learned to wear my protective gear because it hurts to clean your road rash. I'm not excusing what happened, I'm just saying that maybe it was your typical roadrash and some lidocaine jelly before the scrub would have been sufficient. I find it hard to believe no MD or NP/PA examined you son, perhaps he had a mild CHI and doesn't remember.
Again, I'm not excusing poor treatment, just playing devils advocate and seeing things from more than one POV. I hope he recovers well and as a biker I hope he doesn't quit riding because of this experience. I also hope he will use this as a learning oppurtunity as I did and wear all his protective gear.
One of our radiologists refused to allow a CT from head to pelvis, saying it would involve too much radiation in one dose. Does anyone from a "CT it all" hospital have guidelines or limits on how much radiation their patients get?
I am going to have to say I agree there is no excuse for not CT scanning this person. I in the last 20 years have seen a lot. In the more recent era of CYA medicine we scan MVC victims with barely a scratch who have a c-collar in place.
I will admit though on any given day you have to take in to account which ED physicians are working, who your trauma doc's are and who are the radiologists. The various combinations change what you can and can't do not only with trauma, but with other types of pt's as well. One combo may get you a lot of CTS one day and barely any the next with a similar patient mix. It only frustrates us and makes giving good quality care difficult,
I do agree that we CT a lot, but he was in a motorcycle accident. He didnt go to the ER for abdominal pain (gas) or had a stiff neck.
Ive seen a doctor do a CT on this homeless lady that always comes in banged up with a ETOH of 400+ ..Know what? Turns out the time before last, she had a subdural bleed. Was rushed to the O.R.
If i was in a motorcycle accident, and I was clearly banged up I would totally understand the need for a CT (as much as im against it)
Hi, I am a week into recovering from road rash from a motorcycle accident that I was in (sportbike, 100 mph, sliding & rolling, mesh jacket w/jeans & high top sneakers). I suffered road rash on both knees, both elbows & right buttock...a few sprains here & there.
My ER medical treatment was nothing like the trwatment that your son received. They treated the wounds with lidocaine before they began cleaning them. Even then, the pain was so severe that they had to give me a pain medication that put me nearly to sleep-2 doses). After that, they proceeded to clean the wounds & applied NON-ADHERING dressing...gave me a RX for flexirol, an antibiotic and hydrocodeine for pain. Husband has been dressing my wounds using xenaderm (poss allergic reactions to silverdine) and using non-adhering dressings under 4x 4 and then using cling dressing to hold everything in place.
Thank God that you are a nurse and are giving him the best care. I was very fortunate that my mother-in-law is a RN as well, and she has been by my side during this entire situation...Stand by your son and continue to take good care of him. He really needs it, believe me...and pleeaase, no negative comments about motorcycles...that's the last thing he needs right now...it will dissolve his emotional strength that he needs to be able to heal. Good Luck!!
Specializes in Spinal Cord injuries, Emergency+EMS.
One of our radiologists refused to allow a CT from head to pelvis, saying it would involve too much radiation in one dose. Does anyone from a "CT it all" hospital have guidelines or limits on how much radiation their patients get?
have a look at the regime in the Uk under the ionising radiation (medicla exposures) regulations ... or the RCR purple book
IR(ME)R requires that the referrer be able to provide sufficient information why a modality and the associated dose of radiation's benefits outweigh the risks ...
also as others have stated plain films, Ultrasound and MR, good clinical examination skills ( and well validated assesment rules ...) all have their place rather than overreliance on the donut of death and the gratituous irradiation which succees in nothing more than lining the pockets of radiologists and radiographers ...
have a look at the regime in the Uk under the ionising radiation (medicla exposures) regulations ... or the RCR purple book
IR(ME)R requires that the referrer be able to provide sufficient information why a modality and the associated dose of radiation's benefits outweigh the risks ...
also as others have stated plain films, Ultrasound and MR, good clinical examination skills ( and well validated assesment rules ...) all have their place rather than overreliance on the donut of death and the gratituous irradiation which succees in nothing more than lining the pockets of radiologists and radiographers ...
:bluecry1:
The doctor decided we would continue with wound treatment with Silvadene, abdominal pads and kerlex wrap, and appropriate pain medicine an hour before dressing changes. Concern with possibly needing skin grafts later. Come back in one week. 
TraumaNurseRN
497 Posts
agree