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!
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!!
what the h*** were you going 100mph for? risk-takers build an innate fustration for the ed, post care and insurance rates we all pay for(well the ones with insurance that is). 100mph for what?????? ignorant if you ask me. i was a respiratory therapist for 14 years prior to going into er nursing and i have to say, ignorance is rampant with motorcyclists...and what's this please no negative comments??? were you even bothering to wear a helmet....i didn't notice that in your post? do you think er/icu/emds/trauma surgeons/home health/ physical therapists/ect. enjoy taking care of the ignorant, or trauma surgeons having to repair, save lives when half of these people do not have health insurance?????? do you think tax-payers like paying higher premiums for ignorance? 100mph.....for goodness sake...you are lucky you are alive!!!! i say.....cry baby cry on his emotional strength that he needs to be able to heal....he needs to learn the risks of getting on the "mobile 2-wheeler casket".....or better yet....be suctioned via trach for the rest of his life should he become paralyzed and live. but, i bet you get back on your bike, go 100mph again and think nothing of the current technology that will keep you alive should you be ignorant and drive 100mph again and have a tbi/paralyzed, and actually live to be cared for for decades and healthcare costs continue to go up..... slow down!!!!!!:banghead::banghead::banghead: tired of paying and caring for ignorance. thankfully, i can vent about it here.
what the h*** were you going 100mph for? risk-takers build an innate fustration for the ed, post care and insurance rates we all pay for(well the ones with insurance that is). 100mph for what?????? ignorant if you ask me. i was a respiratory therapist for 14 years prior to going into er nursing and i have to say, ignorance is rampant with motorcyclists...and what's this please no negative comments??? were you even bothering to wear a helmet....i didn't notice that in your post? do you think er/icu/emds/trauma surgeons/home health/ physical therapists/ect. enjoy taking care of the ignorant, or trauma surgeons having to repair, save lives when half of these people do not have health insurance?????? do you think tax-payers like paying higher premiums for ignorance? 100mph.....for goodness sake...you are lucky you are alive!!!! i say.....cry baby cry on his emotional strength that he needs to be able to heal....he needs to learn the risks of getting on the "mobile 2-wheeler casket".....or better yet....be suctioned via trach for the rest of his life should he become paralyzed and live. but, i bet you get back on your bike, go 100mph again and think nothing of the current technology that will keep you alive should you be ignorant and drive 100mph again and have a tbi/paralyzed, and actually live to be cared for for decades and healthcare costs continue to go up..... slow down!!!!!!:banghead::banghead::banghead: tired of paying and caring for ignorance. thankfully, i can vent about it here.
i think the 100 mph may have a bit of artistic (motorcycle ) license especially if wearing jeans, i always understood without correct protection you get from denum to bone in less than 10 seconds at 30 mph so i think a mild case of road rash indicates there is a little embelleshment going on.
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!
Openheart Mary, I'm sorry you had to go through this. It is awful there was no professional courtesy provided to you (you do work there, right?) and a little extra TLC. I don't know if your son was stripped head to toe and evaluated, except by you, since you had a detailed account of his injuries. The dirt and debris (on his back, torso) should have been debrided by the MD, PA, NP, whomever was his primary in the ED (not the ED nurse). He should have gone home with Telfa, or some other form of nonstick gauze, as well as some extra Neosporin and supplies until he could be seen by the f/u doc. I would have provided to the guy enough supplies for about 3-4 days (though you can't wipe out your own supplies in your ER). I would provide info on Walmart or CVS for some other nonstick dressings. Of course, I always instruct on s/s of infection and to return if there is doubt, concern, any worsening of symptoms or no improvement. Always stress to return, or call if in doubt.
I do find it hard to believe that the ED MD didn't debride the wound or have a surgeon to come in (if there was capability for a consult, or for a vascular doc). That's the difficult part of that story - did the nurse not realize how dirty the wounds were? If the Morphine 10 mg at a time was not effective, esp. after the second dose, then the doc (and nurse) should've thought that maybe he needed something stronger and taken another look at the injuries for a cause. That is what I would have done - re-evaluate.
I'm not sure when this was posted, so hope this isn't a moot point, but the issue would be with infection and good follow up care at this point. It appears that there was some oversight by the ER staff.... sorry for you and your son.
Yeah its not too late for a CT but why. The purpose would be to rule out serious internal injury, of which its Wed now and the injury occurred on Sat. More than likely he would have shown outward signs of it by now, so only spending needless $$.
Definitely second rate care. What social worker, some ER's may not have one, as far as referrals its common to refer pts to their PCP. Also some facilities may not have referral services either.
Now from the sounds of it this pt should have never even been transported to the facility he ended up at. He as a trauma pt and should have went to a trauma center. You need to be talking with EMS as well. Sounds like they were over their head and just were winging it.
Rj
Some cities have protocols where EMS takes an injured person to the closest ER and it is their responsibility (the ER physician) to decide if that person has injuries that warrant transfer for a higher level of care. It sounds as though this patient was where he needed to be (perfectly appropriate) - I worked at a smaller ER and everyone came to us and we sent out what needed to and kept those that could be managed.
CT's way after the fact for internal injuries are useless - and if there was no indication during the physician's assessment after the injury that warranted a CT, then they did the right thing by not ordering one. I'm sure a CXR was done, as were all of the trauma series xrays. Sounds like protocol to me. Did he complain of abdominal pain? If so, maybe a bedside u/s was done?
Also when discharged from an ER there are on-call physicians for follow ups and they are obligated to see an ER patient for follow up. If there is an issue on the follow up doctors end saying they're not accepting new patients, clarify to them he is not a new patient, but an ER referral for follow up (they are obligated to see the patient since that is part of a contract for taking call). If there is issue with that, call the ER physician director to complain - you'll get a referral quickly.
Thank you all for your input. My son's wounds look like they are getting better. He is still in severe pain, but now is manifesting other s/s.
Our hospital is not designated a trauma center as you all have figured out. However, they do have an emergency department and accept patients.Appropriate emergency care should have, but was not, provided. I'll deal with those things after we are on the upswing in recovery.
This town has two hospitals. I intend to take him to the other ED this morning to be examined by a doctor. I am not convinced there isn't something else going on. Severe pain in left kidney area, extreme bruising, mild swelling. I now do not believe he was even given a physical exam by the doctor in ED. (I was not with him the whole time, they had to have their paperwork, you know). X-rays included flat plate of cervical, thoracic, lumbar and sacral spine, abdomen. My son does not remember being examined.
he was also medicated... and you wrote yourself that you were not there the whole time (just being devil's advocate...)
Glad you're getting him checked out - bruised Kidney, bladder issues are my first thought.... maybe a CT now.
I want to thank you all for your insight and encouragement. I still beat myself up over this, but I hope and pray should I ever be in this type of situation again I will remember, and be able to fight for what I feel in my gut is right.
To update you, my son has recovered. He has a lot of scarring and some embedded gravel that may or may not eventually work out. We are so thankful he is alive. By the way, he was wearing his helmet, and is most definitely very verbal to everyone about the need to always wear a helmet.
I'm a pretty new ER nurse but I know protocol would be to check for internal injuries. Performing bedside ultrasound then off to CT would have been a must for a fifty mile an hour crash on a bike....period. Those wounds on his back could have become infected....we spend precious time cleaning all wounds out....and we're a level one, pretty dang busy. Good Luck to you.....
: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. 
:banghead:
TraumaNurseRN
497 Posts
what the h*** were you going 100mph for? risk-takers build an innate fustration for the ed, post care and insurance rates we all pay for(well the ones with insurance that is). 100mph for what?????? ignorant if you ask me. i was a respiratory therapist for 14 years prior to going into er nursing and i have to say, ignorance is rampant with motorcyclists...and what's this please no negative comments??? were you even bothering to wear a helmet....i didn't notice that in your post? do you think er/icu/emds/trauma surgeons/home health/ physical therapists/ect. enjoy taking care of the ignorant, or trauma surgeons having to repair, save lives when half of these people do not have health insurance?????? do you think tax-payers like paying higher premiums for ignorance? 100mph.....for goodness sake...you are lucky you are alive!!!! i say.....cry baby cry on his emotional strength that he needs to be able to heal....he needs to learn the risks of getting on the "mobile 2-wheeler casket".....or better yet....be suctioned via trach for the rest of his life should he become paralyzed and live. but, i bet you get back on your bike, go 100mph again and think nothing of the current technology that will keep you alive should you be ignorant and drive 100mph again and have a tbi/paralyzed, and actually live to be cared for for decades and healthcare costs continue to go up..... slow down!!!!!!
:banghead:
:banghead:
:banghead:
tired of paying and caring for ignorance. thankfully, i can vent about it here.