? for ER nurses

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Specializes in LTC.

If you were working triage and saw that the chief complaint for a 3 y.o. was "sternal retractions" AND you could hear the child wheezing 2 feet from the triage desk, would you just put his triage slip in the back of your stack and make him "wait his turn"?

Honest to God, this happened to me last night! I came home from work, looked at my 3y.o. on the couch and his entire chest wall was just sinking in with every breath. So, off we went to the ER. I signed him in and let the triage nurse finish w/the patient already in triage. She then proceeded to look at my triage slip and call the name on the top of her stack. I did speak up and tell her that she needed to assess my son now. She then looked at the lady's name who she had called as if she were asking for permission!

It's a good thing I was pushy, too. His O2 sat wouldn't come above 91 in triage and dropped to 86 while we were waiting on the RT to bring a Duoneb down.

It's not like we're a HUGE town, either. We're good sized; big enough to have 2 ER's and one urgent care clinic but not to the point where the ER is filled to capacity on a regular basis. There were only 4 or 5 people in the waiting room last night.

Anyway, thanks for listening to me vent.

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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.

Truthfully, because we weren't there it would be extremely unprofessional for any of us to make a comment regarding this nurses actions. I hope your son is okay.

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Specializes in LTC.

I understand that you were not there. I was just really offended that this nurse ranked breathing difficulties as the same priority as the woman there with the migraine. (I suffer migraines myself and understand the pain they cause.)

And, yes, my son is much better. The duoneb did its job and he was sent home with albuterol syrup. It ended up just being viral. CXR was negative, RSV sputum culture was negative. Labs were WNL.

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Specializes in ICU/ER.

ya i would be ticked too...children and breathing in my mind take precedence!!

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Specializes in Emergency.

When I'm triaging and something like this arises, I follow my A-B-C's.

Now, who knows what was going on exactly with everyone else waiting to be triaged; perhaps the pt having the "migraine" stated it was the "worst headache of my life" and was on a blood thinner.

However, there's been many times that I have looked at pts and brought them straight back to a room. I've had people come to triage wheezing and in obvious respiratory distress, and I don't bother to fill out their vitals - straight back to a a room they go (or hallway, if no beds are open); I'll page RT on the way to a room and once we get into a room I'll get a pulse ox and pulse. Now, if the pt is an adult and says they've been SOB for weeks, if they're speaking in full sentences, and eating McDonalds - we've then got a different scenario on our hands.

I'm glad your son received treatment and is better.

Triage can be a beast - pts lie/exaggerate about their condition, yell at you for bringing a little old lady with chest pain back to a room right away because "I've been here longer, and my toe hurts - I was next", or write vague complaints down (such as "sick", "pain", etc).

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Specializes in Emergency.

I agree with kmoonshine. Working in the ER, that is very similar to the scenarios we see. Patients will present a certain way and just by looking at them you can detect which ones need to be rushed back and those that can wait for a room. Kids are tricky as they can decompensate quickly. But keeping a vigil eye on them and monitoring their sats until they can be seen is key.

I am glad your son is feeling better.

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Specializes in ER.

Can I suggest that should something like that arise again, you call 911. They should be able to provide oxygen and breathing treatment enroute to the ER.

Not that, that excuses the way you were treated during your visit. Glad your son is okay now

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Specializes in LTC.
Can I suggest that should something like that arise again, you call 911. They should be able to provide oxygen and breathing treatment enroute to the ER.

Not that, that excuses the way you were treated during your visit. Glad your son is okay now

Normally, I would have called 911. However, the ER is literally just down the street from our hourse, like 2 minutes by car. It would have taken much longer for an ambulance to get to my house than to just take him.

Thank you for all your responses. I just really needed to vent about the whole thing.

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Specializes in ED, ICU, PACU.

From what you said, it sounds like the triage nurse may need some refresher training in pediatric emergencies.

I am glad your son is OK. May I suggest, if it ever happens again, that you write 'respiratory distress' as the chief complaint? The triage nurse may not have realized that a child exhibiting sternal retractions is suffering from respiratory distress-pediatrics is a whole different ballgame. Actually, I have tried to stay in adult ERs because I know that I lack the specialty pediatric knowledge. Having floated to the ped er a few times, I am in awe over the knowledge base a ped er nurse has. Mixed (ped with adult) er's just don't have that kind of specialization needed for the really sick ped patient & if the child is in bad shape, they will usually transport the patient (with the parent) out once stabilized.

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Specializes in LTC.
From what you said, it sounds like the triage nurse may need some refresher training in pediatric emergencies.

I am glad your son is OK. May I suggest, if it ever happens again, that you write 'respiratory distress' as the chief complaint? The triage nurse may not have realized that a child exhibiting sternal retractions is suffering from respiratory distress-pediatrics is a whole different ballgame. Actually, I have tried to stay in adult ERs because I know that I lack the specialty pediatric knowledge. Having floated to the ped er a few times, I am in awe over the knowledge base a ped er nurse has. Mixed (ped with adult) er's just don't have that kind of specialization needed for the really sick ped patient & if the child is in bad shape, they will usually transport the patient (with the parent) out once stabilized.

In hindsight, I know I should of written resp. distress. I had just came home from a 12 hour shift and was in "nurse mode" as opposed to "mom mode" and wrote the triage slip like I would have for the nurse's notes.

The hospital we went to sends out patient satisfaction surveys/questionnaires following ER visits and you can be sure that I will suggest they have a triage refresher course.

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Specializes in CAPA RN, ED RN.

I'm glad your son is ok too. But too true - "Help, my son can't breathe!" usually gets the attention of the triage nurse. One would hope that the triage nurse knows what "sternal retractions" means but things fall through the cracks sometimes. We have worked really hard to make sure our most experienced nurses are at triage so this sort of thing does not happen.

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Specializes in Cardiac/telemetry, ED.

Refer to the basics A B C's. However I do like the comment/exception to rule - older adult who has SOB for weeks munching Mc Donalds.

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