ER Patients

I can feel you. I am in the obs unit of the ed tonight. The folks placed here with CP are upset that they have to stay the night. If you felt that you were sick enough to come to the ED, then aren't you sick enough to possibly stay? Makes sense to me. The ones I love are the patients that want to write their own orders.......this is why I am here and this is what I want for it......drives me crazy.

I get ticked at anyone who comes to the ER looking for help, but then refuse to follow our guidelines. "No, I don't want a prescription." "No, I don't want to stay."

I get frustrated enough to ask them, "If you're not going to even consider what we're saying, why did you bother to come in???"

Yep - Unfortunately, we deal with this on a daily basis. I once had some parents bring in their newborn for a chief complaint of fever. The fever was around 102 - 103 rectally. - Okay, so what is the first thing you do??? Yep, unbundle them - and then what??? Give tylenol - right? Parents refused and they seemed fairly well educated. They were saying that the fever should "run" it's course and that they have read online and elsewhere not to medicate babies, children et al. - Can you imagine what their answer was in regards to a LP??? Even when the doctor came in to examine the patient and explain things about fever, why & how it should be treated - shaking their heads in agreement with the physician - Later came out and angrily said they were not giving their child any tylenol, motrin and that we had better not tell the doctor!!!!

Yet -they brought this little one in for us to help them. How can we help them if they refuse to be helped?!?!?!?!?

i actually tell my patients ( if they are being narky): "if you thought you needed to come in, and truly think you are ill enough to come to ED, why would you then refuse treatment we reccommend, or want to go home? there are plenty of after hours GP's around."

my favourite patient was the one who demanded an ambulance to travel to the next suburb (where the ED is) because she has had 6 weeks of lady partsl thrush. she hangs around for 3 hours and says " im just wasting your time, and my time, i'm going to go home and try the cream the doctor gave me a week ago."

oh really?... ya think it might work?

I've been guilty.

I was hospitalized when I was about 18 for surgery and rolled my eyes and got huffy when they came in to take blood for the millionth time. I was also in a lot of pain, trying to sleep and a stupid teenager who didn't understand what was going on. I thought they should have just taken a gallon of blood to start out with and ran their tests without bothering me! Anyway, if it means anything, I feel bad about it now that I'm (hopefully) a little bit smarter. :imbar

I have a sad example. Years ago, during the night, we saw a beautiful year-old baby girl for vomiting. Thank God I charted the crap out of that visit. We sent her home with a script for erythro. Mom took the baby to the clinic the next day, hadn't gotten the script filled. In fact, she had it with her when she went to the clinic! The clinic doc told her to get the script filled. Baby came back that night to the ER with the same complaint. Was given the first dose of erythro and Mom was told once again to get it filled.

I found out later that the baby had died. Mom found her during the night, with vomit all over her face and not responding. Instead of calling the ambulance, she and grandpa jumped in the car and headed up the freeway to the next hospital, 50 miles away. Neither realized the baby was pulseless and not breathing. Autopsy showed aspiration. It looks like the baby must have had a febrile seizure and vomited, then aspirated. All because Mom didn't get the script filled. (Money was not an issue.)

Guess what? Mom blames the us for the death of her baby.

I love when the abdominal pain patients come in and then get all huffy when you tell them that no they can't have anything to eat or drink until after the CT scan, not even ice chips. And that is as long as every thing comes back ok. Then they THREATEN to leave AMA, like that is a threat, good go home then not a threat to me.

Or the patients that c/o abd pain and vomiting, then ask for a bagged lunch. I love telling them no.

But on pts that refuse tx, labs, iv's, etc... it drives me crazy. Don't come in. We have 20 more pts in the waiting room who WANT to be diagnosed and tx'd properly. Don't come in for your "quick fixes". Be compliant, follow up with your doctor or the health dept. If you threaten to leave because of the wait or whatever, I am not your mom and I will not keep you here against your will. Sign the form and go.

I understand. I hate it when parents drag their child out of bed in the middle of the night to bring them to the ER because they've had a fever for 3 days, and then they don't even give them tylenol before they came because they wanted the doctor to see how high their temp was. I just wish I could tell them how stupid they are. What makes a fever an emergency in the middle of the night, especially when it's been 3 days.

I say this to myself at least once every shift: "If it wasn't for stupid people, half of us would be unemployed."

Here's a funny one: A family brought in their pre-teen daughter after a copperhead bite and refused to allow us to treat her, saying that God would take care of it. Why didn't you just let God take care of it at home?

I have a sad example. Years ago, during the night, we saw a beautiful year-old baby girl for vomiting. Thank God I charted the crap out of that visit. We sent her home with a script for erythro. Mom took the baby to the clinic the next day, hadn't gotten the script filled. In fact, she had it with her when she went to the clinic! The clinic doc told her to get the script filled. Baby came back that night to the ER with the same complaint. Was given the first dose of erythro and Mom was told once again to get it filled.

I found out later that the baby had died. Mom found her during the night, with vomit all over her face and not responding. Instead of calling the ambulance, she and grandpa jumped in the car and headed up the freeway to the next hospital, 50 miles away. Neither realized the baby was pulseless and not breathing. Autopsy showed aspiration. It looks like the baby must have had a febrile seizure and vomited, then aspirated. All because Mom didn't get the script filled. (Money was not an issue.)

Guess what? Mom blames the us for the death of her baby.

I realize I don't know the whole story, but did they give the baby any IV ABTs? I'm wondering this, because it might have been pointless to give a vomiting baby PO meds- especially since E-mycin can irritate the stomach as it is.