ER Treatment

GeriatricSunshine · Mar 12, 2006

Wow I am actually a little shocked at the above poster. I have had many a dentist and doctor tell me that tooth pain ranks up there with the most severe pain. I had a dental infection, I was not swollen yet BUT I was in pain. I ended up with osteomyletis and that can be life threatening.

I certainly hope I never end up in an ER with a nurse who has such moral problems for people in pain.

As well I do not think it is brilliant to NOT go to the ER with a wild animal bite, that can be deadly and cause infection in very short time.

rjflyn, ASN, RN · Mar 12, 2006

In my experence "dental emergencies" get triaged pretty low. More often that not they are fairly staight forward as far as ED goes. Pain meds, PCN and send them home with strong encouragement to see their dentist as soon as possible. I add that you are going to feel better in 2-3 days but dont let that fool you as you will be back here in this same state in 2 weeks- I have seen it. Also we generally have a list of dentists that care for patients on a sliding scale for those who claim lack of funds. Also most teaching hospitals that have a dental school have clinics for this kind of thing as well.

One final thought rarely do ones teeth get bad overnight. Its a process that takes time. Prevention is the best medicine.

Rj

GeriatricSunshine · Mar 12, 2006

All I am saying is that yes..it can crop up at 3AM. Believe me. When I had to get my last root canal I woke up with a mouth on fire I could not breathe without crying in pain, it was frightening and my jaw was 3X the size it normally was.

In Canada we have no charge (except for taxes) healthcare. If I am in that much pain at 3 AM I am not going to call my dentist especially if he does not have an on call number.I would go to the ER and I will wait my turn.Prevention is key BUT as my dentist explained these problems where the end result is root canal cannot be planned. They can happen very, very suddenly. I think pain is still the 5th vital sign if I am not mistaken.

I agree that people that go to ER should NEED the help and it most times should be a serious problem BUT I will be darned that I am going to wait until Monday or chase down a dentist when I can go to the ER.

BTW the time I was in they put me on IV antibiotics and saline and painkillers, I was admitted and they took out a piece of my jaw. I had great teeth before then.

wildcat81 · Mar 12, 2006

I'm glad you are getting better. Not all people who work in er treat a person like that. If they are so unempathetic, they don't deserve to work there. I'm also glad to see you've had a few good experiences as well. As you know, you can get good or bad service anywhere. It's just a shame people don't move to a different area if they don't like dealing with people directly.

JeanettePNP, MSN, RN, NP · Mar 12, 2006

The few who abuse the system ruin it for the rest who try to use the ER responsibly.

caroladybelle, BSN, RN · Mar 12, 2006

Wow I am actually a little shocked at the above poster. I have had many a dentist and doctor tell me that tooth pain ranks up there with the most severe pain. I had a dental infection, I was not swollen yet BUT I was in pain. I ended up with osteomyletis and that can be life threatening.
I certainly hope I never end up in an ER with a nurse who has such moral problems for people in pain.
As well I do not think it is brilliant to NOT go to the ER with a wild animal bite, that can be deadly and cause infection in very short time.

As I do not work in the ED, it would not be an issue.

Nor did make any moral comments. I would love to know, where in post that I made ANY moral judgements about pain.

I did note that the OP should have been treated politely. As all of us should.

But there were substantially better options for her as cited, than presenting to the ER. An ER/ED is for people who are immediately at risk. They are not good places for continuing/preventative care. Nor are they good for pain control. Their purpose is to prevent you from dying, losing a limb, or bleeding out.

Pain control/preventing infection is better handled by your MD or in this case, a dentist. And if s/he would not fit you in, you need to find a new one.

Please note that I also made an exception for cases where there is potential for pericarditis/joint infection. Those generally require time and involve more discomfort, and one would expect that the OP would have spent more time with her MD, who would still be able to handle the situation better than the ED.

Barring extenuating circumstances, the ED generally will do little for toothache, than give one or two doses of a pain med (if that - some just give motrin, an OTC) and tell you to call your MD/DDS in the morning. It has nothing to do with morality, or making judgements. It has to do with providing appropriate care and recognizing what the EDs priorities are.

And it would be useless, if you waited in an uncomfortable ED, for several hours, just to get a dose of an OTC/pain med, a brief checkover and sent home with a note to call your MD/DDS in the AM. Plus a bill for $100 - $300 just for going to the ED.

-------------------------------------------------------------------------------------------

As far as the animal bite. I cleaned it with warm water and hibiclens, bactracin and a dressing. I also took motrin.

What did the hospital do? Why, they cleaned it with saline, took the required pictures of the wounds and report (required by health department for bites), cleaned it with hibiclens, bacitracin and dressed it. They gave me a script for pain meds (that could not be filled, as no pharmacy in a three county radius carried the drug) and an oral ABX. And then gave me Gamma Globulin/Rabovax. They then sent me with 4 boxes of rabovax and the schedule to give myself the shots. As there was no 24 hour pharmacy, I filled the ABX in the AM. And took OTCs for the pain. Of course, it hurt, but if I had felt the need for something stronger, I would have gone to my MD - a much better source for monitoring infection issues/complications/and pain than an ED.

In the above, basically the ED did exactly what I could have/did easily done on my own, except for the gamma globulin/rabovax. I would have presented to my MD in the AM, and gotten the scripts, and they would have been filled just as quickly. And the GG/rabovax is provided free by the County. The difference was $10.00 charge by my MD, vs. several hundred dollars (I paid $100.00 due to insurance).

GeriatricSunshine · Mar 12, 2006

Regarding the animal bite..I would go to the ER I just would. In Canada the Humane Society mandate states that for all wild and unknown animal bites emergency medical care is required. I would be a very irresponsible person to tell someone not to go and to wait to see their MD. My doctor would kill me if I showed up on say, a Monday morning with this having been bit on the weekend. This can be a very serious situation.

You can clean the wound until the cows come home but you have no idea what kind of disease an animal may be carrying.To wait on it and put a topical antibiotic on it hoping for the best is not responsible.

I am saying this for people NOT in the medical profession. I would never look down on someone that came into the ER for an animal bite, dismissing it as a waste of time (I know you never said you would).I do agree about the continuity of care, which is sometimes a huge problem.The ER should not be used as a replacement for a family doctor.

caroladybelle, BSN, RN · Mar 12, 2006

The fact remains is that the only thing that the ER did was put the same topical ABX on, give the exact same treatment that I did/or my MD would have done and send me home with the same script that could not be filled, anymore timely than my own MD would have done in the AM.

I would not suggest that anyone (especially lay persons) wait several days for treatment -but there essentally was NO DIFFERENCE in what I did other than the GG/RV . I was started on ABX virtually within the same time frame as if I had seen the MD, the delay would have been no different. And the issue would have been less expensive (by several hundred dollars) with no loss in care. I also called to make sure the ED could handle the situation as it was not a immediate lifethreatening emergency.

As a matter of the interest, the ED tried to have me wait 7-10 days to start the RV/GG treatments....to see if we could find the animal. I explained to them that I really couldn't ID the exact animal, even if found. I had to argue to get them to initiate the GG/RV protocol...this despite the fact that there was an active rabies outbreak in the area. If I had not insisted, they would not have even started the rabies treatment, which would have necessitated another (several hundred dollar) visit.

But I am trying to make the point that we need to take control of many of these situations to get proper care. A quick phone call to the ED, can verify whether the situation merited their attention. A quick phone call to the ED could have also allowed them to redirect the OP to a facility that could have better and more efficiently handled the issue. As the OP obviously called her DDS to know that she had problems earlier in the day - as she noted that she could not be fitted in earlier than two weeks, she could have called her MD or explained that the pain was bad enough that she might have to present to the ED, could he refer her to the best one for her problem. All of which would have made her life much easier at a time when she was burdened with discomfort.

Altra, BSN, RN · Mar 12, 2006

I did note that the OP should have been treated politely. As all of us should.
But there were substantially better options for her as cited, than presenting to the ER. An ER/ED is for people who are immediately at risk. They are not good places for continuing/preventative care. Nor are they good for pain control. Their purpose is to prevent you from dying, losing a limb, or bleeding out.
Pain control/preventing infection is better handled by your MD or in this case, a dentist. And if s/he would not fit you in, you need to find a new one.

My sincere thanks to you , caroladybelle. :nurse:

fh15307 · Mar 12, 2006

In the ER where I worked, they had a dentist on call. On night a patient arrived via ambulance for their toothache. They had called 911 and the paramedics had responded.

It took a while, but a dentist was rounded up and the pt was treated. A few laughs, but no questions asked.

fotografe · Mar 12, 2006

If there is a dental school within 50 miles of you, it might be worth it to go there, btw. quote]
DON'T GO TO A DENTAL SCHOOL!! I am getting my first artificial body part courtesy the poor treatment I got at a dental school. It was a series of errors -- started with a graduate fellow who drilled improperly on a healthy tooth and got me a root canal. Then this same fellow was putting in a crown and placed a ridiculously large pin in that broke the root and then just sealed the crown on. This was approved by a faculty member! I have an absess the size of an almond in my jaw and am having the tooth removed this week by a real dentist. Then comes the long and expensive process of getting an implant. So DON'T GO TO A DENTAL SCHOOL!

miss_fit · Mar 13, 2006

Oh, my, foto. That sounds truly awful!

I'd just never heard a bad report in over a decade of practice, so assumed it was a wonderful and safe alternative for those who had the time. I guess it does depend a lot on the school, though.

I hope that instructor, at least, has had hell to pay for such unforgivable treatment of you.