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Favorite and least favorite diagnoses?

Emergency   (6,596 Views | 27 Replies)

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What are your favorite and least favorite diagnoses to work with?

My favorite is DKA. Not sure why, but I think it's because the s/s, pathophys, and treatment all dovetail so neatly together like a mathematical equation.

My least favorite is septic shock. Sitting on a hypotensive patient, prodding the ED doc to order adequate fluid resuscitation while wanting to avoid pressors if at all possible and waiting for the intensivist to come and take over is very anxiety provoking.

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I love asthma. It's one of the most common ones we see in a pediatric ER, and we have a nice, neat little protocol. They get steroids and a triple and are better and go home or get admitted on repeating treatments or continuous. Sometimes they get a chest x-ray, the really bad ones get IV steroids and maybe terb and maybe mag, but it's pretty straight forward and since we have the protocol it's much easier to encourage the residents to move along a little more quickly.

I hate sickle cell pain crises. Hate them. They are often very draining and challenging patients to deal with, it's a ton of narcs that have to be cosigned out and cosigned as administered, and they often have really, really crappy veins so are tough sticks. If we set up a PCA pump in the ER that is a pain to set up and deal with, and it's really ungratifying to keep giving pain meds and reassessing pain to hear "still 10/10, feel the same as when I came in." I get that they probably still have pain and we're probably undermedicating them but c'mon, can you give me a 9? 9.5? Occasionally they are pleasant and easy going and respond to pain medication, but in my limited experience that's such a rarity.

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psu_213 has 6 years experience as a BSN, RN and specializes in Emergency, Telemetry, Transplant.

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One of our ER docs says the 2 dxs. she loves are DKA and bowel impactions (pretty sure the latter is in jest). DKA is definitely a choice for being at the top. And, sickle cell is probably near the bottom the list--very poor access and tons of narcs.

Two other ones that are at the bottom on the list "fibromyalgia flare" and "chronic low back pain."

Then again, what are nurses doing make medical diagnoses? :p

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thelema13 has 3 years experience and specializes in ED.

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I will take trauma alerts, stroke alerts, AMI's, anything, anything but those morbidly obese, dry skin flaking off into the air, don't care about themselves non-compliant DM pts. DKA, HHNC, comatose DM pts are the worst. You run around, busting your a** saving their lives, then you walk into family members bringing in McDonalds or a milkshake. I got written up last week for taking a bag of Burger King and throwing it away on a pt with an insulin drip going. It seems the younger ones think its funny. The pt spoke to my supervisor! My charge backed me up, but my supervisor said I stepped over the line. I said I might as well DC the insulin and push his fat arse out the door.

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Perpetual Student has 4+ years experience and specializes in PACU.

682 Posts; 9,376 Profile Views

In terms of patients who come to us from the ED the best are appendicitis leading to a lap appy. They usually feel better after surgery, and are often young & healthy. Most do very well.

The absolute worst are butt pus patients. Especially when the source of their butt pus is their infected heroin injection site.

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fiveofpeep has 2 years experience and specializes in critical care, PACU.

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Dry skin flaking in the air?! Oh gross! Now I will think of you whenever I hold my breath while moving a patient because I'm worried about inhaling the flakes.

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VICEDRN has 5 years experience as a BSN, RN and specializes in ER.

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Most favorites are the simple turn arounds. What can I say? i have a short attention span. Asthma. DKA with fluid resuscitation. SVT that converts nicely. Don't mind a nice STEMI that goes back out quickly either. Or a sepsis so long as they get an ICU bed fast enough.

Can't stand: anything involving the word dialysis. You know you gonna be there forever sticking them! Patients with THAT list of allergies when you open the chart. (don't hate. y'all know who they are.) pts that spend a lot of time in the health system: cancer, sickle, etc. they always hate on you.

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thelema13 has 3 years experience and specializes in ED.

263 Posts; 9,314 Profile Views

pts that spend a lot of time in the health system: cancer, sickle, etc. they always hate on you.

Very true, don't blame us for your poor health.

Oh, I almost forgot fibromyalgia pts. I try not to turn off the sympathy button when I hear that medical hx. I simply do not believe it when they say that the dilaudid didn't work. At least tell me a 9, or 9.5. Pfft.

I also do not like GI bleeds, smell is horrible, and there is always that risk of the dreaded hypovolemic shock.

Edited by thelema13

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CrufflerJJ has 5 years experience as a RN and specializes in ICU.

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I also do not like GI bleeds

:yelclap:

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DixieRedHead has 20 years experience as a ASN, RN and specializes in ED/ICU/TELEMETRY/LTC.

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I love a heart attack and a stroke. I hate sick kids.

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FancypantsRN specializes in Cardiovascular, ER.

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I will take MI/CVA/sepsis if someone else will take the fibromyalgia/chronic pain/yet another migraine this week patients.

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3,408 Posts; 29,671 Profile Views

I like migraines. Line, bolus, toradol, reglan and they're often better and going home in a snap. I was so annoyed when one of my migraine patients a while ago decided to turn in to viral meningitis. I guess I hate neonates with a fever too even though that's a clear cut protocol. I just hate the million dollar workup, having to find someone to hold for a spinal tap, etc.Sickle cell pain is still my all time least favorite.

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