My trip to the ER

I'm one of those people who would rather tough out just about anything at home, writhing in misery until it passes, then go to the ER. I once tried to ride out cholelithiasis - insisting it would pass ("Tis just a stomachache! I'll be fine.") before riding to the ER via EMS transport, hollering like I was having my leg sawed off 3 days later. Nurses Announcements Archive Article

Two days ago events occurred that this choice was taken off the table and I had no alternative but go, or risk dire consequences.

Let me back up a bit, and first explain I've cared for a couple of feral cat colonies for around 5 years, and my family helps out with the trap-neuter/spay-release (TNR), feeding and watering. Our neighborhood had been overrun by feral cats, but lately, our efforts have started to pay off and the breeding has decreased dramatically. That being said, they are still domestic animals of a sort but without a home, and require food, water, and shelter or they would die.

Some are obviously lost or abandoned and very used to human interaction, while others are wild and have never been touched by a human - ever.

All should be treated with extreme caution because they are not spoiled, pampered house pets, having more in common with their wild cousins running on the African plains than Fluffy the house cat. The only difference is having been domesticated in their lineage they have lost their innate ability to hunt enough to feed themselves, even if they weren't living in an urban area.

The other night a scuffle broke out behind me and I got bit in the ensuing chaos. Not my first cat bite, not by a long shot. Of course, it was my luck (or lack thereof) to have been inflicted by one I hadn't trapped and neutered, or got shots for yet. Lucky, lucky me.

I bet you didn't know the average domestic house cat has 7 rows of long, sharp, serrated teeth tipped in flesh-eating poison? Well ... perhaps that is a bit of a stretch - but it sure feels like it when one is biting you!

Cat bites are nasty business and should never be taken lightly. This is partly due to their unique teeth: their fangs are extremely long and wicked sharp. When a cat bites their canine teeth puncture the skin and inject bacteria from the cat's mouth and the environment deeply into tissue. Because their teeth have small diameters, the seemingly minor wounds heal rapidly. This is unfortunate, because this bacteria thrives in an anaerobic environment - such as when trapped in healed over bite wounds, and severe infections result.

The other reason is due to one organism in particular, a pretty potent and aggressive bacteria known as Pasteurella multocida (an aerobic to facultatively anaerobic gram negative coccobacillus bacterium). This bacteria is the frequent cause of infection after cat bite injuries. Symptoms usually are swelling and local infection around the wound, which left untreated will lead to a very painful abscess.

I knew I would be quite sick very soon, so rather than expend energy trying to trap the cat now (if I was lucky and actually caught the right one immediately) I opted for the rabies vaccine and immunoglobulin injection along with the inevitable antibiotics.

After calling the health department I soon discovered the ER is the only place that carries the rabies immunoglobulin. I had no choice but to go. Rats!

My childish ER aversion stems in part from bad past experiences, and also from not wanting to inappropriately utilize the services of the ER which is in the life saving business. If I could meet my needs anywhere else then that is where I would be going.

With trepidation, I trudged into the ER, sheepishly smiled at the front desk staff and apologetically told them what idiocy had brought me in that day. No one blinked an eye, and all were very nice and professional.

I want to add there was nobody else in the waiting room (which was unexpected). I spent a few minutes chit-chatting with the woman at the check-in desk about caring for cats on the family farm she grew up on, then I was brought right back.

I'll skip over the immunoglobulin injections, which were horrible and made me cry like a big baby (they have to injection into the wound, and all around it too - like an immunological solar system or something). The ER PA kept up a series of nonstop chatter about his son the whole time in an effort to distract me, which was sweet. Then the actual rabies shot (one of a total of four: day 0, 3, 7 & 14) in the shoulder with a large bore needle that could also double as a drinking straw.

I'm not sure why I lied about my pain level but I did. ER nurse: "How would you rate your pain?". Me: "Um ... a 1?". Everyone's eyebrows went up, but I got no challenges about it. Even still, the nurse brought me a ibuprofen 800 mg tab along with my first dose of Augmentin. Again that was pretty nice, since the area surrounding the bite already appeared to have cellulitis less than 12 hours later, and was hot, red and shiny - sort of like a mini sun blazing behind my knee, putting out enough heat to warm a small house.

In my short time there I was offered refreshment more than once, and spent time hanging out with some of the staff who had wandered in just to look at the bite and scratches - then debate amongst themselves on whether a set of scratches were, in fact, another set of bite marks, and with others who came in to carry out orders then sat and told me hair raising stories of their own. Although I brought my own entertainment (a battered, much loved kindle) I rarely used it.

All things considered, I was in and out as fast as someone needing the full rabies package could be - in just under 4 hours. The longest part was the wait while pharmacy mixed up the immunoglobulin as it is weight based (which is kind of funny, because they had a difficulty convincing me to get onto the scale to begin with). The staff were kind and friendly and overall treated me like an old friend instead of the imbecile that I am for turning my back while a catfight was brewing.

I can't honestly say I hope to go back any time soon (or ever) but two days ago all the stars aligned for an unexpectedly pleasant ER experience.

I also had to get rabies vaccines and antibiotics for a feral cat bite. There is ONE ER that does rabies vaccines out of the 12 hospitals in my area. And every shot had to be done through the ER.

All I can say is wait til you get that bill. Immunoglobulin is EXPENSIVE. My minivan, bought new, cost less than the total of this cat bite.

Specializes in ICU; Telephone Triage Nurse.
I hope you provided your praise directly to the hospital as well! :) It's always nice for the ER staff to hear positive feedback.

I had to return to the hospital's infusion center today for rabies shot #2 (they were just as awesome as the ER staff). When I checked in I got the director's name & contact info.

The ER staff will also be enjoying chocolate dipped strawberries later, my treat. I'm not a wonderful cook always, but I dip a mean chocolate strawberry!

Specializes in ICU; Telephone Triage Nurse.
I also had to get rabies vaccines and antibiotics for a feral cat bite. There is ONE ER that does rabies vaccines out of the 12 hospitals in my area. And every shot had to be done through the ER.

All I can say is wait til you get that bill. Immunoglobulin is EXPENSIVE. My minivan, bought new, cost less than the total of this cat bite.

Oh Geezus! Noooooooooooooooooooo!

Specializes in Oncology.

About a month before I started my job (and therefore had insurance coverage), we got a new dog. Said dog cornered one of our cats. Dog had slipped her collar, and I knew I shouldn't get in front of her because I didn't really know her and didn't want to get bit. Dumb move #1: I picked up the cat to remove him from the situation. He hooked his claws into me and held on for dear life. Didn't think much of it and took him to another room to set him free. Sounded logically at the time. Dumb move #2: I let him go. He attacked my head (missed my face) and got my hand a few times while I protected myself.

Dumb move #3: I knew my cat was current on vaccinations and it was late, so I opted to not seek treatment thinking I could keep it clean. Fast forward a couple of days and at 8pm on a holiday I notice that one bite on my hand is hot, swollen and I can't really move the joint. Off to the ED I go. Doc there only writes a script for antibiotics (doesn't even really look at it) and sends me on my way. Good news, antibiotics work. All in all, it cost me over $2,000 and would have only been about $150 if I had just gone to urgent care when it happened, or $0 if I just left the darn cat alone.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Loved the article and the ensuing thread. But I'm still waiting to hear if you liked your turkey sandwich. You did get one, right?

Specializes in ICU; Telephone Triage Nurse.
Loved the article and the ensuing thread. But I'm still waiting to hear if you liked your turkey sandwich. You did get one, right?

Turkey sandwich? Do you work in ER? Is this standard refreshment for ER goer's?

Damn! No, I didn't get one (I actually turned down all proffered tasty treats) but I'm sure theirs were deee-licious! Maybe next time? :cat:

Both the first and second times I was bitten by (confirmed) rabies positive kitties, I was SOOO glad I had been vaccinated. Only had to have boosters at the local hospital's infusion center (and PO abx). And even they were...not fun.

I had a bad bite (non rabid) once that I thought I had cleaned thoroughly...nurse Oranges thought she knew how to clean a deep puncture wound at home...?!?! Yeah, right.

A full week in the hospital on multiple IV abx and 2 surgical consults later I was finally ready to admit that NO cat bite should go untreated. EVER.

Pastuerella is nothing to screw around with. Glad you are ok!!

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Turkey sandwich? Do you work in ER? Is this standard refreshment for ER goer's?

Damn! No, I didn't get one (I actually turned down all proffered tasty treats) but I'm sure theirs were deee-licious! Maybe next time? :cat:

Yep, it usually comes with a Shasta or Ginger Ale, depending on your region. :D

Specializes in ICU; Telephone Triage Nurse.
Both the first and second times I was bitten by (confirmed) rabies positive kitties, I was SOOO glad I had been vaccinated. Only had to have boosters at the local hospital's infusion center (and PO abx). And even they were...not fun.

I had a bad bite (non rabid) once that I thought I had cleaned thoroughly...nurse Oranges thought she knew how to clean a deep puncture wound at home...?!?! Yeah, right.

A full week in the hospital on multiple IV abx and 2 surgical consults later I was finally ready to admit that NO cat bite should go untreated. EVER.

Pastuerella is nothing to screw around with. Glad you are ok!!

Okay, if you are admitting you thought you could clean it, then I will admit since it wasn't a deep bite (I've had deeper into my right wrist and the nerve in that spot - which feels like being hit by lightening) I actually harbored some hope it wasn't too bad - or that I even mistook nail punctures as a bite. I knew I was fooling myself that night though, the unmistakable slit in the skin is a dead give away for a fang puncture.

I was laying in bed the next morning thinking, "This isn't so bad" - then I bent my knee ... Ow, ow, ow, OWIE!!!

It's funny how sometimes we try to convince ourselves something isn't quite so bad (like when you are holding your amputated finger - just kidding!). :D

Ok, since we are being brutally honest 3 ring, let me take it one step further - I LET SOMEONE PUT PEROXIDE ON MY BITES.... I know, I know. I'm shaking my head in shame as I write. In my defense, it was many years ago, before they took peroxide out of the EDs, but, still. I should have known better. I was in "shock" (emotional shock) as I had been clawed on the face, neck, chest, arms, and bitten on the hands, BUT...that was no excuse to let them douse me with a substance that I KNEW delays healing, promotes scarring and promotes infection by killing healthy tissue.

I am not proud, and I wear the scars (even on my face) to this day. Never again.

Specializes in ICU; Telephone Triage Nurse.
Ok, since we are being brutally honest 3 ring, let me take it one step further - I LET SOMEONE PUT PEROXIDE ON MY BITES.... I know, I know. I'm shaking my head in shame as I write. In my defense, it was many years ago, before they took peroxide out of the EDs, but, still. I should have known better. I was in "shock" (emotional shock) as I had been clawed on the face, neck, chest, arms, and bitten on the hands, BUT...that was no excuse to let them douse me with a substance that I KNEW delays healing, promotes scarring and promotes infection by killing healthy tissue.

I am not proud, and I wear the scars (even on my face) to this day. Never again.

You are not the only one my dear A&O. I have done some truly spectacularly duffus things myself (case in point, letting down my guard near feral cats who were in the process of getting a mad-on).

Once in my very early 20's when Retin-A first came out on the market I used my mother's Rx on a pimple. It was extremely high dose, and Rx'd for her wrinkles (she was in her early 50's then - by the way, she didn't have any wrinkles!). Anyway, it's supposed to be used judiciously in very small amounts, and on a completely dry face.

Well, not only did I disregard the dry face part, but I used a HUGE amount over a series of days because it wasn't vanishing as fast as I thought it should (my thoughts then were if a little is good, then a whole lot is even better!).

It ended up eating a hole in my face! I no longer had a pimple to worry about, as now I had an actual wound 3x's the size of the original pimple. It was like a small crater actually.

It scabbed over and took a few months to completely heal (plus, my mom was furious I used half the tube of her expensive Rx Retin-A). She forbid me from ever touching it again - which was fine by me because it caused me great damage, and I still bear the faint pitting scar to the right of my chin to this day.

On a side note, my PCP wanted to Rx Retin-A cream to me recently for a lesion near my eyebrow. A parade of images flashed through my mind's eye and I freaked - I ended up opting for liquid nitrogen treatment at the dermatologist's office instead (who is making a mint off of me lately due to numerous superficial skin CA's inflicted from dumb decisions involving sunbathing, also in my early 20's).

I'm pretty secure in saying I think we have all caused ourselves more harm than good at least once trying to treat something.

Oh Geezus! Noooooooooooooooooooo!

Haha, also, I feel totally ripped off as I received nary a sandwich nor drink of water in more than 30 hours of ER time getting these shots.