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.

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 think I need better glasses - I'm embarrassed to admit I thought your avatar picture was the Flying Dutchman from Spongebob Squarepants for months:

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I feel for you. My 4 year old tried to pet a raccoon yesterday. Almost was successful as it was trapped.

I totally can imagine your pain! Thanks for the story!

Specializes in ICU; Telephone Triage Nurse.
I feel for you. My 4 year old tried to pet a raccoon yesterday. Almost was successful as it was trapped.

I totally can imagine your pain! Thanks for the story!

I had a TB skin test at a Walgreen's Minute Clinic one year when I didn't want to drive in my employer's administrative office which was about a 45 minute drive away (I work from home). The NP administering the skin test told me a story:

A few years ago she went home for lunch, and pulled into her garage of which she had left the roll up door open. In the corner sat a manky looking squirrel with a sporificely furred tail, like a bottle brush.

After getting out of her car she grabbed a broom from a corner and prepared to evict the interloper, striding confidently to where it sat watching her suspiciously with it's little twitchy eyes.

Apparently she thought she would chase it out of her homestead then go relax and grab a quick bite. Little did she know (that is sort if what happened) ...

When she was within 15 feet away from the squirrel it attacked - launching itself in an amazing arch it flew right onto her face, landing on her upper chest area, clinging to her uniform jacket. It also gave her a good bite in the right cheek, tangling in her hair in the process.

She dropped the broom, running in circles and blundering into stacks of items which went crashing to the floor in the mêlée, screaming like a banshee all the while.

The squirrel held on for the ride, chittering angrily.

She said she finally slipped in some liquid on the floor, dislodging the squirrel. It ran under a pile of downed boxes still chittering in triumph (apparently it had claimed her garage as it's territory and had been denning there).

Much the worse for wear, she got back into her car and shakily drove herself to the ER for the full rabies package and wound care for her face. She never made it back to work that afternoon - or the rest of the week.

She also had to call a wild life removal service for the territorial squirrel to finally rid herself of it, as it had moved in and claimed the garage as it's lair - spraying it thoroughly with urine.

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Specializes in Psych (25 years), Medical (15 years).
When she was within 15 feet away from the squirrel it attacked - launching itself in an amazing arch it flew right onto her face, landing on her upper chest area, clinging to her uniform jacket. It also gave her a good bite in the right cheek, tangling in her hair in the process

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Specializes in ICU; Telephone Triage Nurse.
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"Stupid Human! I will spray you in the face - and your garage too!".

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.

Squirrels don't carry rabies. Seriously.

Specializes in Psych, Corrections, Med-Surg, Ambulatory.
Squirrels don't carry rabies. Seriously.

Squirrels rarely carry rabies. If you want to take the chance that this wasn't the first squirrel case in a while, you're probably safe. But since untreated rabies is 100% fatal (or close enough), I think I'd just spring for the rabies package. That's just me.

I laughed so that at that! My daughter actually calls raccoons squirrels”... I'm not sure why....

Specializes in ICU; Telephone Triage Nurse.
Squirrels don't carry rabies. Seriously.

Yeah, I was bit by a cat ... but after giving the squirrel bite story some consideration - and as Triciaj (and also a nurse friend of mine) pointed out, rabies untreated is 100% fatal - I think I too would just knuckle under and spring for the full rabies package (including scrumptious complementary turkey sandwich and ginger ale) just to be on the extra safe side.

Not everyone will agree with this, but I can't say that I find fault with the NP for her decision on that day given the circumstances (and I feel a tiny bit bad too privately thinking I'm glad it wasn't me for once, because all the weird crap seems to happen to me more often than not. I'm just relieved Fate gave me pass for once).

Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Squirrels rarely carry rabies. If you want to take the chance that this wasn't the first squirrel case in a while, you're probably safe. But since untreated rabies is 100% fatal (or close enough), I think I'd just spring for the rabies package. That's just me.

First squirrel case ever, not just in a while. :) There have been none in the US according to the CDC. I had an ED physician coworker who used to get on his soapbox about this! Those woodchucks, however! Lol. They are bad. I had a patient bitten by a squirrel, and the health department refused to treat her based on low risk. She came to the ER and requested treatment. As was our protocol, we called the health department, and they advised against it. She got it anyway, but it was probably more necessary for peace of mind than any real risk. It's a good thing my anti-squirrel-rabies friend wasn't there, he might have not given her the RIG and RabAvert combo!

I also take care of feral cats (anything too wild to be placed in a home by our local rescue agency)in my horse barn. I was bitten by one of my house cats (who was feeling very macho one day) and so I got to forego the rabies treatment but still got a raging cellulitis. The only thing worse is a human bite (more bacteria.)

Specializes in ICU; Telephone Triage Nurse.
I also take care of feral cats (anything too wild to be placed in a home by our local rescue agency)in my horse barn. I was bitten by one of my house cats (who was feeling very macho one day) and so I got to forego the rabies treatment but still got a raging cellulitis. The only thing worse is a human bite (more bacteria.)

Ouch! I'm sorry.

Like this? (It came out so big, but I can't remove it)