triage patients

Specialties Ob/Gyn

Published

Iam always amazed at the reasons some of our patients come in to get evaluated in the middle of the night. We had a patient show up at 2 o'clock in the morning, 35 wks with flu like symptoms to be evaluated. Why would you get yourself (and significant other) up at 2 in the morning to come to Labor and Delivery for the flu? Or they come in at two in the morning with abd. pain for 5 days that is no worse than it was when she went to sleep.

So has any one else encountered this with their patients?

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Good for you Tricia, you are a voice of reason. Too bad, all ER's are not like yours.

Up Vote Up Vote ×

All Right. I thought I had heard it all. Last night I had a term patient come in for eval. Start asking her why she was there. No contractions, no leaking fluid, no bleeding. Luckily her friend with her spoke English. So her reason for coming in: She was on the freeway and had a flat tire. No abdomen trauma, no problems. Just wanted to make sure everything was alright. Baby looked beautiful on the monitor. I had to do everything I could to not laugh right there.

So the midwife went in and talked to here. I guess in the Hispanic culture if they get a scare a "sustos" when they are pregnant that it could affect their unborn child. Learn something new everyday.

Well I thought that was the end of the "sustos" for the night. Two hours later a 28 weeker came in for lower abd. pain, headache and weakness. No contractions. Anyway the midwife comes in a starts talking with her and she had a "sustos" earlier when her son was in an auto accident.

Anyway, i now have a better apprieciation of my hispanic clients.

Up Vote Up Vote ×

Hi all, I have lurked here for a while but this is my first post. I must say this topic is why my last baby was born unassisted in the front seat of my van. I was sent home from the hospital at 4 cm dilated. My contractions weren't "good enough" I was too afraid to go back to the hospital because I thought I would be laughed at. The nurse who sent me home wasn't laughing so hard when she came to visit me the next morning.

Kat

Edited to add: I felt really sorry for the nurse. I think she thought I was really mad at her (I wasn't) I actually thought the whole thing was great! It was frustrating to not be taken seriously though.

Up Vote Up Vote ×

I recently read an article on post partum depression. It said that many of the women who come to L&D repeatedly for various ailments as those mentioned, may be suffering from intrapartum depression. And that those with severe PP depression, had also come in as "frequent flyers" during their pregnancies. It also states this is a red flag for OB's to follow up on.

--Something to think about! Your patient may be asking for help!

Up Vote Up Vote ×
Specializes in OB.

Had one recently who showed up at 3 a.m. for HEMORRHOIDS!

Up Vote Up Vote ×

Had one from the local jail a little while ago. She came in by ambulance moaning and groaning that she was going to have the baby right then. The officer who brought her in was white as a sheet, thinking that he was going to have to deliver this baby on the way. :chuckle Anyway, she comes in doubled over "with pain.". I put her on the monitor, no leaking of fluid or bleeding, but of course there were "contractions" every minute. Palpated contractions. Pt was making her stomach tighten and loosen. Talked with her and kept her occupied for 20 min and no contractions. Doc discharged her back to jail. She made an appearance by ambulance everyday for the next week.LOL It took her jailers that long to figure out what she was doing. She delivered at another hospital, one week past her due date.:rotfl:

Up Vote Up Vote ×

Yep. Gotta love those inmates. :rolleyes: I just want to say to them, 'Thank you for wasting my tax dollars even MORE for your free ambulance ride here. I guess you figured that seeing as I'm already paying for all of your medical care, your child's medical care, your food, your clothing, AND your housing, WHAT'S ONE MORE THING?'

Up Vote Up Vote ×

another nurse told me this a few days ago. caution..ty your bladder first folks!

pt. arrived to the er, 30 weeks pregnant. no discomfort. stated she knew she was in labour. what makes you think so? asked the staff. because... "my farts smell just like my dog's did before she had her puppies!" sorry this is rather crude, but i couldn't stop laughing. maybe she should stop eating that alpo. last week my pt's mom told me" they didn't have prodromal labour back when she was havin' babies." my how we've evolved as a species in just a few years!

Up Vote Up Vote ×
Specializes in OB, Post Partum, Home Health.

Does this sound familliar? 33-34 weeks, comes in for "labor", no uc's seen or palpated, cervix thick and closed on two exams 2 hours apart. You tell her that she is not in labor, cervix not changing etc, tell her she can go home and she tells you "well my cervix never dilates until they put me on pit and break my water". I used to act like this was a valid concern but i am sick of it so now i just say "well good, then you wont have a premature baby because we won't do that until you are due."

I had a pt recently that came in at 2330 on saturday night because a few days ago she read a book that told sx of pih and she thinks that she has had it for past 4-5 weeks (she was 23 weeks) OK, so first of all why not discuss this with the MD who she claimed she had seen twice in that time, or, why not come in or call a few days ago when she read about it?? I agree that some pt's are crying out for help. I do a complete domestic violence screen on all pts with no one else in the room. I ask them if there are any other concerns that they have, they all say no. So, if it is a cry for help, how am i suppose to find out what it is?? Often it is teenage girls and i think that they like the attention that they get from the 500 friends that they bring with them and the other 600 that they call saying "i'm in labor" when they are so not in labor.

OK, I'll get off of my soap box now!!!!!!

Up Vote Up Vote ×

I am sure that these pts. can be frustrating and difficult wasting valuable time and resources...

But I can't help but think of all of the women I know who did *not* go to L&D soon enough because they didn't want to disturb their dr. or the nurses or look stupid, who lost babies just prior to viability due to incompetent cervix. To me, I would rather have people err on the side of caution even if it meant making my job harder--rather than watching a mom experience a heartbreaking loss.

Shannon

Up Vote Up Vote ×
I am sure that these pts. can be frustrating and difficult wasting valuable time and resources...

But I can't help but think of all of the women I know who did *not* go to L&D soon enough because they didn't want to disturb their dr. or the nurses or look stupid, who lost babies just prior to viability due to incompetent cervix. To me, I would rather have people err on the side of caution even if it meant making my job harder--rather than watching a mom experience a heartbreaking loss.

Shannon

I agree that pts who even think something might be wrong should come in. I always tell people if they apolagize for coming in not to worry "we are open all night". However, most of us are talking about pts who KNOW nothing is wrong with them and just want to be induced at 34 wks at 2am.

I love the fake toco ctxs. When I was on orientation me and another new girl would always try to see if we could do that. I could never get that perfect curve (and nethier can the pts I have seen try it). :)

Up Vote Up Vote ×
I agree that pts who even think something might be wrong should come in. I always tell people if they apolagize for coming in not to worry "we are open all night". However, most of us are talking about pts who KNOW nothing is wrong with them and just want to be induced at 34 wks at 2am.

I love the fake toco ctxs. When I was on orientation me and another new girl would always try to see if we could do that. I could never get that perfect curve (and nethier can the pts I have seen try it). :)

Well, that is totally ridiculous. People are so ignorant--what's a few more weeks of discomfort when you are talking about your baby's well-being? Yes, that would start to drive anyone crazy after awhile.

I can't believe people fake ctxs. That never would have occurred to me!

Up Vote Up Vote ×
+ Add a Comment