And yet another example. On Saturday I got report from night shift on a adult PT with COPD on 2L O2 via NC. She had developed a dry nonproductive cough overnight, woke IP at 4 am with SOB, sats in the low 80s. Night shift got her to do some deep breathing, gave her albuterol inhaler and she went up to 95. Our on call doc refused a duo neb order. I go to check on her at 0800 and she's coughing her head off, sats in the low 80s again, goes to 92 with deep breathing but can't sustain it. Gave her some more albuterol, or helped some. She was white as a ghost, couldn't say more that he's or no. Got weekend doc to agree to send her out (still no neb order). Unit clerk calls EMS, I get paperwork ready and call ED to give report. ED nurse was sighing and giving me the 20 questions. When EMS arrives I'm grilled. She's up to 92 again."Well she looks ok now". That's NOT THE POINT. She cannot sustain that,Zithromax and a gonna be calling you in a few hours anyway when this happens again. She ends up getting admitted with ABGs totally out of whack. RN one course of IV Solu Medrol. They send her back the next day. Nurse reporting to me says, "She stops coughing I'd you tell her to". OMG whatever. She has bilat pleural effusions. Not requiring thoracentisis but still. Breeding ground for infection. At one point down to 81 today. And now on PO Prednisone to meaner than a snake too.
Ugh honestly this grinds my gears. I work in a small psych hospital in the sticks, have very limited psych resources in this area, we get admissions from everywhere. The EDs that refer to us blatantly lie, all the time. The truth of the matter is that WOE CAN'T deal with medical problems unless they're stable. Sure we can deal with accuchecks and insulin, sure we can deal with pts on O2 or need neb's, but the stuff we get sent, just omg. One guy came with what the ED said were "healed over self inflicted wounds". What we GOT were 10 stab wounds to the abdomen, multiple to the arms and legs that were down to adipose tissue, massively infected and gaping. We had a pt come in that hadn't had medical care in years with "just some wheezes. She was a full blown untreated COPDer with says in the low 80's. We had an ED try to send us an adolescent PT who OD'd on a handful of Vyvanse with a HR in the 130s and no LFTs or renal panel done. If she becomes an acute cardiac issue, were at least 20 mins from the closest ED. I don't have ap lot of time to manage major medical stuff. I've usually got 20 acutely ill, many times actively psychotic pts to deal with. When they become acute medically (diabetic with BGs ranging.from 36 to 450 in half an hour, kid with a CPK in the thousands, elderly dementia PT with aspiration pneumonia) the EDs give us a rash of hell for sending them, and sometimes they are sent back with basically no treatment. And.many.of the dementia pts really get me. There is really nothing we're going to do for a dementia PT. They are still going to sundown, we aren't making them better. No matter what anyone does they are just going to decline. We push fluids for low BPs. If someones not drinking we bolus with IV fluids. We do ECT so have quite a few nurses with excellent IV skills. Psych patients get substandard care and that's a fact. We can't handle them with acute medical issues and medical floors don't want them. Adults with serious medical issues die 25 years younger than non mentally ill.
Oh and please, if a psych patient is combative in the ED, please feel free to medicate them with anything you want. We usually request it, actually.