Triage Rules / Rants

wow!! sounds like you may be burned out. just take a deep breath and do the best you can. i have never been one to wanna always run to the er for every little ailment. maybe people need to be educated more on what is exactly an emergency, and start utilizing urgent cares. the er room is very over abused because unlike urgent cares where you have to pay up front er lets you get away with paying your bill later. hats off to you and the wonderful job that you are doing. (waiting for acceptance letter for spring 09) may want to try triage, what do you think

Why do people feel that it is OK to yell, scream, verbally abuse and threaten the staff in the ER? I'm sure they wouldn't act that way in a grocery store, bank, or car dealership.

I always say that it is the person who needs to be seen the least who complains the most.

Just over the weekend I was told that Mom was gonna come back and shoot this place up, (after we took protective custody of her child)

I had a pager thrown at me.

Triage is a tough job, you need your assessment skills, and a very tough skin.

I am sure that someone, before the day is through, will post "OMG, you are so uncaring, heartless, cold, etc." So before they do just let me say......you just wouldn't understand if you have never worked triage:wink2:

Here's some of my triage favorites:

"I absolutely need to lie down now" (hmmm, maybe you should of stayed in bed then)

"I've got to pick up my child/mother/neighbor/dog (whatever) in 2 hrs. Will I be done by then?"

"It hurt for 2-3 minutes and then it stopped, but I want to know what it was"

"I was at XYZ's ER last night, but they told me nothing was wrong....I want a second opinion"

"Is Dr. So&So here today, because I don't want to see him/her"

"I just said I had chest pain so I could get in here faster"

"Well it all started back in 1982 when............."

There's plenty more and the sad (funny) part is they're all true!!!

Had a patient come in to the ER Friday because his "stomach was hurting so bad"....He had also been in ER all day Thursday, 29 y/o drinks 2-3 PINTS of liquor a day...HELLO pancreatitis!! When he was dc'd Thursday with scrip for Lortab, he didn't get it filled....he went home and drank! THEN CAME BACK FRIDAY!! His dc instructions included this pearl from the attending "If you don't like feeling like you did this morning and yesterday, never ever drink another drop of alcohol again"...Craziness!

We regularly get people through triage with complaints that wouldn't even cause me to take OTC meds.....you just have to shake your head and move on and not let it get to you!

Such is life in the ER

I had a young female who came in through triage with a frosty drink in her hand complaining about abdominal pain. I said, why are you drinking that? She said cause it's good. She went on to say she just had a double beef cheesy burrito......

I looked around to see who if any managment was there....they weren't...lol and said

I am not taking your abdominal pain seriously at this point,....you just ate that and came into the ER....really?

she just giggled......but you bet your butt I made her sit in triage longer than I needed to. We were packed to the gills in ER today.....finally when she came up and asked when she would get to go back.....I just stared at her and didn't say a word.

Waste of my time and my tax paying dollars!!!!:banghead::banghead:

My triage complaint for the week: Family member accompanied patient. Family member is dressed in scrubs and has some sort of badge on I can't see (and don't care to see). Family member speaks for the patient, patient says nothing. I ask if the patient speaks English, and am told no, the patient doesn't speak any English. I listen to what the family member has to say, which I really do not have time to do, and then let her know I need to call our staff interpreter to help me assess the patient. Family member flips the heck out, "I will translate!" I inform her this is our hospital policy, and she continues on "Well, we've been here lots and no one ever did that, blah blah blah..." (insert major attitude, glares, and spanish speaking complaining about me to the patient while we wait for the interpreter. I am laughing to myself because I do have a basic understanding of Spanish, however, not good enough to do an assessment. I kept my mouth shut, but felt like saying:

#1. You come into this ER in scrubs, so OBVIOUSLY you feel like you are making some sort of point that you are someone-or-other in the healthcare field, so act like an adult.

#2. If you are actually in the healthcare field and take care of patients, that you would surely know how important it is for me to hear from the patient's own lips what the patient's problem is. You surely would understand that the patient needs to tell me about his pain, and that even conversing with the patient is part of my basic neuro and social assessment? Surely, you would not think so highly of yourself that you won't allow your family member to speak for themselves?

#3. And lastly, take your ignorant butt out of my triage and go sit in the waiting room. Since you're in healthcare, I'm sure you know your family member's complaint was not emergent and you didn't actually expect to go back right away.:argue:

I am sorry to hear you are so frustrated. We had a girl who was 30 come in BP 230/130 pulse 140, she had abdominal pain, a patient waiting (needed refill of Xanax & Celexa) was PO'd because "why did that girl go back and was not even sick" UGH! Poor thing ended up having her gallbladder out. She was not even complaining, just said I am having so much pain, been laying in bed with a hot pack on and taking motrin & tylenol for the fever. Apparently when her mom called her and asked her symptoms mom said you better go to ER ASAP. She probably would still be in bed. Me on the other hand would be screaming and crying my way into the ER :)

ROTFLMAO at #16. Been there, seen it, left her hefty butt on the floor!! :)

Worked Triage yesterday.....Our 65 bed ED was filled by 11am. Small things, big things, but by 3pm there are 17 "waiting to come back"....Now mind you..we always keep 2 monitored meds on hold for majors, or bad squad patients....but let me tell you.....Why do some think that waiting a week or two to get into their primary physician vs. waiting 2-3 hours in the ED to be seen for a non-emergency is such a bad thing?.........lol...floors me:banghead:

One of my biggest gripes in triage is...the 10/10 pain scale....does ANYBODY ever have less than 10??

I had a girl a couple days ago with what ended up being a RUPTURED ovarian abscess...very obviously not feeling well upon triage and she only complained of a 7/10......while another "sick" person came after her c/o abd pain 10/10 while talking on cell phone, laughing with family member, walking around just fine drinking a coke and eating chips... :argue:

I know that everyone has different pain tolerances but to me a 10/10 pain level would be cancer, burns, major trauma, labor, etc...the kind of stuff that has you laying in a fetal position begging anyone near by to just shoot you and put you out of your misery...

Am I wrong here??

One of my biggest gripes in triage is...the 10/10 pain scale....does ANYBODY ever have less than 10??

I had a girl a couple days ago with what ended up being a RUPTURED ovarian abscess...very obviously not feeling well upon triage and she only complained of a 7/10......while another "sick" person came after her c/o abd pain 10/10 while talking on cell phone, laughing with family member, walking around just fine drinking a coke and eating chips... :argue:

I know that everyone has different pain tolerances but to me a 10/10 pain level would be cancer, burns, major trauma, labor, etc...the kind of stuff that has you laying in a fetal position begging anyone near by to just shoot you and put you out of your misery...

Am I wrong here??

No, you are not wrong. I once had a patient who came in eating fries from a bag of mcdonald's who stated that he had 10/10 pain as he smiled and giggled at my question. I said "No, sir, I do not think you understand what I am asking. On a scale of 1 to 10, 1 being none and 10 is me ripping your arm off and smacking you in the head with it, what would you say your pain is as you sit in front of me right now?"

He said: Okay, I guess it's a 9.