Have a question for an ER/Trauma nurse? I'll give you my best answer

[TraumaRN]

Why do triage nurses often make people with significant problems wait hours?

I experenced one of these horror stories my self. I now have a permenant scar on the outer edge cornea because of it.

We have to make snap judgements based on what is going on in the department. Simple as that. I know it pisses people off but it's true. And yes sometimes people slip through the cracks that are more sick but we have to go by what we see and how you present.

What kind of turnaround time on STAT troponin tests do you get from your lab? Ever get an erroneous troponin result reported out from the lab?

About 20-30 minutes. They get first priority.

Never seen an erroneous troponin as far as I know.

 

[amdhunter]

Do you peek under the cover when a hot unconscious lady is naked under the bedsheet?

 

[FirNaTine]

Do paramedics actually do surgical airways in the field?

I have a friend who's going through paramedic training and he won't shut up about doing a cricothyrotomy. I'm glad he's enthusiastic about what he's doing but I'm pretty sure he's overestimating what he'll be allowed/trained to do. Would like confirmation from someone who works in a similar field.

To follow up on what TraumaRN stated it will also depend on the state. In MD some do it as a standing part of optional program for field RSI, if they are unable to quickly secure the airway. Other paramedics that are not in the program can as well, there is just more paperwork and physician consult requiremements. In addition to the direct trauma to the throat mentioned above, a medical example would a person with a severe allergic reaction whose throat is swelling closed and you are unable to secure the airway any other way.

Also besides the inital training in the procedure, I go at a minimum every other year to practice on a cadaver, and I am not in the RSI program where I work. Those that are go to some form of airway Con Ed every 90 days, but that procedure is not done at all of those sessions.

I know quite a few that have done the procedure, they are all individually reviewed by several physicians, EMS supervisors, etc. to ensure all less invasive airway procedures have been exhausted. I would say for the average paramedic where I work, it's kind of like the use of a firearm by a LEO. We train for it regularly, but many will retire without having had to use it. Some, black clouds we call them, will do it several times.

 

[TraumaRN]

<snip>

I was awake and conscious the whole time. My question is this: while it hurt and is not something I would like to endure again, was the morphine THAT much of a difference? I did not feel myself that "out of it" at all, yet several nurses and the doc said I handled it all much better than they anticipated I would. <snip>

Let me put it this way. I hate doing it when we do conscious chest tube insertions. Hate it. Most people DO NOT tolerate it well at all. You are like the 1% that does. And yes the morphine did make that much of a difference. You may not have noticed it because you were in pain but you were in far less pain because of the morphine.

My sister is finishing up her RN education, did a rotation (or whatever you call the training period as part of school) in the ER and liked it. She's considering whether she wants to go that direction long term. What things do you like about it, and what things do you dislike? She's level-headed, good under pressure with a generally good attitude about life and people.

What I like about ER is the flexible hours generally. I usually work 3 sometimes 4 days a week thats it. It's always new, you get new patients all day, you get to see some fun pathology, and it's a very dynamic place to work. Level headed and good under pressure are highly desirable. But dislike, well I can't stand drug seekers for one. But mostly it's not dislike it's more like it's easy to burn out if you aren't mentally prepared for it. It's physically/emotionally draining sometimes. It's honest to God the hardest place to work in the hospital. I don't have many dislikes of my job. But there is a lot of quirky bullshit that happens in the ER. Really you have to be prepared for anything. And you have to be ok working a job that doesn't have many routines besides starting IVs, giving meds and triaging.

 

[TraumaRN]

Do you peek under the cover when a hot unconscious lady is naked under the bedsheet?

No I'm not a perv.

 

[Saint Nick]

Do nurses get randomly drug tested?

 

[ichy]

FirNaTine: Thanks for the clarification. I knew that State Police Paramedics who work on the EMS helicopters can do them in Maryland, but they're obviously a special case. I was also curious how you could stay competent at a procedure that's used that rarely.

 

[TraumaRN]

Do nurses get randomly drug tested?

Only if you are doing something to warrant it. You'll get drug tested to get hired. And they all have zero tolerance policy on drug use.

My current employer makes it simple, you refuse the drug test you lose your job.

Take the drug test and flag positive for something you shouldn't you lose your job.

 

[ichy]

Ooh, another gory question. Have you ever seen an ED thoracotomy actually succeed, or is it as futile a procedure as I've heard?

 

[IronWing]

What level of effort is required of an ER doctor before they bill? My wife was in the ER a couple years ago. One doctor treated her. One walked in the room chatted for a few minutes and left. A third literally walked in the room, turned around, and left as if he were in the wrong room. All three billed the insurance company.

Also, WTF is the problem with offering/allowing a patient a drink of water? I was escorting an injured coworker to the ER. The nurse set him up with morphine and gave him more any time he asked. But ask for a drink of water? "I'll have to check with the doctor." Disappear for forty minutes, return with a 4oz cup. same deal when my wife was in.

 

[TraumaRN]

Ooh, another gory question. Have you ever seen an ED thoracotomy actually succeed, or is it as futile a procedure as I've heard?

I've seen 4 of them.

One succeeded.

Statistically it's futile but you do have a slim chance.

Generally speaking if you have a gunshot wound to the heart and we do a thoracotomy your chance of survival is <1%

If you have a knife wound to the heart and as long as it's to either left/right atria or your right ventricle you have about a 20% of surviving.

If you have a knife wound to the left ventricle it's <1%.

The one I saw was a knife wound to the chest that punctured his right atria. They cracked his chest, threw in a couple quick sutures to his heart, shocked his heart with the internal defib paddles got a pulse back, and then ran to the OR to finish what they started. He did live. But it's incredibly rare.

 

[nanette1985]

Speaking of drug seekers, how can a normal person in pain get painkillers from an ER? If someone is really in serious pain, how can that person get help?

 

[GT1999]

How common is this scenario. This happened to me last thanksgiving day:

Let me first state that I do not do drugs at all, so it's impossible this was due to inhaling something due to drug use...

Day before thanksgiving: Trouble breathing, had to leave the window open for colder air to make it easier for me to breathe
Thankgiving day: Trouble breathing, rapid breathing, caughing up mucus
Thanksgiving night: My gf (now fiancee, who's an RN) brought me to the ER at the hospital she used to work at. They put me on oxygen, which helped but my blood-oxygen levels were still low. The ER doctor decided that there might be something wrong with me at this point and decided to keep me. The nurse wanted to send me home on antibioltics saying it was just a pneumonia, but the doctor insisted to keep me insisting something was wrong with me, HE SAVED ME LIFE by keeping me inpatient. I would've died at home!
Thanksgiving night around 10pm: Admitted inpatient to the intermediary ICU, blood gas blood tests came back bad. They intubated me.
Midnight: Inpatient @ ICU, sedated on a vent

2 days later: Lung biopsy sent to Mayo in AZ which came back with higher than normal white eocynaphilic (sp?) white blood cells but they could not find anything wrong. Possible cause was that I inhaled something which caused this but they were not sure.

At this point I was on medical leave from work, I'll leave out all of those details as they are not relevant.

Days to follow - approx 20 days I was in a sedated state at the ICU with breathing difficulty on a vent. They had me on IV antibitics, fentanyl drip, propophol, and morphine shots which caused me to get jaundice along with the other drugs they had me on. They put two pick lines in me, one was a special one going straight to the heart for the blood gas levels I believe? They also drained fluid from both of my lungs and installed a G-Tube for feeding as I lost 40 lbs at the point (down from 230 to 190lbs). They also put me in a roto-prone bed which rotated to help with the fluid in my lungs.

Around mid December I started to get better, but not enough. My gf, the nurse, insisted they cut for a trach in my neck because the tubes might cause vocal cord damage, so they cut for the trach.

Days later I was concious but I do not remember anything from Thanksgiving night intitially at the ER on. I'm assuming that's because my body was in shock. I don't even remember giving them the OK to intubate me.

Eventually I was out of the ICU by Christmas of '10. I started to walk which was hard due to all the muscle degredation from laying in bed. My insurance denied physical rehab, but they eventually gave in. I was sent to a nursing home which I clearly remember was being one of the worst experiences as I was totally with it at that point. They had me in quarantine as one of my bacteria results came back positive which was resistant to antibiotics. This eventually turned out to be as a false positive... so I was in quarantine throughout all of this and everyone who came to visit me had to wear full gear including masks and gloves.

They sent me back to the hospital after being at the nurse home for 2 days (laugh), where I finished physical rehab.

Total time out of work was 2 days short of 3 months, total ICU time was over a month...

Still no root cause... which baffles my mind. All I'm left with is knowing I have a fiancee now who will stick with me if I'm dying , and tons of scars...

 

[TraumaRN]

What level of effort is required of an ER doctor before they bill? My wife was in the ER a couple years ago. One doctor treated her. One walked in the room chatted for a few minutes and left. A third literally walked in the room, turned around, and left as if he were in the wrong room. All three billed the insurance company.

Also, WTF is the problem with offering/allowing a patient a drink of water? I was escorting an injured coworker to the ER. The nurse set him up with morphine and gave him more any time he asked. But ask for a drink of water? "I'll have to check with the doctor." Disappear for forty minutes, return with a 4oz cup. same deal when my wife was in.

First off I don't deal with billing, but trust me I think it's bullshit. Wish I could answer that for you. But I know it's mostly a flat rate.

And I KNEW the water question would come up. The water thing is because so many times we aren't sure whats wrong with you. And if something is seriously wrong and you need procedural sedation or rushed to the OR...then giving you water could be a bad thing. Generally I don't have a problem giving you water but I need a few test results back first. And of course it depends on what brought you to the ER.

Fast way to piss me off is to come to the ER actively vomiting and ask me for water. No. Just fucking no. Once I get you some anti-emetic and your lab work comes back then we can try water. Not while you are vomiting.

 

[vi edit]

Also, WTF is the problem with offering/allowing a patient a drink of water? I was escorting an injured coworker to the ER. The nurse set him up with morphine and gave him more any time he asked. But ask for a drink of water? "I'll have to check with the doctor." Disappear for forty minutes, return with a 4oz cup. same deal when my wife was in.

It could be a precaution in the event that somebody needs to go to surgery. They don't want you aspirating intra-op. They do the same thing to a lot of women in labor incase they need to get wheeled off for a c-section.

 

[TraumaRN]

Speaking of drug seekers, how can a normal person in pain get painkillers from an ER? If someone is really in serious pain, how can that person get help?

Well honestly you have to come in with the correct things wrong with you. That's how you get pain meds. But first off. In the USA we WAY WAY WAY WAY overprescribe narcotics. If you are in serious pain, broken bones, appendicitis etc you should get narcotics while in the ED.

On the other hand just because you sprained your ankle does not mean you need to go home on vicodin/percocet. Honest to God Motrin/Aleve/Tylenol all do a decent job at pain relief as long as you take them as prescribed and around the clock until the pain/injury heals.

More than anything else, I see massive amounts of prescription drug abuse. More than weed, more than heroin, more than crack/cocaine. And unfortunately we in the medical field do it to ourselves. People expect to get these heavy duty painkillers all the time.

 

[TraumaRN]

How common is this scenario. This happened to me last thanksgiving day: <snip>

Very very uncommon. Glad to hear you are ok and hope all is well with you! :thumbsup:

 

[CRXican]

Well honestly you have to come in with the correct things wrong with you. That's how you get pain meds. But first off. In the USA we WAY WAY WAY WAY overprescribe narcotics. If you are in serious pain, broken bones, appendicitis etc you should get narcotics while in the ED.

On the other hand just because you sprained your ankle does not mean you need to go home on vicodin/percocet. Honest to God Motrin/Aleve/Tylenol all do a decent job at pain relief as long as you take them as prescribed and around the clock until the pain/injury heals.

More than anything else, I see massive amounts of prescription drug abuse. More than weed, more than heroin, more than crack/cocaine. And unfortunately we in the medical field do it to ourselves. People expect to get these heavy duty painkillers all the time.

I'm a noob EMT and dread picking up out of the ER.

Last pickup of the night last night was a lady with back pain (chronic) certainly already on a regimen of pain meds. How she even convinced someone to take her to the ER is beyond me.

I'm not sure what the ER gave her if anything but she obviously wanted MORE. "How can they let me leave with the same pain I came in with?" was her question. My reply, "I guess it's not an emergency. To them" (though I obviously agree and can't tell her what I really think).

Her pain was a "10/10" or "Maybe a 9" She didn't make a sound being loaded onto the gurney, into the ambulance or during transport (nice bumps along the way). Such a waste of time, money, resources.

 

[umbrella39]

I work in a level 1 trauma ER as an RRT, and my biggest pet peeve is the huge amount of Medicaid mothers that bring in their sniffly nosed kids instead of going one of the many urgent care buildings along the way or imagine this, making an appointment to see the kids Doctor! Nothing worse than being in a trauma bay trying to get a patient intubated, tube secured, doing compressions, and getting them on their vent and getting initial ABGs, oh and now we have to go transport to CT, while you are getting incessant calls at 3am to give express stat breathing treatments to babies who should be home sleeping, as if albuterol was going to fix their cold anyhow... Off soap box...

 

[ichy]

Medicaid patients should have to pay significant co-pays for ER visits.

 

[yuchai]

What's your opinion on PPACA (Health Care Reform)? In what ways does it impact someone like you?

 

[CPA]

What level of effort is required of an ER doctor before they bill? My wife was in the ER a couple years ago. One doctor treated her. One walked in the room chatted for a few minutes and left. A third literally walked in the room, turned around, and left as if he were in the wrong room. All three billed the insurance company.

Also, WTF is the problem with offering/allowing a patient a drink of water? I was escorting an injured coworker to the ER. The nurse set him up with morphine and gave him more any time he asked. But ask for a drink of water? "I'll have to check with the doctor." Disappear for forty minutes, return with a 4oz cup. same deal when my wife was in.

What you described is typical and most insurance companies won't pay the "attending" surgeon. They will then appeal and be denied again. You should NEVER be billed for those charges or be forced to pay them. If you do, consult your insurance company or lawyer.

 

[CrazyAznDriver]

Hey my wife is a trauma surgeon! Keep up the good work.

 

[BUTCH1]

I'm a noob EMT and dread picking up out of the ER.

Last pickup of the night last night was a lady with back pain (chronic) certainly already on a regimen of pain meds. How she even convinced someone to take her to the ER is beyond me.

I'm not sure what the ER gave her if anything but she obviously wanted MORE. "How can they let me leave with the same pain I came in with?" was her question. My reply, "I guess it's not an emergency. To them" (though I obviously agree and can't tell her what I really think).

Her pain was a "10/10" or "Maybe a 9" She didn't make a sound being loaded onto the gurney, into the ambulance or during transport (nice bumps along the way). Such a waste of time, money, resources.

Yea, if you've got pain issues it's a rough ride, when I had a kidney stone I felt every bump on the way in, sounds like that patient just wanted to get nuked on meds..

 

[Nintendesert]

Where's the worse place you've removed a remote from?