An experienced physician can fairly accurately separate the wheat from the chaff so to speak. For instance when I am taking a history, I may ask a patient if they have had a cough. If the response is, “yeah I had a cold last spring” then I politely nod and ignore that part in my decision making.
Yep, some folks just don’t have the wherewithal to check BP at home. The converse is also true; I’ve had patients bring me BP logs with 10 measurements a day for the last week and want me to divine some pattern in their chaos.
CMC is a local hospital group in Charlotte.
STEMI is ST Elevation Myocardial Infarction, probably the most serious kind of heart attack.
Triple A or AAA is an Ascending Aortic Aneurysm- a defect in the main artery leaving the heart that can lead to sudden and massive internal bleeding. Tends to be fatal if it happens outside of a hospital, and even in a hospital, the survival rate is still not optimal.
Sounds like your friend’s experience was more a problem with the provider than the facility. Stupid is stupid in the biggest hospital or the smallest. But yes, occasionally we will see patients with prior work ups that seem, um, unusual. I’ll often give the benefit of the doubt that the patient had a different presentation or some subtle discrepancy that led the prior doctor down one path instead of another.
Also Triple A stands for abdominal aortic aneurysm, and is quite deadly as you mention. Although I suspect if your friend was complaining of chest pain they were probably looking for aortic dissection which is an unrelated problem in which the wall of the aorta tears and blood is pumped down a false lumen. I understand garden hoses can do this, but I’ve never seen that happen to one of mine.
Is it possible that a person missed and hit an artery in the neck, yet could still function close to normal? I’m almost positive someone I’m close to hit an artery. It was aprox. 36 hours ago. Eyes went huge. Super high…weak dope. Most noticeable thing now is ringing in ears, soar throat, hoarse voice, extremely bad headache. She also has this “just not right” feeling. I don’t want to panic and cause anyone possible legal consequences, but I don’t want anyone to die either. I just keep thinking that if something serious was going to occur, it would have already done so.
I’ll lighten things up a bit, my cousin was an ER nurse for several years in her 20’s. She went on to work in a private office longing for regular office hours.She was bored and unfufilled and now in her 40’s has been back to the ER for most of career because it was exciting.
I see that the OP was from 5 years ago, what is your attitude now as opposed to then?
—As an aside when her son son was around 10 or so he broke his arm, went to the front of the line for treatment and he realized wow, my Mom really does do this, it’s not like TV.
I spent a week or so in an ED during nursing clinicals. Very boring but it wasn’t a large facility (like four beds and an urgent care room) and it was fairly rural. My last day there a guy came in, “I fell off a trailer house shoveling the roof and landed on a central air unit. Ow, my back.” To his credit, he did have a tiny little red mark on his back. He spent ages like, “Ow, it hurts, omg… no, I’m okay, I better not have anything but, God, it hurts…” before finally saying “well, maybe a little something…” Dose of fentanyl while waiting for blood, urine, and imaging to come back.
So the doctor comes to us bitching because he’s a known drug seeker, actually left his friend dead on the side of the road in a failed drug seeking attempt* the year before, obviously had nothing at all wrong with him… AND THEN GIVES THIS ASSHOLE 10 VICODIN ANYWAY. :smack: WTF.
Three days later I was in the attached clinic going over the schedule to try to fit a frantic lady with a sick baby in somewhere and I see the guy’s name: ER follow up. I told the nurse to go ahead and double book that slot because the guy wouldn’t show up anyway. Sure as shit. So what’s up with doctors giving pills to people they know don’t need them?
They wanted to go to the ER but thought it best to show up with some physical sign of pain, lest they be thought liars. So the passenger jumped out of a moving damn vehicle. The driver, this patient, left him there a bit before having a crisis of conscious and calling 911 with the incredibly plausible story, “I totally just found him like that…” So the doctor during this current visit, and after googling his name to be sure, went in and said “I know you were the one driving that car. There must be easier ways [than being forced to sit in a hospital for four hours because fentanyl] to get drugs. Here have these drugs.” :rolleyes:
When I was a young child and got taken to the doc every year for the annual physical exam (remember when they used to do that?) and the doc sent us across the street to the lab for me to have the blood drawn, the lab tech would sit me down in a small room full of microscopes and shelves full of boxes of glass slides and stuff. The tech would draw the blood, then right on the spot, squirt some onto a glass slide, use the edge of another slide to smear it across the first slide, stick it under the microscope, and start counting. She (usually it was a she) had a little hand counter, like you sometimes see theater or museum ticket-takers using, to count whatever they were counting. They always let me look into the microscope to see it too.
How long had it been since they did blood labs like that?
TLC apparently just ordered 35 more episodes of its new hit, “Sex Sent Me To The ER.” (Single-clicking the link is safe for work; the video clips on the site may not be). I’ve seen a couple of episodes, and it’s actually pretty well done, as ER shows go.
In the Army, back in 1971-72 I was assigned to a Hematology/Oncology laboratory in El Paso. I used to draw blood, take some of it with a pipette, add a specific amount of acetic acid and put the result in a special slide. The acetic acid would lyse the red cells, leaving the white cells for me to count. If I had all the proportions right, I’d come up with a correct white count, which I’d relay to the doctor. I’d also put more blood in a little capillary tube, plug the end with clay and spin it in a centrifuge, giving me the hematocrit (ratio of blood cells to plasma). More blood would go on the slide and get spread out, dried, stained, and examined for types of cells. You’d look for abnormal red cells, percentages of the different types of white cells, the presence and quantities of platelets, and other abnormalities. About halfway through 1972 they opened a new hospital, which the clinic moved into, and they had a new machine called a Coulter Counter, which automated much of that process, was more accurate, and took about a third of the time. I ended up drawing blood, running up to the lab, and then doing the slide anyway for the doctors to look at, because most of my patients had very abnormal blood counts.
This is a pet peeve of mine. We have better tools now to identify these patients including electronic medical records and statewide databases of presciptions that have been filled. But still some of my colleagues just give these patients narcotic prescriptions. Unfortunately the driving factor is often patient satisfaction scores which are ostensibly used as a measure of physician quality.
As Threbus says, blood counts are done on an automatic counter most of the time these days and the results are available in minutes. For abnormal results, there will be a manual count and sometimes a pathologist review, so the technique you describe is still used from time to time.
Back when I worked in retail pharmacy, we had several customers who had been banned from the local hospital’s ER. Now, if they came in by ambulance with a really truly life-threatening problem, they might have been seen, but if they came in any other way, they would be sent packing and presumably arrested for trespassing.
And this was after EMTALA. I worked in that town from 1999 to 2002.
We have made attempts to develop “care plans” for our most frequent, uh, customers, which usually consists of an EMTALA mandated medical screening exam and stabilization, and no narcotics under any circumstances.
