ER torture chamber?

Great Debates
1

Do Emergency Rooms have to be Pits of Agony?

I watch a lot of ER programs, there being mainly mind numbing stupidity on the other cable channels I can afford, and it seems to me that so many of the larger hospitals have little regard for the patients pain.

I hate pain. I’ve been in pain. When in pain all I want to do is get out of pain. I don’t want more pain dumped on top of the pain I already have. I can stand some pain, but it is not my favorite thing to do.

Before I get ripped to shreds, I’d better elucidate. I understand that the medical staff needs to find out all forms of detales and things about the patient before treating him or in order to treaat him right. Sometimes they can’t give him pain killers because they need to know everything that might be wrong. Sometimes it seems like they don’t care nor want to take the time.

I cringed when this Black guy came in all beat to hamburger from an accident, awake and in pain and they shoved a tube up his nose and down his throat. Then the Doctor ran his thick finger in the 6 in wound in his scalp checking for damaged bone. Not even adding a topical anesthetic.

That made me jump in sympathy for the poor guy. In the ambulance, they rammed a tube in his arm and another up his cock. At the ER, they fingered the exposed bones of his leg, asked him a million questions and decided he needed a tube in his chest. So, they hacked him open and ran in a garden hose sized tube to drain blood from around his lungs. He did a lot of screaming over that one and I clenched my teeth to keep from joining him.

In the mean time, the assorted nurses and doctors were dubbed in telling about how hard a job it was doing their work, but how rewarding and it had to be done, and how much they cared (in basically no BS, flat voices).

I looked at the poor b*****d as they rolled him to surgery and thought that the KKK could not possibly have hurt him more than the ER did.

In some programs, they inserted chest tubes after numbing the area but in most they did not. Doctors in a few numbed up gaping wounds before inserting gloved, ham fingers to inspect them, but in most they did not. I watched them reduce a fractured leg on a guy without giving him morphine which almost made me climb over the back of the couch and cringe behind it. He did a lot of screaming, which a couple of tall, thin, experienced nurses frowned at in annoyance.

On one I watched, this young man came in with a healed over bullet wound in his leg. He had been in a week or so earlier and they had sent him home leaving the bullet in. That seems to be the thing these days. They’ll leave the bullet in. Some X-rays in patients have shown many bullets from old shootings left in. Someone once told me that the heat of shooting the bullet makes it sterile, so it’s left alone if not life threatening.

Aren’t bullets lead? Won’t they leach lead into the body?

Anyhow, this guy was in major pain, the wound puffy as heck and this absolutely beautiful, young lady surgeon came out to examine him. That New York City type of beauty, you know, the long, black hair, black eyes, exotic face, full lips, makeup and all? Pale complexion. She agreed, it needed to come out.

So, she plunked him on a table, called in some staff, got out her surgical kit and, as he asked about something to numb the area, she assured him that he did not need it. Then she cut him, blood and puss spurted out, he screamed, she got irritated and told him to settle down and reached inside with forceps to pull out the bullet. It took her a few seconds to find it. Staff had to hold him down. He made a lot of noise. The beautiful surgeon looked up at the camera, forceps still imbedded in his leg, with a ‘gosh, what’s his problem’ look on her face. Then she popped out the slug and squeezed the wound to drain it. The elicited more noises from him. Loud ones.

He was kind of a mess at the end. So was I. I decided that I did not want to marry the surgeon after all if she had so little compassion. A friend of mine in the medical field, having seen the same show, said that at the very minimum, local anesthetic should have been injected or, since he had a ride, he could have been put out or even given a tranquilizer.

He said, the ER surgeon was just in a hurry. It seems that happens a lot in big ERs.

I like to avoid ERs now, if I can. Mine is not as bad, but they tend to let you sit in the waiting room in pain for hours.

I guess cuts in hospital funds have led to over worked staff who cut corners to handle patients. I don’t know, but I didn’t and don’t like it.

2

You mean as opposed to the scads of folks lining up to have to pay the ER a visit? :rolleyes:

I am not a doctopr (nor do I play one on TV) but I have faith that the ugliness that we see in emergency situations is all because they are trying to save your life.

Save the niceties for scheduled surgeries without complications.

Unfortunattely, we can’t schedule when we’re going to get shot or in an accident, but it’s nice to know that there are people there who will be there even if it’s not on schedule to take care of us.

Yer pal,
Satan - Commissioner, The Teeming Minions

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3

Local anesthetic takes a few minutes to work. If this man had a hemothorax as severe as your description seems to indicate, he needs a chest tube stat (or, as I say, the level above “stat”–“fucking now”).

Yes, it sucks, and it’s painful. The alternative is death, plain and simple. Trauma care doesn’t allow for many niceties–the few minutes it would take for the lidocaine to set in, or even the few seconds it takes to draw the stuff up, can mean the difference between life and death.

The tube in his arm (an IV) allows drugs to be administered quickly. The tube in his penis (aka a Foley) drains the urine in his bladder, which can be important diagnostically (particularly if there is blood in it). Again, neither is pleasant, but both are necessary, and neither can wait in this situation.

As for the surgeon, she probably could have used some anesthetic. I’ll reserve my comments about the bedside manner of many surgeons I’ve come across. I will say that the ridiculous hours kept by medical personnel take a toll on one’s concern for the patients. I’ve seen the most caring physicians you could imagine change completely after a 30-hour call shift.

Dr. J

4

I did a month rotation in the Ben Taub ER (level I trauma) in my second year of medical school, last year.

First of all, lemme get this out the way. Surgeons are notoriously short on compassion. Part of this comes from the need to get everything done, fast. Often, too fast to get the drugs into the system. Even a good lidocaine block takes 5-10 minutes to set in, and in a relatively pain free zone like the scalp, you can staple it back together in 10 seconds. Since there is no visible scar there, 10 seconds of a bit of pain beats 5-10 minutes. Also, trauma surgeons work fast because they are really, really busy. Surgeons (mostly) lack compassion for a number of other reasons also, some legitimate and some aren’t. The job is enormously stressful, and to cut someone open, you need to kind of devalue them as a human, I think. Also, surgeons don’t treat many kinds of belly pain because they are looking for acute changes in pain which are really important.

Also, many things are painful and you can’t really treat that pain. Chest tubes are really painful. Numbing the skin (which I have always seen done) just gets rid of the pain of a 1 cm cut. You can’t effectively numb the intracostal space, which you have to tunnel through (with a hemostat or with your finger), as it is so vascular and there are some major arteries and nerves running through there. Once you get through there, the pleura are really, really irritable, and this adds pain. There is really nothing that can be done to ease this pain either.

Next, most people do get loads of pain meds in the ER. Especially for setting a broken bone. It is still really, really sore, but generally the orthopods need a relaxed person so they can get an accurate set.

Next, bullets can stay in. Usually they are left in. I have no idea about the lead. It sounds like what you are describing is an abcess around a wound – the tissue lining the wound has become infected and the body has cordoned it off. This needs to be incised and drained. No amount of analgesia can help – it is dead and fibrosed tissue. So, we just numb the skin and cut away. The patient usually screams, but again, there is nothing we can do. It ain’t pleasant. Not by a long shot.

So, what are the upshots of the ER? I’ve seen a bad car wreck go from ambulance bay to surgery in under 10 minutes. That is what you need – an efficient, highly skilled surgical team to stabilize you so that you can get fixed in surgery.

What is the protocol? It is, unfortunately, all about pain. But like Satan said, it is all to save a life.

It starts with being scooped by the ambulance. They will put a C-collar on you (uncomfortable) and immobilize you on a 6 foot wood backboard (also uncomfortable). If you are lucky, they’ll put 2 16 gauge IV lines into your brachial veins. You will be transported.

We will receive a report from the EMTs and unceremoniously cut every single stitch of clothing off of you (while you are strapped to the backboard). Note that they don’t show this on TV. If it is a high probability that you have a neck injury, we will take some films of your neck. This involved “pulling for a C spine” where I stand at your toes and grasp your hands and pull as hard as I can.

We will put in a Foley catheter without anesthetic. We will do a rectal exam (to check for bleeding). If deemed necessary after more abdominal films, we will do a diagnostic peritoneal lavage by where we stick a needle into your peritoneal cavity and flush you out with 4 liters of saline. We can also put in chest tubes, do thoracotomies (if you are really out of it), and stick you any number of more times, including central lines into your jugular/femoral/subclavian veins or arterial lines into arteries. We can also paralyze you and intubate you in preparation for surgery.

We can do all of this in about 10 minutes if pressed.

5

DoctorJ wrote:

But once they jab the IV tube into his arm, can’t one of the drugs they administer via said tube be, say, a knock-out drug? Intravenous knock-out drugs work damn quick, from what I’ve heard.

6

Some problems :

  1. You need to interview a patient to find out what happened.
  2. For more major things, the patient is often not concious.
  3. For more minor things, you need to be able to see a change in situation. The most rapid way to do this is by asking the patient if the pain is getting worse.
  4. For many things, you need patient compliance. You also need informed consent for treatment.
  5. The risk of general anesthesia is relatively high, especially for a non-stable patient.

But, as I stated, for many serious injuries, morphine and other heavy duty pain killers are given. For setting a bone, the orthopod I knew used judicious morphine and Versed (concious sedation - an X-Files drug if there ever was one) as well as a muscle relaxant.