Thursday, August 13, 2009

A Perturbing ED Visit

It is a cloudy, cool day. And I am tired.

I shouldn’t be. I got a decent night’s sleep last night, but it was only for about 6 hours. That in itself was not as good as I would have liked,  but it was better than the less-than-2 hours of sleep I got the night before.

We just got done with a call from My Favorite Nursing Home to the Hospital Across The Street for a 55 year-old female staff member who had a syncopal episode. She was taking care of one of the patient residents when, from what we were told, she “got dizzy, then everything went black.” It lasted for only a few seconds, but it was long enough that when she woke back up she was glassy-eyed, diaphoretic, and a bit lethargic. When we arrived she was awake and alert, and dry. She was still complaining of some dizziness. Denied chest pain, denied nausea/vomiting, denied headache. A 12-.lead was relatively normal. Blood glucose was at the top end of the normal range. She was mildly tachycardic, actually borderline. Blood pressure was a little bit high.

Not too much I was going to do for her except get a current set of vital signs and get IV access. By the time we got her loaded aboard the ambulance her Oxygen level was (and had been) 99% on room air. And she was pink and dry by that time as well.

When we arrived at the ED, I got to the triage nurse, this guy who is nothing more than a troll. He is incredibly sour, really disagreeable, and generally just plain nasty. Once I got past him and we got a room assignment, we got her in the room and I was awaiting her nurse to give report. While I was there one of the ED techs came to the room with a 12-lead monitor. She immediately set on throwing me out. When I told her I wanted to talk to her nurse, she told me to talk to the triage troll. Rudely.

I shouldn’t ever be surprised at that hospital, but it always seems to reach a new level every time I go there. It was all I could do to not grab her by the hair, drag her out of the room, and beat her into the ground. I thought better of it, though; I cut my losses and left. Figured it was just easier not to deal with the hassle. But other than triaging the patient, I never got to talk to the nurse who was primarily going to be taking care of her.

For some reason, it seems like this is a common sort of thing in the hospitals down here. I would like to give report to whomever is going to be at the end of the line when it comes down to patient care, but it seems like more often than not the nurses don’t seem to be interested in talking to us. I ran into that in New Hampshire years ago as an EMT-Basic, but at least up there it seems to have resolved itself. I don’t run into that anymore, and I’m happy about it. I just wish it wasn’t so seemingly blatant in Boston. Or anywhere I’ve been in Massachusetts.

I suspect at some point I may reflect the rudeness that is shown to me back at some unsuspecting ED nurse somewhere. Should that happen, I have no doubt I’ll get into trouble for it. But if it does, it does. And hopefully it will be worth the aggravation of administrative trouble to make a point.


Karen Brook Westhaver said...

That IS perturbing. And to hear it's commonplace in some places is SO not good. Makes NO sense as it's important in pt's best interest for the person who's next to render care to know the facts as well as your observations/the presenting issue which got her there etc. Yikes. It's not like there were people piled to the ceiling on a crazy weekend or holiday night or even a full moon. No excuse. Sorry to hear this is how it goes for pts and sorry it's how it goes for you at that hospital and the others with this shoddy style. Dangerous, too. Triple yikes.

TOTWTYTR said...

A lot of nurses seem not to like to triage, hence the surliness. Then again, a lot of ED nurses seem to continue to work well after they have burned out to cinder status.

One thing that I seem to have broken the nurses I deal with is their demand that we do vital signs at triage for them. I'll do it if it's a nurse I know, but it's a courtesy.

I had one nurse complain (formally) because I wouldn't do them. He was even more cranky when our supervisor walked in and told him that we didn't need to do it. I thought his head was going to explode when the attending physician in the ED told him that it wasn't our job.

I make a point of calling him by name and giving him a big smile when I see him. For some reason, he just walks by me without so much as a wave.

Walt Trachim said...

That nurse you describe sounds like the one I was talking about... If it is, he indeed is a troll, isn't he?