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* The 16 month old with a 102 fever of unknown origin. Fast track course: straight-cath (2 attempts needed), IV line (3 attempts and 3 nurses needed), abbreviated sepsis workup, APAP, Rocephin, etc...
* The 39 year old with back/flank pain and fever. Fast track course: IV line, 2 liters Normal Saline, Percocet, Dilaudid, Zofran, etc...
* The 21 year old with a sensation of "something stuck in my throat" after eating fish the night before. Fast track course: throat x-ray to confirm that there was, indeed, a fish bone stuck in her throat, several telephone calls and mountains of paperwork to arrange a transfer to a higher-level facility with ENT surgeons on call and to schedule an OR
* The 45 year old with elbow cellulitis here for IV antibiotics. Fast track course: after initial consultation/secondary exam, ER doc brought in to review the case, finally IV line and 90 minute infusion ordered
* The 5 year old with severe cellulitis of the thumb with streaking up to the elbow. Fast track course: IV line, pain medicine, skin marking, Rocephin injection, etc...
Combined ER time of those five patients: north of 16 hours.
Four IV starts are about what I expect in a regular ER assignment where the patients stay for an average of 3-5 hours instead of 45 minutes.
It was a day. All I can say is thank goodness for ER Techs.
As an aside: I went through my scribbled notes and as near as I can count, more than 10 of the 26 patients we saw were smokers. Compare that rate of 39% to the state-average of 18% smokers.
5 comments:
The ER is not a place that interests me at all. I give you tons of credit.
Notice how certain types of disease processes happen in pairs or threes?
I used to see it all the time in the hospital on the med/surg floor too.
Nice blog.. I'll put a link up.
Holy cow - I don't work in an ER with a fast track, but is there no way to "de-fast-track" a patient if they turn out to be sicker than originally thought?
a patient can be sent to the main part of the ER, but that means getting the Doc to agree.
I would liken this to getting the Doc to agree to having all of their teeth pulled using only sutures and plastic straws. I suppose it's possible.
Holy Cow! Our fast track is adult only, and the need for IV anything negates the fast-track status and sends them to urgent or acute. I give you tons of credit on that one!
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