Wednesday, October 8, 2008

Connecting the Dots

I just realized that I never answered my post from almost two months ago.

The answer:  all of those patients were triaged as blue charts (ESI triage category 4) and sent to fast track, where I was working that day.

The periorbital fracture was transferred to a level 1 trauma center for an expert surgical consult.  The Blunt abdominal trauma was sent to the main ER where a code trauma was called and the patient was transferred to a level 2 trauma center, the spontaneous pneumothorax, I learned a couple days later, ended up not being a pneumo after all, but he sure had all the signs and symptoms (young, thin, tall, male smoker with sudden onset of left sided chest pain made worse with inspiration or sitting.  In fact, the only initial finding that was missing was diminished breath sounds).  The intractable N/V patient was eventually sent home after his third round of Zofran and his second liter of IV fluids and a course of IV antibiotics.  The peritonsilar abscess (adult patient), incredibly, was sent home after staying in a fast track bed for 11 hours and receiving 5 rounds of pain meds, 2 doses of Zofran, Levaquin, Clindamycin, Rocephin, several diagnostic tests, and 3 liters of fluids.  And finally, the back pain guy was found to be FOS.  Literally.  And the oncoming PA decided that it would be a good time and place to do an enema.  That's right - a curtain-partitioned room is a great place to free the poo.  Needless to say, I was more than happy to pass the buck to the oncoming nurse as I ran for the exit.  I had served my time.  Incidentally, I caught up with the nurse a few days later and he said that finally some sense had been talked into the PA and she let him go home with narcs, Robaxin, and a couple of poo-gliders.

I think the triage nurse was drunk that day.


ToradolQueen said...

OMG!!! This is a typical day in our ER - our triage nurses must ALWAYS be drunk!!! I HATE it when chief complaint is 'spin doctored' up to look like something to fit in Fast Track. I had a level 2 resp distress - altered VS, unable to speak normally, diaphoretic, etc. Triage flagged it as "go to Fast Track ASAP" Triage nurse reasoning: I didn't want them to sit in the waiting room" Isn't that the definition of a level 2??!! Can't wait in the waiting room without danger??!!

Braden said...

"I didn't want them to sit in the waiting room"

That was the exact same reasoning that the triage nurse gave for sending back the blunt abd trauma, and that was my exact same response back.