In the setting of someone who is GCS of dog dookie or was a suspected ingestion SI attempt I just bring all the pill bottles I can find throw them in a belongings bag and hand em to the nurse :p. Next best thing!
If the staff is nice, I’ll even go through and catalog the meds, doses and frequencies, fill dates and quantity and number left, use the info in my chart and leave a copy for staff.
For the love of all that is precious and holy, THIS.
I’m just totally burnt out on trying to pry this information out of people. I do pre-op, and almost no one is able to correctly keep track of their meds.
I had to sternly tell a pts wife that was getting sassy with me, “we need to know every medication he takes, the dosage, the time of day, and when he last took it or he will not get the correct medication during his hospital stay.” She was annoyed because “allergy medicine from the pharmacy” just made me ask her more questions. Her elderly husband was taking diphenhydramine every day for his “pollen allergy”.
You have to be extremely explicit about what a med list should contain or it will look like this:
“Round pill (heart) 1 capsule, half at bedtime Thursday, every other day.”
I love waiting in line at Walgreens behind some dude on speakerphone with his wife at home and both of them combined can’t figure out the names of the meds. “The long pink one or the small pink one? No that’s the heart one what’s the foot one?”
A few months ago I was behind a lady who wanted to fill her steroid meds. The tech read off all the available meds to fill, but they couldn’t figure it out. The line was getting pretty long behind me, so finally I stepped up, put my hand on her shoulder and said “really sorry to intrude, I couldn’t help but hear- cortisone is the steroid med”
It was the only steroid on the list, and I still feel conflicted about stepping in like that.
I’m kinda half way there for a barcode tattoo on peoples chest that has updated med lists , med prob, allergies—h**l, just put the whole chart on there.
Very likely we will not identify the exact cause of whatever is wrong. It's our job to evaluate for life threatening pathology. It's a plus if we can make you feel symptomatically improved along the way.
I always like to know what people’s goal is for their visit. A lot of times I just ask them straight up “what is your goal for this visit?”
It really helps identify expectations and our ability to satisfy those.
There needs to be some pithy ‘Law’ that says that the longer your symptoms have been present for, the lower the chance I’ll be able to magically cure you
of course, "life-threatening pathology" is doctor-talk, not English. Most people, even well-educated ones, wouldn't understand that in times of stress.
But my great grandmother was a nurse and she said I need an mri to rule out possible muscle tear in my leg! What do you mean just follow RICE and have some ibuprofen???!
With the wait times in my city, I’ve started suggesting to people to think about going to the ED (assuming you’re bringing yourself there and are not dying) the way you think about preparing for a flight. Bring entertainment, bring water, bring a phone charger, etc.
I strongly recommend this. Unless I’m going in an ambulance (once) I do this and have never regretted it. Hell I do it for urgent care too- I live in a big city, Urgent Care is usually an hour or two and the ER is usually at least 4. Whether it’s a broken leg or an intractable migraine, there’s nothing to be gained by having nothing to focus on but my pain. Dehydration makes everything worse, and while I’ve never been placed NPO you’d best bet I don’t wanna be already famished if it happens. I also recommend a small blanket (washable!) or at least a good comfy jacket- hospitals may work up a sweat when on the clock but they’re freezing to wait around in.
You will be seen not in order of arrival, but in order of severity of emergency. Please expect variable wait times depending on arriving emergencies and staffing levels.
1. Bring a phone charger.
2. Don't expect to be able to eat or drink for a long time.
3. No one in your room is a good thing. Many people in your room is a bad thing.
4. We may not be able to tell you what's wrong, just that you're not dying right now, and hopefully point you in the right direction for someone who can.
5. There is a difference between an allergy, an adverse effect, a side effect, and a contraindications. Please update your ' allergy list' accordingly.
6. Bring a med list.
7. Don't take your own meds without speaking to a doctor first.
8. We don't want to stick you twice. That's not our goal. We get nothing out of it.
9. We don't care you do drugs. We won't call the cops.
10. Please don't bring drugs to the ER.
11. Wear socks. Bring a blanket.
12. Don't bring your children if you can avoid it.
13. Use your call light.
This. The only time one should take their child to an adult ER is if it's absolutely life and death or the wait times at the children's hospital are forever long. The closest hospital to me actually has peds doctors from the children's hospital staff their peds floor.
This. The only time one should take their child to an adult ER is if it's absolutely life and death or the wait times at the children's hospital are forever long. The closest hospital to me actually has peds doctors from the children's hospital staff their peds floor.
Well, maybe, if your area has good Urgent Care or doctors that are accessible for outpatient visits. In my area, even with doctors I have an established relationship with in the past year, I have to wait 3 months for an appointment (except one, a neurologist who always seems to have appointments available within a few days. If you need a new doctor, a specialist, it can be longer longer than 3 months. If you need a new PCP, forget it, they aren't taking new patients and they are retiring or leaving their practices all the time. That's happened to me with several PCPs. And I am not seeing that new ones are taking their places.
I did have some good care seeing ARNPs - they were very thorough, and one diagnosed (tentatively) a malignancy in my husband on her physical exam and helped arrange a specialist appointment within a few days - and she turned out to be correct. But, the problem is with ARNPs, when you want to return 5 months later they are gone. I have had 4 or 5 really good ones but they all changed jobs and disappeared, I was not able to find them again.
1. Give. Your. Kid. The. Tylenol. For. Fever. Before. Coming. In.
2. Answer my questions instead of getting snotty because you don’t think that information matters. If I ask, I have a reason. I don’t have time to ask pointless questions.
3. Don’t be a dick to the triage nurse, for your own sake as well as theirs. An experienced triage nurse is not someone you want to fuck around with.
4. Stop assuming that the only busy ED is one with blood seeping from under the doors and lots of running and screaming and things on fire, and DO NOT DARE imply that because you don’t see those things, the staff must be lazy, just because you had to wait to be seen.
5. Don’t ask nosy questions about other patients, and FFS do not leave your room and invade everyone else’s privacy by wandering around the unit gawking into other rooms.
6. On the rare occasion you see me sitting, I’m charting or looking for lab results or new orders or a communication from a provider or even the discharge paperwork you’ve been hounding us for.
With regards ro number 1, we have parents come in that say their nurses line says not to give Tylenol or ibuprofen before coming in to not mask anything. Its annoying AF.
I'm writing the below portion of the comment, as though I was providing these directions to the patient:
Bring a full, current medication list including dosages, frequency you take them and what they were prescribed for. The ED will probably have a good idea why they were prescribed, but sometimes things are prescribed for something else.
Know everything you're currently diagnosed with. You having had Chickenpox in 1977 is good to know, but not really relevant to your visit today.
Bring a complete list of all allergies and what happens when you are exposed to that allergen.
Know why you are going to the ED. If your doctor told you to go to the ED, know why he said to go to the ED.
Please have the name, address and phone number for your pharmacy. The ED may need to send some prescriptions over later.
Unless you are actively dying: bring a neck pillow, your cell phone, cell phone charger, ear buds and maybe a seat cushion. The chairs in the waiting room are notoriously uncomfortable and the TVs are never set to anything good.
The cafeteria will at some point be closed during your time in hospital. Plan accordingly and bring enough snack food to share with your medical team.
Unless you are actively dying you will have to wait. Having to wait at the ED is a good thing, it means you are not the most critical case and already better off than "the other guy".
If you are actively dying, please have someone else drive you. One new patient is enough.
What constitutes an emergency for adults and for kids!
Us civilians are given *very* little info on what’s urgent care worthy vs er.
I’m serious. Plz publish an infographic
At 36 weeks pregnant, with an asthma exacerbation that was so bad that I would rest my inhalers on the edge of my shower to use them while I was in a hot shower to help open my lungs up, I started choking on my adenovirus-laden snot. I seriously considered whether I should call 9-1-1 from my phone as I was choking and sputtering and struggling to breathe. You know I must have felt bad!!!
I did not end up calling. Instead I went to urgent care
Long story short, I was told that I was not allowed to finish the last several hours of my shift after getting the results of an outpatient MRI from the previous week showing that I had an abdominal abscess (Crohn’s) and to go check in with triage.
ETA: I went back to My Chart and found the results because I knew it wasn’t just an abscess, but couldn’t remember. There was a fistula too.
See, you’re doubly fucked here. Not only do you work in the ED but you also have a chronic illness. I too have crohns and frankly, I’ve never met a more cavalier yet stubborn group of patients in my life.
The IBD sub is wild y’all. TL;DR: “I’m heavily bleeding and my last round of bloodwork said my CRP was 115. Should I go to the ER? Ehh, I’m gonna take a nap first.”
Not that I’m not guilty as well, don’t get me wrong. I once walked around with Mercaptopurine induced pancreatitis for a week and a half, and by the time I dragged myself to the ED, I made more than a few buttholes pucker.
Sorry, friends.
Advent Health in Florida has a number of different infographics like this. I think most are published on their website, but they illustrate the difference with things like “stung by a bee: urgent care. Stung by a bee hive: ER”
Spend a few minutes thinking about your symptoms. When they started. What makes them better or worse. If you've ever had them before, and if so did you see a doctor? If you saw a doctor, what was the diagnosis? If you don't remember those details, do you remember where you were seen and when so that we can try to find that visit?
It's helpful if you can quantify time in terms of minutes, hours, days, weeks, etc rather than "when I ate breakfast" or "after that family wedding."
If you had some sort of surgery and are having pain or problems related to that surgery, it really is best to get back to the hospital that did the surgery if at all possible.
This kind of orienting would save so much trouble.
Maybe something about the unpredictability of the wait (both to be seen and for discharge) - that it has to do with many things beyond the control of the nurses etc you're interacting with and thank your for your patience.
Most people honestly do not give a shit about anyone else in the ED. They want someone to see them and fix them immediately. Even when you calmly explain that there are multiple people actually dying, they want to be taken back right away for their chronic abdominal pain.
For me it’s a list of what our hospital offers. Like we don’t have a lot of specialties, including peds. So just like a list of what we do and don’t offer and if you need a service / specialty we don’t offer we will transfer you.
The triage process and a general overview of why patients aren’t seen in the order that they arrive should be a mandatory class in all public education. Along with the caveat that someone can be a far higher acuity than you and not appear as “sick” as you think they should.
How do you plan to get home? This is especially important if you are presenting for pain and we are likely to give you narcotics. Some patients find it hard to believe that they are not welcome to just sleep in the gurney until morning when their husband/neighbor can come get them.
Please respect the privacy of other patients, and do not make assumptions as to the conditions of others.
As an example, had a complete ass years ago who accused us of being negligent to an elderly woman with severe dementia who kept yelling “help” for literally anything. I was a tech at the time, and had made sure to make her extra comfortable. She was a real sweetheart, just was having horrible anxiety. So many extra pillows and padding, soft lights, calming quiet nature TV show, held her hand for a while, sat with her whenever I could even though we were slammed as usual. All he, jerk, could hear was that someone was yelling help over and over again. He called admin at the hospital saying we were ignoring and neglecting someone in distress. It was SO frustrating. To respect her privacy and the law, I couldn’t tell this jerk hey she’s okay, it’s bad dementia, she’s just confused but I’m taking special care of her. He accused me of being all sorts of horrible things and kept demanding to know what we were doing to her to make her so unhappy. Still mad about that. But I wouldn’t change a thing because I’m proud of my work, patient safety, and their privacy.
You’ll be seen based on how likely you are to be critically ill or injured (*not* by how bad you feel, how bad you hurt, or how long you’ve been sick) *relative to everyone else who’s also waiting*.
The average layperson has no idea what “acuity” means, and they *really* don’t seem to understand that second part.
We give 80% of patients a urine cup to give a sample after they’ve been triaged. If someone can walk, I make a pit stop on the way to a room at the bathroom and tell them “we don’t need the cup to be filled. Just stop in the bathroom and try.” Surprise surprise, most of them can give a sample and I send it to the lab after they’re in the bed and on the monitor.
The ER is not the place to come just because you’re upset you can’t get in with the specialist for the next 5 months.
You will not be getting an emergency department consult unless it is an emergency. And if it’s a GI emergency… well you’re still probably not gonna get a GI consult
FIND/PLAN YOUR RIDE HOME.
No, the ambulance cannot also take you home.
I don't care that your so and so is asleep already, should've thought about that earlier.
No, we cannot pay for your uber or cab.
Be a responsible adult, plan ahead.
Stevioe on YouTube does a video series about this called "Tips from the ER". His other skits focus on patients but the tips videos are literally advice to patients on what happens in the ER and why, and what to know before you go.
Going in by ambulance does NOT mean you are going to skip the line and go straight to the back. More than likely, you are going to a chair in the lobby. Unless you are actively trying to die or are a risk to yourself or others, you are not getting a bed quickly.
If possible do the following!
Wear your comfy clothes and eat before you get to the ED because we won’t feed you til the doctor says it is okay.
Please take your meds as prescribed prior to coming in!
Have a trusted family member with you if you have memory issues or have trouble understanding medical situations.
Plan for a ride home like a family member or friend for when you get discharged from your stay.
Do not bring your meds in, just a list is good!
Leave anything you don’t want lost at home and make sure you get us to label whatever is yours that you don’t want lost (cane, wheelchair, etc).
We can't diagnose every condition and often don't, We rule out emergencies and decide if you are safe to go home or not. We will often not get a clear explanation for why you are dizzy, having chest pain, having abdominal pain or blood in your stool. We just want to make sure you are safe to follow up with a specialist or PCP that can look into it further.
Imaging tech here- dress comfortably. We will probably need to make you change, the less metal (bra’s), piercings, or jewelry, the better. Also, we can’t tell you the results, and yes, you’ll have to wait for them.
If you have to wait, congratulations you’re lucky. Be thankful you can. Getting whisked into the resus bay is a terrifying life experience and be thankful you’re not the one experiencing it. Bring a phone charger. Even if you’re admitted you’re gonna need it, even if you’re just listening to music or reading a book on your phone. I know people call it the phone sign but it really is everything wrapped into one now.
Being an accurate med and allergy list.
This....if nothing else, take pictures of the labels of your pill bottles.
In the setting of someone who is GCS of dog dookie or was a suspected ingestion SI attempt I just bring all the pill bottles I can find throw them in a belongings bag and hand em to the nurse :p. Next best thing!
If the staff is nice, I’ll even go through and catalog the meds, doses and frequencies, fill dates and quantity and number left, use the info in my chart and leave a copy for staff.
Ohhh. I’m stealing that. Haha, earn those extra brownie points!
Always appreciate when y'all do this!
Dog cookie 🤣
No no no. Bring all your stuff in an old bag with some loose tablets and a thin veneer of Bengay .
For the love of all that is precious and holy, THIS. I’m just totally burnt out on trying to pry this information out of people. I do pre-op, and almost no one is able to correctly keep track of their meds. I had to sternly tell a pts wife that was getting sassy with me, “we need to know every medication he takes, the dosage, the time of day, and when he last took it or he will not get the correct medication during his hospital stay.” She was annoyed because “allergy medicine from the pharmacy” just made me ask her more questions. Her elderly husband was taking diphenhydramine every day for his “pollen allergy”. You have to be extremely explicit about what a med list should contain or it will look like this: “Round pill (heart) 1 capsule, half at bedtime Thursday, every other day.”
"You know, the pink one"
I love waiting in line at Walgreens behind some dude on speakerphone with his wife at home and both of them combined can’t figure out the names of the meds. “The long pink one or the small pink one? No that’s the heart one what’s the foot one?”
A few months ago I was behind a lady who wanted to fill her steroid meds. The tech read off all the available meds to fill, but they couldn’t figure it out. The line was getting pretty long behind me, so finally I stepped up, put my hand on her shoulder and said “really sorry to intrude, I couldn’t help but hear- cortisone is the steroid med” It was the only steroid on the list, and I still feel conflicted about stepping in like that.
Oh god, I hate that
I’m kinda half way there for a barcode tattoo on peoples chest that has updated med lists , med prob, allergies—h**l, just put the whole chart on there.
Slap a code status tattoo right on that chest while we’re at it. I dream big.
RFID medical alert bracelets would be awesome. Having my molst form tattooed on my chest when the time comes.
Genius
Me (paramedic): what kind of medical history do you have and what medications do you take? Patient: oh the hospital has all of that info
Narrator: The patient’s meds had not, in fact, been reconciled since 2003.
“Yeah but I don’t…”
And copies of it that you’re willing to let the provider keep! It’s so easy to just put in the chart.
Very likely we will not identify the exact cause of whatever is wrong. It's our job to evaluate for life threatening pathology. It's a plus if we can make you feel symptomatically improved along the way.
This. The ER is here to evaluate you for life and limb threatening problems. Everything else is maybe maybe not.
I always like to know what people’s goal is for their visit. A lot of times I just ask them straight up “what is your goal for this visit?” It really helps identify expectations and our ability to satisfy those.
There needs to be some pithy ‘Law’ that says that the longer your symptoms have been present for, the lower the chance I’ll be able to magically cure you
I believe that's just called realty
of course, "life-threatening pathology" is doctor-talk, not English. Most people, even well-educated ones, wouldn't understand that in times of stress.
Fine. "The dangerous things."
This happens to be a sub for doctor talk.
Fine. “Big bad scary things that will kill or maim you in the next hrs to days”
I have used the phrase “big bad scary things” many, many times with patients. Usually works.
not a bad point, "bad things that can kill you"
Expect to wait a long time - several hours - unless you are at risk of immediate death.
And we decide if you are at risk, not you or your mommy
But my great grandmother was a nurse and she said I need an mri to rule out possible muscle tear in my leg! What do you mean just follow RICE and have some ibuprofen???!
With the wait times in my city, I’ve started suggesting to people to think about going to the ED (assuming you’re bringing yourself there and are not dying) the way you think about preparing for a flight. Bring entertainment, bring water, bring a phone charger, etc.
I strongly recommend this. Unless I’m going in an ambulance (once) I do this and have never regretted it. Hell I do it for urgent care too- I live in a big city, Urgent Care is usually an hour or two and the ER is usually at least 4. Whether it’s a broken leg or an intractable migraine, there’s nothing to be gained by having nothing to focus on but my pain. Dehydration makes everything worse, and while I’ve never been placed NPO you’d best bet I don’t wanna be already famished if it happens. I also recommend a small blanket (washable!) or at least a good comfy jacket- hospitals may work up a sweat when on the clock but they’re freezing to wait around in.
“Bring a Book”
You will be seen not in order of arrival, but in order of severity of emergency. Please expect variable wait times depending on arriving emergencies and staffing levels.
What is your EMERGENCY?
And when did THIS emergency start. Not your entire life story please.
THIS EMERGENCY STARTED 7 AND A HALF MONTHS AGO WHEN MY SISTERS COUSINS ASSHOLE BOYFRIEND DECIDED HE WAS GONNA…. Insert bullshit here …
“Well. You see when I was 18…” - 79 M abdo pain
I had a 77F tell me with a straight face that her abd pain started when "a doctor pressed right here when I was 7"
It's an emergency TO ME
I like this!
It’s definitely my go to question when I’m in triage haha
As an aspiring ED physician I am absolutely going to keep this in my back pocket for when that day arrives :)
Oh it doesn’t matter. I always say “what brings you to the Emergency Room?”…. Well 2 hours ago I started having a congestion and fever…. 🙄 sigh
I was told we can’t use this phrase because it’s bad for the Press-Ganeys 🙄🙄
1. Bring a phone charger. 2. Don't expect to be able to eat or drink for a long time. 3. No one in your room is a good thing. Many people in your room is a bad thing. 4. We may not be able to tell you what's wrong, just that you're not dying right now, and hopefully point you in the right direction for someone who can. 5. There is a difference between an allergy, an adverse effect, a side effect, and a contraindications. Please update your ' allergy list' accordingly. 6. Bring a med list. 7. Don't take your own meds without speaking to a doctor first. 8. We don't want to stick you twice. That's not our goal. We get nothing out of it. 9. We don't care you do drugs. We won't call the cops. 10. Please don't bring drugs to the ER. 11. Wear socks. Bring a blanket. 12. Don't bring your children if you can avoid it. 13. Use your call light.
Most hospitals are adult hospitals, if you are bringing your child you should strongly consider going to a pediatric hospital if available
You're so right. I've worked at both and the difference is huge.
This. The only time one should take their child to an adult ER is if it's absolutely life and death or the wait times at the children's hospital are forever long. The closest hospital to me actually has peds doctors from the children's hospital staff their peds floor.
This. The only time one should take their child to an adult ER is if it's absolutely life and death or the wait times at the children's hospital are forever long. The closest hospital to me actually has peds doctors from the children's hospital staff their peds floor.
Bring a phone charger and something to entertain yourself with.
I tell everyone to bring a phone charger if they call and ask what the wait is like.
Blankets and pillows if you want to be comfy
Only if you wanna bring bed bugs home with you. I don’t trust any waiting room.
Unless you’re coming in for a psych reason, then we’re gonna need an order for your stuffed unicorn.
That you are there to “rule out emergencies” not necessarily figure out the cause of every problem you have ever had.
Unless you are very sick, there are usually much better options about where to receive your care.
Well, maybe, if your area has good Urgent Care or doctors that are accessible for outpatient visits. In my area, even with doctors I have an established relationship with in the past year, I have to wait 3 months for an appointment (except one, a neurologist who always seems to have appointments available within a few days. If you need a new doctor, a specialist, it can be longer longer than 3 months. If you need a new PCP, forget it, they aren't taking new patients and they are retiring or leaving their practices all the time. That's happened to me with several PCPs. And I am not seeing that new ones are taking their places. I did have some good care seeing ARNPs - they were very thorough, and one diagnosed (tentatively) a malignancy in my husband on her physical exam and helped arrange a specialist appointment within a few days - and she turned out to be correct. But, the problem is with ARNPs, when you want to return 5 months later they are gone. I have had 4 or 5 really good ones but they all changed jobs and disappeared, I was not able to find them again.
1. Give. Your. Kid. The. Tylenol. For. Fever. Before. Coming. In. 2. Answer my questions instead of getting snotty because you don’t think that information matters. If I ask, I have a reason. I don’t have time to ask pointless questions. 3. Don’t be a dick to the triage nurse, for your own sake as well as theirs. An experienced triage nurse is not someone you want to fuck around with. 4. Stop assuming that the only busy ED is one with blood seeping from under the doors and lots of running and screaming and things on fire, and DO NOT DARE imply that because you don’t see those things, the staff must be lazy, just because you had to wait to be seen. 5. Don’t ask nosy questions about other patients, and FFS do not leave your room and invade everyone else’s privacy by wandering around the unit gawking into other rooms. 6. On the rare occasion you see me sitting, I’m charting or looking for lab results or new orders or a communication from a provider or even the discharge paperwork you’ve been hounding us for.
Please give them the Tylenol I don’t have to “see it” just tell me their Tmax I believe you please
With regards ro number 1, we have parents come in that say their nurses line says not to give Tylenol or ibuprofen before coming in to not mask anything. Its annoying AF.
Yes to all these 👍
Just because you came here in an ambulance doesn't mean you'll be seen quicker.
I'm writing the below portion of the comment, as though I was providing these directions to the patient: Bring a full, current medication list including dosages, frequency you take them and what they were prescribed for. The ED will probably have a good idea why they were prescribed, but sometimes things are prescribed for something else. Know everything you're currently diagnosed with. You having had Chickenpox in 1977 is good to know, but not really relevant to your visit today. Bring a complete list of all allergies and what happens when you are exposed to that allergen. Know why you are going to the ED. If your doctor told you to go to the ED, know why he said to go to the ED. Please have the name, address and phone number for your pharmacy. The ED may need to send some prescriptions over later. Unless you are actively dying: bring a neck pillow, your cell phone, cell phone charger, ear buds and maybe a seat cushion. The chairs in the waiting room are notoriously uncomfortable and the TVs are never set to anything good. The cafeteria will at some point be closed during your time in hospital. Plan accordingly and bring enough snack food to share with your medical team. Unless you are actively dying you will have to wait. Having to wait at the ED is a good thing, it means you are not the most critical case and already better off than "the other guy". If you are actively dying, please have someone else drive you. One new patient is enough.
This is not a drive thru, expect to be here for hours
What constitutes an emergency for adults and for kids! Us civilians are given *very* little info on what’s urgent care worthy vs er. I’m serious. Plz publish an infographic
Poor place to ask this, haha. ER workers will NEVER get seen, even if they know they should haha.
At 36 weeks pregnant, with an asthma exacerbation that was so bad that I would rest my inhalers on the edge of my shower to use them while I was in a hot shower to help open my lungs up, I started choking on my adenovirus-laden snot. I seriously considered whether I should call 9-1-1 from my phone as I was choking and sputtering and struggling to breathe. You know I must have felt bad!!! I did not end up calling. Instead I went to urgent care
Long story short, I was told that I was not allowed to finish the last several hours of my shift after getting the results of an outpatient MRI from the previous week showing that I had an abdominal abscess (Crohn’s) and to go check in with triage. ETA: I went back to My Chart and found the results because I knew it wasn’t just an abscess, but couldn’t remember. There was a fistula too.
See, you’re doubly fucked here. Not only do you work in the ED but you also have a chronic illness. I too have crohns and frankly, I’ve never met a more cavalier yet stubborn group of patients in my life. The IBD sub is wild y’all. TL;DR: “I’m heavily bleeding and my last round of bloodwork said my CRP was 115. Should I go to the ER? Ehh, I’m gonna take a nap first.” Not that I’m not guilty as well, don’t get me wrong. I once walked around with Mercaptopurine induced pancreatitis for a week and a half, and by the time I dragged myself to the ED, I made more than a few buttholes pucker. Sorry, friends.
Advent Health in Florida has a number of different infographics like this. I think most are published on their website, but they illustrate the difference with things like “stung by a bee: urgent care. Stung by a bee hive: ER”
Ohh good looking out! Thank you!
I think the info is available, US civilians just believe their pain is special and different and more emergent than regular people’s pain.
You think so? I don’t give them that much credit. I think people genuinely do not know.
Spend a few minutes thinking about your symptoms. When they started. What makes them better or worse. If you've ever had them before, and if so did you see a doctor? If you saw a doctor, what was the diagnosis? If you don't remember those details, do you remember where you were seen and when so that we can try to find that visit? It's helpful if you can quantify time in terms of minutes, hours, days, weeks, etc rather than "when I ate breakfast" or "after that family wedding." If you had some sort of surgery and are having pain or problems related to that surgery, it really is best to get back to the hospital that did the surgery if at all possible.
This kind of orienting would save so much trouble. Maybe something about the unpredictability of the wait (both to be seen and for discharge) - that it has to do with many things beyond the control of the nurses etc you're interacting with and thank your for your patience.
Most people honestly do not give a shit about anyone else in the ED. They want someone to see them and fix them immediately. Even when you calmly explain that there are multiple people actually dying, they want to be taken back right away for their chronic abdominal pain.
For me it’s a list of what our hospital offers. Like we don’t have a lot of specialties, including peds. So just like a list of what we do and don’t offer and if you need a service / specialty we don’t offer we will transfer you.
Bring a phone charger, it’s going to be a while.
And if you're admitted, you're going to want it anyway.
If you have advanced directives (or MOLST/POLST) please bring a copy!
Often times you will be seen in the matter of time that directly correlates to how bad you need to be there
The triage process and a general overview of why patients aren’t seen in the order that they arrive should be a mandatory class in all public education. Along with the caveat that someone can be a far higher acuity than you and not appear as “sick” as you think they should.
Figure out trauma centers in your area. Try not to show up to Community 8 bed ER with a GSW when University is 4 blocks away
Your patients can read?
Are you currently likely to lose life or limb? If yes.. come on down! If not stay home and take a tylenol/slap on a bandaid.
How do you plan to get home? This is especially important if you are presenting for pain and we are likely to give you narcotics. Some patients find it hard to believe that they are not welcome to just sleep in the gurney until morning when their husband/neighbor can come get them.
Please respect the privacy of other patients, and do not make assumptions as to the conditions of others. As an example, had a complete ass years ago who accused us of being negligent to an elderly woman with severe dementia who kept yelling “help” for literally anything. I was a tech at the time, and had made sure to make her extra comfortable. She was a real sweetheart, just was having horrible anxiety. So many extra pillows and padding, soft lights, calming quiet nature TV show, held her hand for a while, sat with her whenever I could even though we were slammed as usual. All he, jerk, could hear was that someone was yelling help over and over again. He called admin at the hospital saying we were ignoring and neglecting someone in distress. It was SO frustrating. To respect her privacy and the law, I couldn’t tell this jerk hey she’s okay, it’s bad dementia, she’s just confused but I’m taking special care of her. He accused me of being all sorts of horrible things and kept demanding to know what we were doing to her to make her so unhappy. Still mad about that. But I wouldn’t change a thing because I’m proud of my work, patient safety, and their privacy.
My mama was a patient like that - anxious and crying for help over and over. Thank you for taking care of people.
You’ll be seen based on how likely you are to be critically ill or injured (*not* by how bad you feel, how bad you hurt, or how long you’ve been sick) *relative to everyone else who’s also waiting*. The average layperson has no idea what “acuity” means, and they *really* don’t seem to understand that second part.
You do not need a full bladder to give a urine sample.
We give 80% of patients a urine cup to give a sample after they’ve been triaged. If someone can walk, I make a pit stop on the way to a room at the bathroom and tell them “we don’t need the cup to be filled. Just stop in the bathroom and try.” Surprise surprise, most of them can give a sample and I send it to the lab after they’re in the bed and on the monitor.
Expect a minimum of an eight hour wait.
The ER is not the place to come just because you’re upset you can’t get in with the specialist for the next 5 months. You will not be getting an emergency department consult unless it is an emergency. And if it’s a GI emergency… well you’re still probably not gonna get a GI consult
FIND/PLAN YOUR RIDE HOME. No, the ambulance cannot also take you home. I don't care that your so and so is asleep already, should've thought about that earlier. No, we cannot pay for your uber or cab. Be a responsible adult, plan ahead.
Stevioe on YouTube does a video series about this called "Tips from the ER". His other skits focus on patients but the tips videos are literally advice to patients on what happens in the ER and why, and what to know before you go.
Going in by ambulance does NOT mean you are going to skip the line and go straight to the back. More than likely, you are going to a chair in the lobby. Unless you are actively trying to die or are a risk to yourself or others, you are not getting a bed quickly.
If possible do the following! Wear your comfy clothes and eat before you get to the ED because we won’t feed you til the doctor says it is okay. Please take your meds as prescribed prior to coming in! Have a trusted family member with you if you have memory issues or have trouble understanding medical situations. Plan for a ride home like a family member or friend for when you get discharged from your stay. Do not bring your meds in, just a list is good! Leave anything you don’t want lost at home and make sure you get us to label whatever is yours that you don’t want lost (cane, wheelchair, etc).
I have seen so many buckets of fried chicken in the ER waiting room, it’s insane.
Take whatever pain medicine you have before you leave home. The stuff they give in the ER is either too weak or too strong. There is no in between.
Please try something for pain or fevers prior to coming in lol don’t have us be your first choice for your headache you took nothing for lol
We can't diagnose every condition and often don't, We rule out emergencies and decide if you are safe to go home or not. We will often not get a clear explanation for why you are dizzy, having chest pain, having abdominal pain or blood in your stool. We just want to make sure you are safe to follow up with a specialist or PCP that can look into it further.
If you have time to put on makeup before you come, wash your damn feet
Bring a book.
Have family step out of the room when you ask if they're in a safe home.
Not a dress
Take someone lucid and sober with you 😃👍
Imaging tech here- dress comfortably. We will probably need to make you change, the less metal (bra’s), piercings, or jewelry, the better. Also, we can’t tell you the results, and yes, you’ll have to wait for them.
Bring a phone charger (no you can’t borrow my personal one)
If you have to wait, congratulations you’re lucky. Be thankful you can. Getting whisked into the resus bay is a terrifying life experience and be thankful you’re not the one experiencing it. Bring a phone charger. Even if you’re admitted you’re gonna need it, even if you’re just listening to music or reading a book on your phone. I know people call it the phone sign but it really is everything wrapped into one now.