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Sunday, April 21, 2013

Triage That Rash A Level ONE Next Time!!!

Or don't.  Probably don't.  Definitely don't.

At our hospital, we use the ESI triage system, where a 1 is the most critical patient (CPR currently in progress) and a 5 is the least critical (somebody sneezed earlier).

Well, there was a young lady there with her six year old son who had a small, seven inch by 3 inch red area on his left forearm.  It was itchy, and red.  The kid had been playing outside at a friend's house, out in the monstrous expanse of property that people tend to have out here.  The kid has had poison oak before, and it looked just like this and felt just like this.  This rash had been progressively getting worse over the last week or so with continuous scratching.   No, the kid had not been to a dermatologist or his primary doc.

The night this mom decided to bring her son in for the poison oak spot was a particularly rough one.  Rooms were all full.  The on-call nurse had been called.  We had CNAs sent down from the floor to help vitalize, transport, and take care of other CNA-y tasks in order to free up the nurses to do meds, assessments, and work codes.

Out of the 8 nurses there (including the charge nurse and triage nurse), three were in a trauma room with a traumatic arrest, two were in another room (on the opposite side of the ER) working a cardiac arrest, and one (me) was in yet another room working a damn STEMI.  The triage nurse was up front, triaging patients in the waiting room.  With two doctors, we had one in each of the arrests, while one occasionally popped his head into the STEMI since he was close.  This left one nurse to attempt to take care of the other seventeen rooms by himself while the rest of us were in critical situations.

Well, this night happened to be one where the majority of people in the ER were using it for something that they actually needed to be in the ER for.  That meant that most of the other seventeen rooms were needing monitoring, meds, etc.

Ok, so here comes the lady with the poison oak kid.  She marches out of her room (I can see out of the glass doors of the room I'm in) and asks in a quiet and respectful tone screams her lungs out at the poor nurse trying to keep an eye on seventeen rooms.
The Not-So-Patient Patient: This is fucking bullshit!  I've been here for three damn hours!  When is the doctor going to see my son!?!?
Nurse BusyAsHell (in a calm, but stern voice): Ma'am, there are multiple patients in this ER that are dying on the table as we speak.  The doctors and other nurses are in the middle of saving them and bringing them back to life.  You guys are going to have to wait a while.
The Not-So-Patient Patient:  But we've been here three hours!!!
Nurse BusyAsHell: Ma'am, we don't see patients based on how long they've been here, but on how critically ill they are.  That means your son is going to have to wait a long time.  The good news is that he's not the sickest person here.
The Not-So-Patient Patient: Well, if there isn't a doctor in my room in the next thirty minutes, I'm walking right out of here!
Nurse BusyAsHell: Well, that's just not gonna happen, so have a nice night.
*Lady grabs son by the arm and stomps out of ER cussing and yelling.

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