Surfing for Porn - AKA reading other ER blogs

I seriously Laughed My Ass Off reading THIS blog.  No seriously.  It slid down the back of my thighs, did a ski jump off my muscular calves, and landed with a greasy sounding PLOP! on the floor behind me.

Seriously.

OK, it really just slid off my backside like the blob it is and settled into the canyon between the couch cushions.  I'm still trying to find a way to reattach it.  Cuz I need my ass.  I truly do.

So props to Candice  and her amazingly funny blog.

(Plus - she uses the word fuck a lot and how can I resist a fellow trash mouth?  Huh?  How can I?)

Come to think of it, I haven't cussed much lately on my blogs.  Maybe that preachy woman actually did get to me.  Must remedy.  Pronto.

Sanctimonious Assholes.

I feel better already.  Sigh.........

Medical Screening Exams

At our facility, the RN's perform the Medical Screening Exam (MSE for short).  An MSE is the initial exam you receive in the ER to determine if your need is emergent or non emergent.  This must be done before any financial information is requested from the patient (such as insurance info).  Basically, it's a quick assessment and any testing that may be needed (such as a quick lab draw or xray) to determine if you truly need to be seen and use up ER resources.  An MSE is required by our government so that we don't dump you on some other hospital or refuse to treat your emergency if you don't have insurance.

Let us discuss......

Please.

Because some things drive me to drink and this is one of them.  

#1 - This does not, I repeat, NOT mean that you are entitled to a free ER visit.  We DO get to charge you.  We just cannot ask for financial info until after the MSE.  Some hospitals happen to not charge for MSE's that are not seen by a physician, but every facility is different and can choose what they charge for.

#2 - An MSE is NOT an ER visit.  It is a screening to determine if your situation is emergent or not.  Emergent means life or limb threatening, or acute pain.  Example:  A stroke is emergent.  A sprained ankle is not.

#3 - If we deem your visit as non emergent, we do have the right to tell you so.  We also may tell you (but not always) that there is NO need for you to be seen in the ER and that you should follow up with your primary provider.  Follow ups can even wait until Monday.  Yes - they can.  If you are seen in the ER anyway (either because you insist on it or because the facility allows it), you will probably have a tremendously long wait (think 6-8 hrs) because the emergent patients come first.  You come last.  Sorry, that's just the way it is. 

#4 - If you do not have a primary provider - get one.  If you do not have insurance to see a primary provider, what makes you think that going to an ER will be any cheaper?  We are usually 4 or 5 times the cost of going to a doctor's office.  Example:  office visit for sprained ankle approx $100.  ER visit for sprained ankle approx $600.  Most physician's offices will work with you to arrange payment options.  Yes, even those that ask for money up front.

Side vent - for those who say they cannot get in to see a physician because they have not established previously with the practice, take the time to do so on a day you have some free time.  That makes it so much easier for you to get that appointment for a sore throat when you call the doctor's office.  If they already have seen you and you've established care, they can put you into the open slots they save for daily immediate care cases.   

#5 - We'll ask for money too.  We just won't ask until the MSE is complete.  That means we may tell you that you need to pay your $100 copay (average ER copay) up front before being seen any further.  Yes, we are an ER but we are also a business.  

#6 - If your visit is deemed Emergent, then you will be seen regardless of insurance, ability to pay, or any other defined item.  You will be taken care of.  Period.  But...... it is our decision to make.  Not yours.  

#7 - Even if a physician performs your MSE, these same rules apply.

Now let's move on to the nurses, because we have some stuff to learn too.

SHHH - don't tell anyone I said that out loud.

#1 - Not every person needs to be seen in the ER.  It is OKAY to MSE them and discharge them out of the ER for follow up with their primary provider.  

#2 - YES - even if they have no insurance to be seen at a clinic.  Do you think that means we'll ever get paid?  We do not (yet) get government reimbursement for non emergent visits. 

#3 - Standing Orders may be used for MSE's.  As long as your policy says so, then do so.  Think of it this way - if you have a Chest Pain come in, do you wait for the MD to come up from the cafeteria and give you an order for an EKG before you do one?  Didn't think so.  I bet you use your cardiac standing order sets (or some such name). 

#4 - And for you overachievers out there....... when in doubt, have them seen by the ER doc.  We are not allowed to diagnose a patient.  Remember your scope of practice.  

#5 - Last but not least, an MSE is a whole different monster than Triage.  Triage determines who should be seen in what order.  An MSE determines if they should be seen at all.  

Of note for all you medical peeps out there:  Our state has determined that it is within the Scope of Practice for an RN to perform Medical Screening Exams as long as a proper orientation and monitoring program is set up and followed.  

And apparently I am supposed to remind you that this is my OPINION and not a teaching tool for MSE's.  If you'd like a teaching tool, you may contact me via email and I will share our MSE orientation packet and monitoring program.  It's not big, nor is it impressive.  Just warning you now. 

Alrighty then, I am off to pour a glass of vino because just typing this out made my head hurt.

Photo Blog

Just a quick note to post a link to a new photo blog.  There are some pretty neat pictures at Eastern Oregon Photos. 

I'll Just Get Right On That Suzy Q

If you are diagnosed with a fracture and the ER doc tells you to follow up with an ortho doc, it is NOT our job to arrange that referral for you.  We are busy.  Go to your primary care doc within 1 to 2 days and have their office staff arrange for the referral.

I do not have time (nor the ability on a weekend) to call your insurance, obtain approval, and then arrange an appointment with the ortho center.

I'm too busy doing CPR on this 21 year old who overdosed on sleeping pills.

And if you continue to be snippy with me, I will curse you in my prayers.

Just sayin'................  

Time Machine and the Flu

2 years ago these same symptoms would have been called "A Virus" and everyone would have been told to go home and let it run it's course.  Now all of a sudden everyone has "the flu" and is getting rx'd for Tamiflu or hospitalized, sometimes unnecessarily.

I brought this up to Dr Q the other day at work.  

"I know," he responded.

Love how the media has determined how we treat patients this year.  

Sigh............

Reciprocity

My new friend Richard, AKA Rich apparently, left me a comment asking I link to his post about iPhone apps for EMS personnel.

Hmmmm.... I thought.  Ah-ight.  Can do.

So HERE YOU GO.  

Alas, in my little Burg one cannot use an iPhone.  Piss poor service and reception I hear.  Our 4 bars of Verizon equals 0.25 bars for iPhone.  

But for the betterment of humanity, I shall overcome this little setback and post the linkyloo for those of you who can use it.  My selflessness is of benefit to you.  Yes, Yes.  I know.  

I deserve the Nobel Peace Prize too damn it.  

Update From The Burg

Well craptastic - it's been a while eh?  I guess my life in the ER has not been interesting enough to provide you all with a story or 2.  Either that or I'm just a lazy piece of work that hasn't had the inclination to log into my blog and share.  I'm going for the second excuse.  

Flu season has hit my little burg.  Not only at work, but at home.  I have 2 sickies home today skipping school.  I heard that 50% of my oldest kiddos class is out of school sick with flu like symptoms.  We also have about 15% of our staff out related to their own or their child's illnesses.  Oh boy - the joys of winter!

I've been spending a lot of time on the internet looking at non medical things - like facebook.  Sometimes you need a break from anything medicine related.  Right now is my Sometime.  

I had someone ask me a while back, "Do you think this is a trauma?" for a patient who was pitched over a motorcycle, into a barbed wire fence, and had 2 long bone fractures, a positive LOC (loss of consciousness for my non medical peeps), and a probable flail chest.   

Um..........

Yeah.

Idiot.

Some people are dumber than a box of rocks. 

It's Not A Tumah! It's Not!

"OH MY GOD !  MY WIFE IS HAVING A SEIZURE IN THE CAR!  HELP ME!"  He screams as he runs through the ER doors.

Up we jump, 'cuz we're like Les Schwab Employees.........always running to greet you.

Lucy and I hop up out of the chairs at Nurse's Station, leaving our Peanut M&M's behind.  Sigh.....I had just opened that damn bag.  Now I won't get to finish it.

We walk out the double doors and into the drive up.  A blue '78 Caddy is idling with the front door open.  A large, no very large, lady is sitting in the front seat applying lipstick.  

"Is this your wife?" I ask.

"Yes ma'am," he replies.

"She's not having a seizure," Lucy says.  She's a smart one, that Lucy.  

"Well she was!"  he insists.  "She had a seizure at home so I threw her in the car and drove her up here!  It scared me!"

You threw her in the car? I was thinking.  How on God's green Earth did you do that alone? 

Finally his wife pipes up, "Oh yes, I had a seizure.  I'm so lethargic now.  I just can barely stand up honey.  You'll have to help me out of the car."

Um....... I call a bullshit. 

"No ma'am.  You'll have to get into this chair on your own.  I've got a bad back."

Up she pops and flops down into the chair.

"OK dear, you better hurry and get me in there because I feel another seizure coming on."

Oh Dear God.

Lucy and I escort her back to Exam 2 and get her onto a stretcher.  She pulls out her cell phone and calls her daughter as I'm trying to obtain her history.

"Sarah?  Sarah?  You better come up to the ER.  It's your mommy honey.  I can feel a seizure coming on and they have me in the ER.  Hurry baby, hurry!"

Oh for Christ's Sake.  Insert eye roll here.

I hooked her up to the monitor and got her vitals.  I finished her history and went out to talk to Dr. Q.  It was right about this time that her daughter showed up.  She walked into her mother's room and within 10 seconds was out in the hallway screaming "MY MOTHER IS HAVING A SEIZURE!  HELP ME!"

So Lucy and I leisurely make our way to her room.  By leisurely I mean we finished our bag of Peanut M&M's and downed the rest of our Diet Cokes.  We then scratched our butts and walked over there.

Now before you give me the whole uneducated attitude of "GASP!  What a shitty nurse.  Why would you not RUN?  Run, Forest Run!  That poor lady is having a seizure.", let me explain something to you........

This lady was having a seizure like I was winning the lottery.....

Not happening.

I did not for one second ever think this woman truly had a seizure.  Not once did she act post-ictal.  

Anyway - back to Exam 2.

Lucy and I walked in to the room and observed her "seizure."  And let me tell you, that's a loose word to describe this event.  I like to think that "Idiotic fake ass 3 year old fit thrower faker" would be more suitable.

Our patient's husband and daughter were standing beside her stretcher wringing their poor little hands while our patient was babbling and cooing like a baby.

I shit you not.

She was shaking her head back and forth and saying "wah wah wah bah bah bah momma momma dadda dadda wah wah wah bah bah" over and over.  And over.   Then she started kicking her legs.   And asking for her "ba-ba".

Oh Good Lord in Heaven above.  Help me please.

Right about that time, Dr. Q runs in to save the day.  "CT Scan STAT!"

"Dr Q - please observe the patient's seizure first."

He takes one look at her and orders a psych consult, then turns around and walks out the door.

Daddy and Sarah were not too happy with us.  "She doesn't need a psychiatrist!  She needs a doctor!  There's something wrong with her!  She probably has a tumor."

"It's not a tumah" I said in my best Arnold accent (points for throwing in the Terminator here).

"It's highly unlikely your mother has a tumor," Lucy replied.  "She is not having a seizure, she is having some type of mental event."

All of a sudden Mommie Dearest popped up and said "I am too having a seizure!"

Ho Boy.  We've got ourselves a winner here Bob Barker!

The end result of this visit was a psych consult, a discharge, and a family complaint that we did not offer her a CT Scan for her Tumah.    Two days later I was eating at our local greasy spoon when her daughter came on shift as our waitress.  Oh joy.  I got to hear her tell the guy next to us how the Hospital didn't take care of her mother and she wouldn't even take her dog there.  Well goody for you.  We don't want your dog there either.  

Dear Mr Resident: way to smack down the haughty x ray tech. I'm very proud of you.

At class. I'm cracking up listening to the med students sitting beside me discussing how much they know. I'm also getting an ear full about how much nurses suck. they obviously don't know as much as they think they do or they'd know nurses will save their asses through med school and fix their mistakes. Oh preach on dear med students. Preach on.

This is my Tom Tom. Cell phone on my shoulder, pen in hand, writing as i drive. I'm gonna end up one of my own patients. Stupid stupid nurse.