Tuesday, January 11, 2011

Step into my triage box...

It's always an interesting night when I'm in triage, for two reasons. First, it means we actually have extra staff, enough that we can spare a nurse for out front. Second, instead of being a shit magnet, I'm a stupid magnet. Yes, ERs in general attract the not so brilliant, but sometimes I really have a special talent. Such was Sunday night.

A guy brings his two-year-old son, complaining of a cut on his head that was still bleeding a little bit.

I started doubting the bleeding part when it took the guy five minutes combing through his son's buzzed hair before he asked the kid, "Okay, buddy, where is it?" The kid points at the part of his head that apparently hurts, and we finally find it. A little round abrasion, right there on the top of his head, a whopping two millimeters in diameter.

Needless to say, there was not much blood involved.

"So, what's the problem? Why did you bring him in?" I asked.

"Well, he hit his head on the corner of a door this morning, and tonight when we were putting him to bed, he sad that it hurt," the man explained, looking at me expectantly.

I obviously didn't get his point.

"And did you give him any medicine for the pain, like Tylenol or Motrin?" I asked.

"No, I just brought him straight here!" the man said.

I promptly triaged him a level five, which is completely non-emergent.

I essentially had the same conversation with the parents of my next patient, except instead of a non-laceration and a headache, we were talking about an improving cough and a "really high fever" of 98.9F.

"So why did you bring him in today?"

"Well, he's already been on antibiotics for four days, from the pediatrician, but he's still having fevers. I felt like the Motrin wasn't working, so I stopped giving it to him, and just use the Tylenol, but now his fever comes back every five hours. It gets really high, too, like a hundred and ten degrees."

Right. I resisted the desire to ask how they measured his temperature to 110 and if his fever started coming back after she stopped the Motrin.

Seriously, guys? The FDA makes these medications over the counter for a reason - if you follow the directions, they're very safe and very effective.

Although sometimes, talking to these people, I wonder.

When we hit a lull around 10pm, I made my way to help out in the back. Fortunately, it was a pretty calm Sunday night, and we only had about eight patients. I was just considering asking if I should be sent home early for low census when the EMS radio went off.

My stupid magnet was working for the ambulances, too, apparently.

Over the radio, we received report: "We're bringing you a 40-year-old male patient, discharged from your facility yesterday with pancreatitis. Today he noticed his left wrist turning purple, and called us. He admits to drinking seven beers tonight..."

We stopped listening there. Everybody threw out names of our frequent fliers, and finally somebody mentioned the right one. I knew, because he'd been my patient the day before. We then speculated that he'd gotten drunk, fallen, broken the wrist, and not noticed until it started turning purple.

No such luck.

First, he had to peel off all eight layers of clothing he was wearing. Then we asked, "What's wrong today?"

He pointed to a big bruise on the inside of his wrist and said, "It looks like you guys messed up when you started an IV!"

"Well, that's what happens when you come in twice a week, drunk, with your pancreatitis. The alcohol thins your blood. You're going to have bruises."

"Yeah, but it hurts!"

"And what do you want us to do about it?"

We didn't get a clear answer to that one.

Sometimes I have trouble deciding whether I'd rather be a shit magnet or a stupid magnet. I lose patience very quickly with stupid. Although, watch tomorrow be a shitty day. Then I'll change my mind.

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