Thursday, March 6, 2008

Late night reflections...

Had a patient who came in after hot roof tar in a bucket overturned and splashed all over his hands, neck, ears, and face. We called a burn center and they told us mineral oil would take it off. Believe it or not, we did not have access to a vat of mineral oil. The work crew that came in with the patient brought in a large amount of alkali "degreaser". We tested it on his hand and it took the tar off without doing any more skin damage. We went to work to remove all the tar. Of course, under the tar was a second degree blister. Everywhere the tar splashed was a painful blister. The patient was amazingly cool about the whole situation. He smiled, he joked, he helped remove the tar along with his buddies. We took over the ER bathroom with sponges, towels, degreaser and fumes. What I learned: Cool the tar as fast as can using cold water. Use a alkaline degreaser or mineral oil to remove the tar as fast as you can. Take antibiotics to ward off infection and apply silvadene or neosporin to help heal the burns. This guy was lucky, he was wearing a hard hat and goggles that protected his head and eyes. His safety goggles were covered in tar...

Had another patient who came in complaining of "the worst headache" of her life. This is a key phrasing that many health care professionals interpret as either a brain bleed or meningitis. Either way, a life threatening illness. The patient was in her early twenties and, in my opinion, was so focused on herself that she didn't pay any attention to anyone else. When she was brought to our waiting room we had four other patients waiting to be seen. So basically she walked into a "full" waiting room. She proceeded to walk straight up to the nurses station and ask, "Am I supposed to wait? Can't you put me a room right now?". So basically she is saying, 'I am more important than everyone else.". That pisses me off. I told her she needs to wait, just like everyone else. Not that we down played her complaint. But the possible appendicitis and the severely broken ankle was just as important. We got her into a room and did our usual, blood draws, IVs, meds, ordered a head CT. The PA (physicians assistant) had told the patient the possibility of meningitis (which any good practitioner would because of the original complaint) and the tests we would be doing. What bothered me about this patient (besides the fact that she thought she was the only person in the department) was that she was not acting like a typical meningitis case. I know, because I had meningitis three years ago. She claimed to have the worst headache of her life, but she was laughing and joking with the twenty family members coming in and out of the room. I couldn't tolerate light, voices, and sent everyone out of my room. She claimed to have neck pain but easily moved and adjusted herself to a position "to get comfortable". I hate to be cynical but when I had meningitis I was unable to move, open my eyes, and was vomiting (dry heaving) about every minute. I just wasn't buying it but I have been wrong before. I kept my opinions to myself this time. Well, every test turned out negative and she went home with a diagnosis of sinusitis. (Infection of the sinuses which causes a bad headache but far from life threatening.) An ER nurse has to be very careful of peoples complaints because some people way over exaggerate and some people are so stoic you have no idea how sick they are until they "crash".

1 comment:

Mama Nomad said...

yes, pain perception is so relative...i have seen and heard a lot about this in labor....a women "can't" be ready to push b/c she hasn't made a peep or broken a sweat, no way she's at 10 centimetrs! then another can be screaming up a storm and saying "i want to die!!" (a good sign of transition--lol) and only be at 3.

it would be risky to assume someone didn't have something serious, but keeping your mouth shut while the tests confirm and the diagnosis is made would be tough!