ER and Emergency Services

Circulatory, vascular... whatever you want to call it, it’s just such a tacky, cringey way to put it 🤣
I’m pretty sure Vegarica cooked that one up (can't say for certain), probably trying to be all fancy with her "refined" American vocabulary 😂

And then, bam—it hits you with the shock, the irreversible kind, where everything just falls apart—everything just collapses...

kemik said:you know, I’m just not so sure about that.

I really don't want to sound like I'm judging Kimberly Wright—honestly, I don't even have a strong opinion on her—but I have this nagging fear that if they had been told that in Oakland (a place I wouldn't set foot in even if a heart attack hit me right in the middle of their parking lot), she and her boyfriend wouldn't have just taken it; they would have kept moving until they found a doctor willing to actually do something.

Kimberly Wright, please, correct me if I've got this all wrong.

Well, here I am, correcting you. You've got it wrong. In Oakland, one of the doctors actually looked at his hand and started talking about an anti-tetanus shot, telling us to head over to the registration desk. Then the nurse realized the guy didn't fall under the jurisdiction of the new hospital, so she waved someone over to ask the chief resident if they were allowed to admit us. The answer was no, and they told us we had to go to St. Jude's instead. At the place where the doctor examined the hand, he said this and that needed to be done and told us to register at the desk. But then the nurse at the clinic near the downtown area brushed us off because we didn't fit the criteria for St. Jude's, and once we got to the facility over on Washington, the doctor there gave us the same instructions on what to do and sent us along to the specialist clinic.

At no point did anyone ever say, "Oh, it's nothing to worry about, you can just head home and relax."

Scott Allen10 said:but, don't we all agree that any kind of "shock" is basically just a total meltdown?😂

You betcha, kiddo...🧐 ...I mean, if there's air bubbles or turbulence involved, what else could you call a complete disaster?...😵

Whenever you're dealing with an infected wound, you really need to get unspecified to the patient if they haven't been fully vaccinated—meaning all three doses—within the last 8 to 10 years. Even if they have been up to date, if we're looking at a high-risk injury, like a combat wound from a gunshot or an explosion, or even something messy like a puncture from farm equipment or a cut contaminated by soil where tetanus spores might be lurking, you've got to go the extra mile. In those cases, you’d administer a booster shot along with tetanus antitoxin hyperimmune globulin (usually around 250-500 units IV), plus a triple antibiotic cocktail. Fortunately, that's not quite the situation we're facing here.

Susan Martin24 said:Look, you can't just stand out in the hallway doing triage—nobody would take you seriously, and I guess unspecified is right here 😘
That might work in a war zone, but if you want to run a real clinic, you have to actually examine and log every single patient who walks through the door. We’re talking dozens of people every day, so yeah, the wait times get crazy... you can't just wrap everything up in three minutes...

there wasn't time for triage, but there was plenty of time to basically tell people to beat it and go to another hospital, huh? 😉

I mean, if dozens of "wrong" patients show up at one ER clinic every single day, and a huge chunk of them don't even need emergency care, wouldn't it be a genius idea to have a reception desk staffed by an intern (or better yet, a trained nurse)? *okay, look, I don't know exactly how much specialized knowledge is required or what the official hierarchy is, so please don't correct my terminology* —but they could act as a sort of triage. That would, like, A) take the load off the doctors; B) speed up the whole line so people who actually need help get seen faster; and C) help those folks who otherwise end up sitting in a waiting room for four hours just because they needed some Tylenol

Or maybe even phone triage is a decent fix? (Though, honestly, that didn't really help when my grandma was sick, even though it worked perfectly for my grandpa thanks to the instructions from the guys at the ER, which meant the ambulance didn't have to come out)

What doctors really need to wrap their heads around is that patients—regular folks (even those who think they know something but are totally wrong)—are in pain, they don't know what's wrong, and being scared is just a totally normal reaction. When people are scared, we all know they get tunnel vision, so it's totally expected that they'll head to the only place they know: the ER.

So, like, that desk I was talking about could
- tell one patient over the phone, who's had diarrhea since this morning but isn't vomiting, that it's just a standard stomach bug and to (if they don't feel better) hit up their regular doctor tomorrow
- tell another person who has a massive fever and a killer sore throat despite taking meds to head to an infectious disease clinic instead of trauma...
- tell a third person that it's totally normal for their first period after ovarian surgery to be super painful and that they shouldn't panic...

And all of that would just relieve the pressure on
the main ER
emergency admissions
the healthcare system in general

atlantis, honestly—the stuff you’re rambling about? I feel like my primary care physician should probably be the one handling that kind of situation instead of me

grumpycat said:brisknomad6, honestly, what you’re talking about sounds like something my family doctor should just handle over the phone, I guess.

I mean, I don't think they're actually paid to be on call 24/7 or anything...

Like, at my local clinic, maybe 80% of the patients are retirees. Just imagine how much sleep those nurses would get if they were actually expected to be available around the clock. My grandpa alone would probably be calling her at least once a week because he can't catch any Z's at 3 in the morning.

Plus, the ER is pretty far out from us, most of them are strangers, and I'm basically the only one who calls 911 if something goes sideways—so we really only reach out when it’s a legit emergency.

Hey Susan Martin24, I was wondering—couldn't that be a stronger local allergic reaction rather than just simple inflammation? Even if my hand wasn't super swollen right after a few hours, but then it flared up later. Honestly, if we're talking about an insect sting, that’s the first thing that pops into my head. It doesn't always have to involve the whole arm swelling up; sometimes you just get a localized, milder reaction.

Atlantis - honestly, that’s a great concept in theory, but in practice? It’s just not happening. 🙄

Let’s talk about phone triage for a second. 😬
Basically, that’s how almost every ER dispatch center operates—you get a nurse on the line (usually, though sometimes it’s a doctor) who gathers all the initial info.
There are two major roadblocks here:
1. Patients or their families don't always give accurate information. Sometimes they do it on purpose, sometimes it's just an honest mistake. You can't really blame the ER if things go south or someone passes away because the intel provided was wrong. 😈

2. Even if they take the advice given over the phone and follow it, patients often still insist on coming in anyway, or they feel like things are getting worse. So, you haven't actually solved anything; you're still dealing with a massive influx of unnecessary visits that clog up hospital capacity and force people who truly need urgent care to wait in line.

And regarding a dedicated triage desk—man, that would be amazing. I remember being asked about this ages ago, and I was such a huge advocate for it.
Take the Emergency Room at Mayo Clinic, for example. You’ve got young doctors just starting their residencies working there, but the whole system kind of falls apart when there's pressure to give every single patient a full, exhaustive workup with every specialist exam imaginable. It happens mostly because people are terrified of missing something—even though mistakes happen regardless—and they want to prevent any grounds for a lawsuit. You know the drill: "They didn't even look at me, they just sent me home and said I was fine, but then my heart gave out..."

So, no matter how you slice it, it's a mess. People are waiting, they're being bounced from department to department, or sent back to their primary care docs. I don't see a way to fix it unless we replaced those one or two doctors on a shift with like ten of them. Then everything would run like a well-oiled machine. But let's be real, there's zero chance of that happening. Medicare has these incredibly strict mandates on staffing ratios—like, exactly one surgeon per 40,000 to 60,000 people—and they don't budge on those numbers even an inch. 😈

Honestly, you guys have no idea how relieved I am that I don't have to deal with the headache of ER organization and shift scheduling anymore. 🎉

atlantis said:I mean, I don't think they're actually paid to be on call 24/7...

Well, looking at my doctor's office, for example—it’s like 80% retirees—so just imagine how much more sleep she'd get if she actually had to be available around the clock. I bet my grandpa would end up calling her at least once a week just because he couldn't sleep at 3 in the morning.

The thing is, the Emergency Room is pretty far from him, and he doesn't really know the staff there, so I'm usually the only one who calls if something comes up... so we really only reach out when it's absolutely necessary.

My doctor is definitely reachable (and even the pediatrician I know privately—he stays available to his patients on his personal cell phone)
Honestly, the lady taking care of your grandpa would probably pick up twice, but by the third time she realized he was just messing with her because he couldn't sleep? Yeah, she wouldn't answer.
The real issue is that when people make those unnecessary calls to the Emergency Room (or show up there for nothing), the paramedics can't get to the people who REALLY need them in time—if they even make it at all.
Stuff like that, along with a whole bunch of other UNNECESSARY tests, should really be filtered through primary care physicians first...

Hey silentmason15, I’m actually pointing that out because the local reaction to an insect sting usually pops up pretty fast—we're talking pale edema and induration within an hour or two—before it eventually turns into redness and itching...
Anyone who’s ever dealt with a mosquito or a wasp bite knows exactly what I'm talking about... 😬

Given all those reasons—all this back-and-forth about whether a patient is "right" or "wrong," and the endless driving around—I’m going to ask once more if someone could just answer my original question. And let me be perfectly clear: I didn't exactly set out today with the intention of spending the entire day chauffeuring someone from one hospital to another. I only went because we were completely in the dark about what was happening; I just wanted a professional to take a look and maybe offer some help if it was actually necessary. It happened to be a holiday, too, so getting him in to see his regular doctor wasn't even an option.

So, I am still waiting for an answer to the question I posed. Or perhaps I should just rephrase it for clarity: Should the Emergency Room at the new hospital have admitted him regardless of the fact that we showed up during such a chaotic mess?

Kimberly Wright said:So, I'm still waiting on an answer to my question. Or let me try asking it differently: should the Emergency Room at the new hospital have admitted us right away, even if we were just there because of some minor nonsense?

Nah, not really. It wasn't actually a case for the HOSPITAL itself, but rather for the primary care physician (George's) who handles the vaccinations and prescriptions, just like it was planned 🙄

Maybe you could try looking for it right here —or, I don't know, just reach out to them directly

And hey, if you're looking for where everything is located, I think they actually have a little "map" or layout based on where people live right here ...

Susan Martin24 said:It’s honestly just so they don't miss any mistakes—because let's be real, stuff always slips through the cracks anyway—and so patients don't have some reason to sue them, you know? Like, "Oh, they didn't even look at me, they just sent me straight home and said I was fine, but I'm actually feeling like total crap..."

Look, the patient doesn't even have a leg to stand on for a lawsuit if a doctor just brushes them off in passing while walking down the hallway and tells them they're fine. Especially when the patient is dealing with total agony—which, by the way, is freaking hilarious because it's such a CRITICAL CONDITION—the patient just turns around and heads home, and there isn't even a single shred of paper evidence left behind saying they were ever even at the Emergency Room 🙂

Ashley Moore8 said:you can also find a "breakdown" by residential area right here

I’ve been down that road before... thanks for the heads up... but honestly, just try figuring out which hospital someone living in a suburb like Naperville actually falls under. I remember an attendant at a local hospital looking at that exact same chart, and she ended up sending us to the wrong facility entirely, which wasn't exactly helpful, was it?

Lisa Gonzalez - look, you really need to read more carefully here. It’s exactly because of interpretations like yours that we can't get any actual treatment done "on the fly in a hallway." 😬

Also, let's not confuse the two things here—you shouldn't swap the patient's rights for how the healthcare system actually operates on the ground.

If a patient shows up—and I'm going with what Kimberly Wright said about them coming in for "nonsense"—it doesn't mean they have to be admitted immediately just because they think they should be. After an initial assessment (which was already mentioned, where some doctor in the hall checked them out, gave their opinion, and said they need anesthesia, antibiotics, or whatever else), the exam can be delayed or they can be sent to the appropriate facility.

Honestly, if I were in that spot, I'd do the exact same thing. I'd take a quick look at their arm, tell them to follow up with their primary doctor or head to the Emergency Room to get what they need.
I mean, sure, I’d probably also suggest they put some ice on the swelling 😬
But since I'm a specialist, I can't just write them a prescription for antibiotics 😍
We aren't allowed to do that—well, technically we can, but only for a private prescription, not one covered by Medicare 😈

Susan Martin24 said:Lisa Gonzalez - seriously, try reading more carefully - it's exactly because of interpretations like yours that they can't actually get any decent treatment done "on the fly in the hallway" 😬

Look, that’s just how things are over at the Cleveland Mayo Clinic's Emergency Room. You can write whatever you want, but that's the reality.

Kimberly Wright said:been there, done that... thanks anyway... but seriously, try figuring out which hospital someone living in a suburb like maybe Naperville would actually fall under. I had an auntie look at the exact same chart at a new hospital once, and they ended up (wrongly) sending us over to St. Jude's instead.

I don't know, if I were in your shoes, I think I'd just call the hospital that feels most like "mine"—like, in that Naperville situation, my gut would say go to Northwestern first—and then they could probably just (over the phone) point me toward where I actually need to be.