How Long?
Posted by WhiteCoat on January 2, 2008
When the triage nurse came back with a smirk, rolled her eyes, and said “call the helicopter,” I knew what was coming next. A parent had brought their child to be examined for a cough that was present for 2 hours.
It kind of reminds me of the old George Carlin routine about driving: “Did you ever notice that everyone who drives slower than you is an idiot and that everyone who drives faster than you is a MANIAC?”
I’ve seen it mentioned over at Nurse K’s and at GuitarGirl’s blogs lately.
How long are people supposed to wait before coming to the ED?
If someone comes in with symptoms for a couple of hours, the first question everyone asks is why they came in so soon.
If someone comes in with symptoms for a few days, we ask them why they waited so long.
Symptoms for months tend to elicit the most creative comments from the staff (any others to add?):
“Ooooh, call the trauma team, stat.”
“Pull out the crash cart, this one’s critical.”
“Hey, doc! Word of your reputation must have gotten around! He’s here for an eleventh opinion.”
“Radar is showing a positive suitcase sign (i.e. an elderly patient has a suitcase with them when they register to be seen), get a stat admitting consult.”
So what is the “optimum” amount of time to wait before schlepping to the emergency department?
January 3, 2008 at 12:33 am
For me personally…ONLY if I think I am dying (sepsis doesn’t feel real good) OR if my pain is so bad…I wish I was dead.
I would rather “believe” nothing is wrong and did that with kids too. When our 1st born was one (1981) He fell and hit his forehead on the leg of a dining room chair. I couldn’t get to him fast enough and simultaneously as I picked him up my husband walked in the door-thank God. I took one look at our son and exclaimed” OH MY GOD…HE HAS A BRAIN HEMORRHAGE!” It was an instant raised hematoma and looked so scary. I gave him to husband, called the ED (I didn’t work there then)and the doc told me to watch him and to check his pupils…to wake him periodically and check. He was fine.
January 3, 2008 at 12:37 am
“It must be Thanksgiving… or it must be Christmas- because the med floor is filling up with elderly pts.” (Staff perceives some families to intentionally “dump” elderly pts their because they don’t want to be bothered.)
January 3, 2008 at 1:20 am
I’ve often wondered how long I’m supposed to wait before seeking medical treatment. Although, for me that usually means going to my PCP. But there are some things that I know we’ll get sent to ER for anyway, so I just go sttraight there. That’s when I start wondering if it’s too soon or too late. Too soon and I won’t be taken seriously, too late and I get yelled at by the doctor for not coming in sooner. Is there a guide somewhere?
January 3, 2008 at 7:46 am
I’ve never gone to the ED without calling the pediatrician or the PCP first. Even for emergencies, I’ll drop qa call to them.
However, the wait time depends on the age of the patient. If it’s me or Cranky Husband, we’ll generally wait to see our regular doc, or wait as long as possible. If it’s one of the two older kids, there has to be spurting blood, fever over 105, or dangling limbs. For the five-month old Butter Biscuit (who has prematurity issues), I’ll go in a heartbeat, and unapologetically.
Generally, though, I try to be as pleasant as the circumstances allow. My policy is detente. As long as I get no ‘tude, no ‘tude will be given. All bets are off if staff is rude — then I haul out my Big Book of Creative Invective, and go to town.
January 3, 2008 at 8:31 am
Well, I think it depends on how much pain you’re in. If you aren’t in much pain, you don’t need spcialized care, go see your gp (or whatever it’s called in the states - in sweden it’s a generalised care specialist) in the morning. But feel free to call the healtcare hotline and ask their opinion. Saves you a lot of hours (yes, in the bigger cities in Sweden - still tiny by most standards, the ER wait times are horrendous. Unless you’re actually ill, of course. But if the triage nurse says you can wait, then you’d better be prepared to wait. For somewhere betweem five and ten hours.
So - if we’re supposing that you’re not in that much pain, but it’s still bad enough that you couldn’t, say, go to work? Optimal time would be after a night. Or half a night. Or something like that, when you obviously can’t sleep because of your problem, even after trying over-the-counter meds. In my (very limited, that is) experience, anyway.
On a side note, I spent yesterday in the ER (it’s mandatory as part of our surgery course) and I noticed a phenomenon: The CristmasBladder (or whatever you want to gall it. Gallstones and other similar issues, after a week or so of that lovely christmas food). That really can’t be something limited to Gothenburg, Sweden, right?
January 3, 2008 at 9:01 am
It depends on what’s wrong with you and what ELSE is wrong with you. If you’re a totally healthy person with cold and flu symptoms for two days but nothing else, not even asthma, you need to stay home. If you’re really miserable and vomiting and having diarrhea AND it’s been a week AND you’re losing weight AND you can’t even keep fluids down (but don’t tell me you can’t keep anything down and then tell me you had McDonalds for breakfast), you might need to come in. But call your doctor first.
I almost never fault parents for bringing babies in, especially if they’re new parents. I would be nervous too. We got a young couple who tearfully ran in with their seven-day-old baby who “Oh my GOD she spit up through her NOSE AND THEN COUGHED AND TURNED PURPLE!!!” The mother was crying, the father was nervous, and the baby was totally fine. But if I was a young, inexperienced, sleep deprived parent, I would rather err on the side of caution.
January 3, 2008 at 9:14 am
For a child coughing? I would say at least 1-2 days unless there is wheezing or respiratory distress. The other one with peds that kills me is fever for 2 hours!
January 3, 2008 at 9:52 am
For me and my wife, we’d always prefer the $20 PCP copay over the $250 ED copay - if given any sort of choice. Her emergency appendectomy was our only trip to the ED in 10 years - and she was wheeled over from her PCP’s office attached to the hospital. Everything else, gets 1) the wait it out treatment, 2) call to the PCP, 3) visit to local urgent care outpatient clinic, and distant 4) trip directly to ED.
Don’t get me wrong, if my 2 year boy is bleeding from the ears, he’s going straight to the ED, but for anyting else, the ED is absolutely the LAST RESORT.
I fortunately have no experience living with anything other than private health insurance, so I’m admittedly completely out of touch with the realities of access for others with public payers.
January 3, 2008 at 12:05 pm
They should come to the ER five minutes after my shift ends, obviously.
January 3, 2008 at 1:13 pm
Why is it the sickest people are often the most polite, while the ones who should be home in bed with some ibuprofen are rude and demanding?
January 3, 2008 at 4:28 pm
The last kid I brought to the ER was my 10 year old son, who I took to our PCP a few days before. Our primary doc said he had strep and started him on antibiotics. But after 3 or 4 days, one would expect to see improvement. I told my son that he looked way sicker than any of the patients I had taken care of at work (med-surg). So he was really struggling with getting fluids down and still had a fever. Took him to the ER, and wouldn’t you know it - he not only had strep but influenza A and influenza B. So, as least I knew the antibiotics were working for the strep…
As far as my husband - before I ever was in nursing school I definitely waited too long to get him to the ER. He started feeling really rashy and itchy - then faint - can you see it coming? So I’m trying to haul 3 kids in the car so I can take him to the ER when I finally realized that wasn’t gonna happen because he was passing out in the front yard. I called 911 - found out he was in full anaphylaxis from ME giving him naproxen. I swear the only thing that saved his bacon was the fact he had taken some benadryl when he first felt itchy. That was waiting too long.
Anaphylaxis - scary business - can’t get to the ER fast enough.
January 3, 2008 at 7:00 pm
It depends what it’s for. I’ve only gone to the ER a handful of times. When I fell of a horse and cracked my helmet hitting my head I went right away. Asthma attack- 1.5 hours and 6 albuterol puffs later I went, stomach flu I had for 12 hours and really wasn’t gonna go, then I passed out, woke up, and passed out again, so I went. Just depends.
January 3, 2008 at 7:31 pm
I avoid the ER like the plague, pun intended. Pain must be severe for me to take my dependents there because of the co-pay. Currently, I’ve been so strapped I’ve been living with a respiratory ailment for three weeks while saving up for co-pay and possible medication when I visit my PCP.
January 3, 2008 at 10:01 pm
I went in to the ER at 7 a.m. after vomitting all night.
checks bp & temp and asks how long I’ve had my cough.
Triage nurse (”TN”
“About a month” I reply.
TN - why haven’t you seen a doctor?
Me: well, I had a cold and then the cough never went away but I have reflex and allergies so I cough a lot anyway.
Diagnosis: Pneumonia! Now, I had actually googled pneumonia and everything I read said if you have chest pain and a fever over 100 to see a doctor. I had NEITHER. Well, back pain started with the throwing up.
Anyway, I spent 8 days in the hospital with pneumonia in both lungs and an electrolyte imbalance that required i.v. magnesium and phosphorous.
January 3, 2008 at 10:09 pm
If it’s something that your grandma would give you soup for and tell you to “take a nap” to cure, don’t come in. If you are coughing up tons of green sputum, have COPD, are pale, tachycardic, and febrile and can’t tell me your name without taking 2 breaths in between the first and last name, then grandma probably would probably NOT tell you to take a nap. If your grandma is 30 years old, then this rule does not apply.
If you need pain medications to sell, come in when Dr. Bloody Gloves is on so that you don’t need to make repeated visits. He’ll give you enough to live off for the month.
If you have anything else that you perceive as severe, use your best judgment.
January 3, 2008 at 11:25 pm
Go visit your regular doc if you got something mild…go to ER if it’s deathly ill-like. Plain and simple.
January 4, 2008 at 12:49 am
Ever since I’ve been “on my own,” I’ve had this dilemma. As a child, my parents had insurance through Kaiser. I don’t recall ever going to the emergency room, but we sure did use urgent care. A lot.
I agree with Jamie. Too soon? Too late?
A couple of years ago, I woke up with pain in my left flank. It was kind of a dull ache, so I assumed it was muscle strain. I noticed that the pain kind of moved, and was becoming more intense. I must have slept funny. As the day progressed, the pain became more intense. I thought about making a Drs apt., but was worried it was only gas. I assumed that since it wasn’t in the lower right quadrant, I was OK. By about 7 that night, I was throwing up and had a ridiculously high fever. So then I was thinking stomach flu. Within an hour I was pretty much experiencing the worst pain I’d ever felt. I decided to make my first trip to the E.D., if only for some pain relief.
Surprisingly, I was seen pretty quickly (I went to the hospital I volunteered at at the time which happens to be a high volume urban ER). When the Dr. came in, she took one look at me, made a fist, and hit my lower back. Duh, wanna be PA. Pyelonephritis!
So, emergent or not? Obviously, had I gone in when I first had symptoms, my PCP likely could have taken care of me. On the other hand, a few months earlier, my friend told me the sad story of a colleague who had passed away at age 26. Her situation was almost identical to mine. Acute flank pain, assumed it was nothing, by the time she made it the ER, she was septic.
January 4, 2008 at 9:48 am
Interesting topic. I’ve only been to the ED once as an adult (age 32), for myself, and the decision to go was easy. I felt like I was dying - unable to breath, severe chest pain, high fever, sweats - all with extremely rapid onset in the middle of the night, secondary to having had the flu for the previous 4 days. I had bacterial pneumonia - turned out it was a very good thing I went to the ED when I did. I’ve taken my toddler to the ED twice for respiratory distress (she is asthmatic), but consulted with her allergist on the phone first both times (she was admitted on one of those occasions - treated, improved, and discharged from ED on the other).
Seems the “I think I’m dying” feeling is a good decision node to use for non-trauma issues.
January 6, 2008 at 11:51 pm
When do you go, after what length of time? When it becomes an emergency. If you’ve had the sxs for months and they haven’t changed , not an emergency. Acute abdominal pain, broken bones, uncontrolled bleeding, uncontrollable vomiting/diarrhea for hours, yadda yadda yadda
January 28, 2008 at 11:18 pm
I go if it won’t wait (can’t be managed at home) til morning.
I have been bullied into going by my husband because he rolled over in bed, missed me, and realized I was weeping and pacing in pain because the “damn, I think I’ve got another UTI” hurt too much for me to even sit down, let alone sleep. (Kidney involvement.)
I’ve gone with him to the ER when he had sudden horrendous testicle pain that blew from “I think I racked myself last night” to the point he was pale, sweating, and let me drive him there in six hours. (Epididymitis.)
Next time we break something, though, unless there’s cyanosis or a protruding bone, not going. We did that when he tripped and broke his fibula just above the ankle joint. He knew it was broken, he heard it snap. After a seven hour wait, with no pain meds, they X-rayed it, gave him an aircast and told him to go to the local orthopedic clinic to get it casted tomorrow, now go home. That’ll be $900.
We make just over a thousand dollars a month. We are among the uninsured. If we’d known that was how it was going to go, we wouldn’t have bothered the people in the ER. I would have got my orthopedic boot out of the basement and my crutches, fed him some of the Vicodin I have for breakthrough pain, and waited and gone to the orthopedic clinic in the morning. Would have saved us a hunk of money. But we both thought you go to an ER for a broken bone.