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Your 5 least favorite chief complaints in your ED


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Had a guy "told by work to come in" for a queried STI...in fact was brought in by his boss.  Yeast balanitis secondary to poor hygiene in the woods on a fire line...who'd also had an indiscretion earlier.

 

A late boss of mine coined a diagnostic term for this sort of thing - "Drippy Conscience Syndrome".

 

SK

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The trick lies in telling them that (a) their problem isn't going away without seeing a tooth fairy and (b) it is only to get ahead of the pain control curve.  I get them started on 600mg of Ibuprofen before they leave the dept and tell them they need to take it regularly.  If they bounce back, I document them as non-compliant, tell them they're at risk of developing lidocaine toxicity (a bit of a fib) and that while I'm comfortable with me extracting teeth, they won't be when I'm done with them...especially if they just needed a root canal.  Oh, and it's not something that's routinely done in the ER.  

 

You touched on a BIG problem - most ED's don't have on call dentistry.  I can call for OMF (in the large tertiary centre), but getting emergency dentists in many places is like pulling hens' teeth (pun intended).  Issue I have is, in Canada, despite there being "universal health care", that doesn't extend to oral health - it costs nothing (except in taxes) to go to the ER, but you pay through your ass to go to the dentist unless you have extra health insurance (or are on a government assistance or Treaty Status Aboriginal)...and even then you still do.  I'm sure the same happens in the US - tooth fairies make WAY more money than a lot of MD's do.

 

Another issue of course is that most normal humans at least hate (if they aren't outright shyte scared of) dentists...which, second only to cost, is why most people avoid going.

 

SK

 

I hate to drag this back from the dead but to throw a wrench in the destist talk... we have a dental student-run clinic 9a-8p or so where cost is sliding scale based... and people walk by this clinic to come into the ER. We discharge them to the clinic (you can get there FROM INSIDE THE HOSPITAL) and often they come back a few days or weeks later...never having gone to the clinic.

 

So sometimes people just do what they do. I've seen this same dude for STIs like 5 times now. Appears like a normal guy otherwise. Mind blowing.

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I hate to drag this back from the dead but to throw a wrench in the destist talk... we have a dental student-run clinic 9a-8p or so where cost is sliding scale based... and people walk by this clinic to come into the ER. We discharge them to the clinic (you can get there FROM INSIDE THE HOSPITAL) and often they come back a few days or weeks later...never having gone to the clinic.

 

So sometimes people just do what they do. I've seen this same dude for STIs like 5 times now. Appears like a normal guy otherwise. Mind blowing.

But, you make the mistake of thinking dental care is in the patient's agenda........

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chronically poor dentition = an easy way to score pain meds.

we had one guy, who even after extraction of ALL of his teeth and placement of dentures kept coming in saying the dentist had left fragments of bad teeth in him and he was going to see them "any day now" to get that fixed...this dragged on for a year, with unaware clinicians giving him meds every time. one of my partners even told him " if I give you 100 vicodin right now will you promise to never come back to this facility?" the guy said no.

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  • 2 weeks later...

Thankfully not common enough to be a least favorite yet but I have an interesting one from my last shift:

 

"It's my pancreas again.  My PCP sent me in for 2 mg of IV dilaudid and 25 mg of phenergan"  Proceeds to present "order" dated sometime in 2012.  

 

In perusing the EMR, it appears this was honored multiple times before a care plan was put in place.  

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  • 2 weeks later...

this is why ketamine was invented...

At my hospital procedural sedation is a pain in the butt.lots of paperwork, MD has to administer it and is suppose to be present during the whole thing, 2 nurses, etc. I don't bother the docs for it unless it is a really really really bad lac. I've only done it twice in 3 years for kids lacs. Twice for abscess on kids (one facial and one in groin)

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I'm in a clinic-based UC, not an ER, but still. My new (least) favorite is when the CC is simply "Personal."

Come on, bro, if you can't tell the nice lady at the front desk what's going on, I understand and I sympathize, but that is just not how this works. People have walked up to that desk and said whatever it is you think you can't say, I guarantee you. Don't be a wuss. And besides, it makes me cranky to have to play silly guessing games, or wait until the LPN rooms you.

 

We're on this kick recently where we are taking extra care not to try and triage people at check-in. We're making sure anyone who presents has the chance to see a provider, and that's great, that's how it should be, it's good for my CYA documentation. But if your issue is one that we just plain won't or can't handle, it's a waste of time. Looking at the list, I can go out and grab someone to talk for a minute about their issue and why they categorically need to take it to the hospital ER; if it's a mystery I can't do that.

 

Recently it was "my psychiatrist won't prescribe me Viagra and said I had to go to someone who is comfortable doing it." My response was "yes, that's right, and that isn't me." Thanks for playing. Sorry you had to incur a copay, but it was your choice.

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  • 1 month later...

1. Any musculoskeletal complaint where they haven't even tried OTC meds.

2. "Medication refill"

3. Subjective neuro complaints without any objective neuro findings.

4. Pt had surgery at '(some other hospital)', now with complication

5. Abdominal pain in the elderly--just scares the hell out of me after some of the horrible things we've diagnosed

 

 

Sent from my iPhone using Tapatalk

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I trained in a level one trauma center in Texas many years ago.

A segregated ER in that there was a Surgery ER, A Medicine ER, a Psych ER and a Gyn ER lovingly called the Tuna Pit.

 

I spent most of my time in the Surgery ER.

 

One night a long term alcoholic wanders up to the Pit Boss - a second year surgery resident - and wants to know when he will be seen for his belly pain (pancreatitis, again... the medicine pit turfed all pancreatitis to the surgeons for unknown reasons - guess they don't do NG tubes). The resident is a very polite Doogie Howser who looks more like Opie from Mayberry - he tells the man - "well, this man has been shot and this man has been stabbed and we are doing CPR in this room.... so, it will be just a bit to get to you since you are up and walking without a wound"

 

The man wanders off and calls out "No wonder Kennedy died here".

 

I have multiple issues that go to the ED that disturb me beyond belief. Most of them have been listed above.

 

Common Sense is at an all time low these days and folks just don't get it - tylenol, sudafed, pepto, NPO, tincture of time, rest, fluids, chicken noodle soup, stop drinking alcohol, stop doing drugs, stop drinking red bull - just amazes me how little people know or care to learn.

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