On Behalf of the ER

I've decided that today would be a good day to hopefully explain some mysterious going-ons that patients and families of patients have asked about. It's meant to be a not-very-comprehensive but also-not-sarcastic little list.

1. The ambulance came to pick up my mother, but then sat in the road while they fiddled around in the back putting in an IV. Why weren't they rushing to the ER?

- A lot of times, the medics will perform interventions that they feel is needed immediately before transporting the patient. For many of these interventions, having an access point to the vascular system is important. This is especially true if a patient is unstable - it's best to put an IV in while it's still possible (i.e., there is still enough blood pressurizing the veins to allow a peripheral IV attempt) rather than having to resort to more invasive methods (needle that goes into bone marrow, needles that go into your jugular, etc). Keep in mind that IVs are the gateway through which fluids and many medications can be administered.

2. The nurses are all just milling around outside. Why am I just sitting in this room, what am I waiting for?

- Unfortunately, this question occurs due to a lack of communication. Once the initial barrage of assessments, x-rays, and blood draws is over, we have to wait to have the results back. Our lab can take around an hour or two to return the more common tests, while some uncommon ones may take longer. X-rays are usually available for the ER doc to see within a few minutes, while CT scans and ultrasounds have to be digitally sent to a radiologist off who-knows-where. The radiologist types up a report of his/her findings and then faxes it to us in about an hour and a half.

- The reason the nurses may be milling around is because he or she has done everything for the moment, and is now waiting for results or more doctor's orders. The ER personifies the "hurry up and wait" mindset. Also unfortunately, the nurse cannot always stay in a room with a patient while waiting - he/she needs to be available to take care of the other 1-4 patients he/she may be responsible for.

3. Why was that person brought back before me? I was here first.

- During registration, a nurse will triage each patient that checks in. The patient is marked 'non-urgent', 'urgent', or 'emergent'. These are based many variable such as why the patient is checking in, initial impression, past medical history, etc. That man sitting in the chair may be complaining of back pain after lifting heavy furniture, but if he is also pale as a sheet, has a blood pressure of 90/50, and has a history of an aortic aneurism, he is going to go ahead of someone with an abscessed tooth. The entire system is centered around priority. Nobody comes into the ER for fun, and it is understandable to be frustrated by the wait and the feeling of being bypassed by other patients, but critical patients always come first.

4. Why do I have to get all these procedures done again? I had all the same ones on my last recent visit.

- While the previous test results may be good to set a 'baseline' (what your lungs usually look like in x-ray, what your ekg usually shows, etc), we need to see why you feel or look the way you do now. We're trying to figure out what changed, and in doing that we need to look at all the potential causes. You may have had an ekg done last week, but today you're having chest pain, and another ekg may show that parts of your heart are dead. Things like that are very very important to catch.


I may or may not add more questions here as they arise. If anyone reading has any, go ahead and comment and I'll try my best to answer it!