ER BFF and I were having a deep philosophical discussion the other day about which complaint is the absolute worst. For me, it's a toss up between vaginal bleeding vs. elderly constipation. Not always, but vaginal bleeding usually has at least somewhat of a dramatic spin that requires hostage negotiator level de-escalating skills. Plus it's a guaranteed pelvic set up, which is a pain in the ass, and at my facility you're guaranteed to wait at least 10 years for a transvaginal ultrasound to get done, so, yeah, you better hope the patient is nice. Elderly constipation really doesn't require an explanation I hope. Once you've done a fleets enema on one old person with unsteady gait and then had to watch them on the bedside commode for half an hour so they don't take a monster dump all over the floor and then fall in it while the room fills with the smell of 5 days worth of angry hardened turds, you understand.
I figured at least the last one was universal, but her answer surprised me: toothaches. Her explanation was that the situation pretty much always turns into drama. The patients that come to our ER with dental pain generally tend to think it is a life threatening emergency. Most have Lortab at their disposal at home, so when they aren't offered anything more than that once they've waited 6 hours to be seen, they are PISSED. I get her point, but I would still rather talk down 10 angry toothache patients than administer one fleets enema to just about anyone, so I guess it's just a personal preference.
So. What say you, internets? What chief complaint gives you the most nightmares?
Sort of agree with you but... disimpacting an elderly constipated patient is far worse than your fleets enema scenario!
ReplyDeleteannoying would have to be the nursing home pt. w/ Alzheimer's who's sent in (from the nursing home) for...wait for it: confusion. Seriously.
ReplyDeleteLeast favorite? As in my night is just going to suck now? probably any complaint in a patient with active C-diff. That smell just lingers...
I wish there was a like button for the dementia/alzheimers confusion patients. Nursing homes suck.
DeleteI'm going to go with "I can't really figure out why you're here." You know, when the cc is "I went to my doctor yesterday and he gave me antibiotics for my bronchitis and I'M STILL COUGHING." Or "I broke my arm yesterday, and it still hurts." Etc.
ReplyDeleteOk I hear what you're saying but honestly a toothache is probably the WORST pain I can think of. And yes I have two children & I've had surgery before and I would just about rather have any kind of pain than a toothache. Just thinking about it makes me break out in a sweat. On top of the fact that I am phobic about the dentist. So then you've got tooth pain on top of major anxiety & probably a little compassion would be nice if I'm hurting enough to come to the ER for it. Just saying. :)
ReplyDeleteThe er would be an inappropriate place to go for a toothache, wait until the morning and go to the dentist. Er can not do a thing for you.
DeleteThat's not strictly true. If infection has set in and started to spread that 'toothache' belongs in the ER. Lots of people who don't have insurance or money let things like toothaches fester into super badness.
DeleteMine least favorite is the crackhead with sepsis. It's going to take a few nurses to get the 2 sites for cultures while he whines about how he's so scared of needles, he will start getting cranky because he wants his fix so he'll be bugging you every 5 minutes for medicine for his horrible horrible pain, and of course we'll have to get him a tele bed, which are in short supply at my hospital, so we're going to hang out for at least half the shift.
ReplyDeleteI don't like ETOH with feces from head to toe! Thats a trip to the decon room...if the stinky mink can make it, if not, its a throw packaged bath towelettes and close the door! The second worse is abdominal pain...usually pain med seeker with chronic constipation wanting the vitamin D/ morphine...which by the way causes more constipation and yes you guessed it...abdominal pain!
ReplyDeletemale hematuria - creevy drip set up
ReplyDeleteGI bleed yuk
heroin overdose - these people are always a pain in the ass
Necrotic draining tumors vs Sickle Cell Crisis. Usually, the tumor folks are pleasant, it's the Stink that's so strong, it gets a capital S. The Sickle Celler kids we get (in their late teens/20s) want dilaudid and benadryl every 30 seconds. (And if they don't get 'em, they want to know why, why, why, why they can't have 'em...)
ReplyDeleteGI bleed
ReplyDeleteDisimpaction
ETOH
Don't really care for any of them!
anyone who overdoses. it's frustrating. it's obvious they meant to take those 30 clonidine tablets yet they always say it was an accident. come on... then you get frequent flyers. we had a chick who "tried to commit suicide" like 30 times. i hope i don't sound like i lack any compassion but come on!
ReplyDeleteHave you all forgotten the absolute worst of the worst????
ReplyDeleteRetained. Tampon.
Enough said.
YES.
Deleteabsolutely. I still smell them for years afterwards.
DeleteI think at least 80% of constipated elderly folks should just get instructions to give yourself an enema/drink mag citrare/take colace and go home. Why are we giving enemas to outpatients? I'm guessing they don't give enemas in the doctors' office.
ReplyDeleteElderly constipation is also my least favorite.
Other bad ones:
1. Drug addict panic attacks
2. Drunks that are awake
3. Chronic chest [wall/fake] pain patient with remote history of MI--usually needs some cardiac workup, pain never less than an 8, demanding dilala
4. Toddler/schoolage fever with Dr. Big Work-Up (think cath UA on a 5-year-old)
So, for the non medically trained, is disimpacting different than giving an enema?
ReplyDeleteAnd retained tampon? WTF? Why go to the ER for that, just reach up in there and get it, yeah your hands might get dirty, wear gloves or wash them after. Or am I missing something here?
With disimpacting, you stick your finger up their butt and dig the stool out with your fingers using a nifty hook motion. Yummers.
DeleteA tampon can get crammed up there (including the string) if a gal has sex with a tampon in. Most often though, it happens when she shoves another in without remembering to remove the first one. Several days later, god help us, she shows up at the ED. The stank is way beyond a GI bleed in my opinion.
DeleteOne doctor told me about manual disimpaction "it's like scooping peanut butter out of a jar with your finger." WTF?! Thanks for ruining my go-to midnight snack, fucker.
DeleteQuads with "increased suctioning requirements".
ReplyDeleteStage IV decub with pus pouring out of it, tunneling on all sides, necrotic flaps of skin over the whole thing. And the smell! I saw a lady with three of these this week, plus multiple Stage II's, and a doctor who didn't want us to cath her. Sigh.
ReplyDeleteWorst Complaint....all of the above plus an asshole doctor...
ReplyDeleteamen.
DeleteBelieve it or not, had this scenario multiple times in the ICU.
ReplyDeleteGI Bleed with c/o tarry black stools x 2 wks. History of multiple GI bleed with no source found. Pt is Jehovah's Witness so blood products are a no-go. The merry-go-round of "why can't you fix me?" is exhausting and frustrating on both parts.
Any trach-related complaint makes my soul shrivel up and die. I got hit in the neck one time with a trach loogie and I'll hate them forever, no take backsies. Gah.
ReplyDeleteAs for regular mundane stuff, enemas are the worst. Nothing I'd rather do less than shove a tube up your butt, fill it with soapy water, then wait until you inevitably explode and leak shit all over the floor.
Don't care that much for multiple amputated fingers or toes, but I can deal. Now, retained week old tampon? I'd rather cut off my own fingers.
ReplyDeleteI hate TPA calls. With a passion. A burning, undying, red-hot passion.
ReplyDeleteI second. Is it bad that I secretly wish the CT shows a big ol bleed rather than the pt endure the tPA run around?
DeleteNursing home patients. The ones that are pretty much in a vegetative state and come from some crappy ass nursing home where they're obviously poorly taken care of, and I want to clean them all up and make them perfect-looking but it's just impossible.
ReplyDeleteCan't believe you have to do enemas in your ER. I hand them the bottle of mag citrate with their discharge instructions and get them outta there. If I had to be any part of relieving the constipation, that would probably be the worst diagnosis fo sho.
my icing on the disimpaction cake: creepy DOM's (dirty old men) who LOVE it.....icky icky icky.
ReplyDeleteOMG I love you guys, my toes are curling! You guys are awesome.
ReplyDeleteBoth bad, but for me its the vaginal bleeding w/ cramps when 6-18 weeks pregnant, just the talking and emotional roller-coaster is way worse than having to deal with the soap-suds.
ReplyDeleteI work on the inpatient tele side and had a patient who took K pills and skipped dialysis in order to get admitted. He was on the light and repeatedly asked for dilauded and IV benadryl. PO benadryl had been ordered and I had it in my hand. Refused. "IV works better." Pain at 10/10 yet the pt was able to walk to the bathroom on his own where I would find him "picking his pimples" before his obligatory chest CT. Pt was 27 years old and on disability and MA for his renal failure. Unbelievable. "Missed" dialysis is a semi-frequent scenario on my floor. yuck.
ReplyDeleteI hear ya girl. I would rather do any sort of "messy" job for an actual sick, appreciative patient than those annoying drug seeking whiners any day!
DeleteI'm not a nurse or doctor but I can tell you what the patient can do for a toothache.
ReplyDeleteAn essential oil blend called Four Thieves Blend applied right to the infected area and two Aleve. Sounds stupid like it won't work but it really does work. Sometimes you have to put it on every couple of hours for a day because the pain keeps coming back but then the pain goes away for a while after that.
Lost tampon
ReplyDeleteLost strawberry- long gross story, but I didn't want a fruit plate for awhile!
Constipation
Pelvic pain
My least favorite transfer call is a young child/infant, post-arrest, whose pulse came back after an hour of CPR and 20 doses of epi. Not only are they brain-dead, but they have so much organ damage that they can't even be a donor. Why do people resuscitate for so freakin' long??
ReplyDeleteI despise the young type II diabetics who obviously don't care, and need dilaudid for (who knows what) spend the hours under their sheet, the peek out to ask for pain meds, but only shove a hand when it's blood sugar checking time. That and drunks, like long term drunks, who we have to detox while curing their other ailments. Can't we just hang an alcohol gtt with their ABXs??
ReplyDelete