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Old 05-23-2013
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Default Run out of time in an ER case

I've been looking for the answer to my question online, but haven't found any satisfactory one. I'm hoping you guys can help me out.

If I've run out of time and my 15 mins is up, what's the best thing to tell a patient that has come to the "ER" with a serious condition (ex:ruptured appendicitis, splenic rupture, etc). My Q has 2 parts:
Q1) What if I haven't reached the counseling yet, should I just abruptly say "The nurse will come to give you meds and we'll meet immediately after that" ?
Q2) What if I'm in the middle of my counseling? How can i abruptly end a sentence, esp coz he/she is in immediate need of Rx??

Any ideas will be appreciated!
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Old 05-23-2013
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Quote:
Originally Posted by megz2107 View Post
I've been looking for the answer to my question online, but haven't found any satisfactory one. I'm hoping you guys can help me out.

If I've run out of time and my 15 mins is up, what's the best thing to tell a patient that has come to the "ER" with a serious condition (ex:ruptured appendicitis, splenic rupture, etc). My Q has 2 parts:
Q1) What if I haven't reached the counseling yet, should I just abruptly say "The nurse will come to give you meds and we'll meet immediately after that" ?
Q2) What if I'm in the middle of my counseling? How can i abruptly end a sentence, esp coz he/she is in immediate need of Rx??

Any ideas will be appreciated!
Hi!
THe first thing you should do is not to think like this.. you have to do everything in your power to finish in the allotted time.. that is continue to practice hard!

IN ER cases (Appendicitis, acute cholecystitis, MI, PE etc) the amount of PE you have to do is relatively small.. that is only do a focused PE along with 1 or 2 associated systems.. WIll give you an example.

For acute appendicitis: start with abdomen.. if you want and/or can do either heart and chest.

For acute cholecystitis: exactly as appendicitis.

For MI: Start with heart, then do neck (specially carotids), auscultate the chest and palpate it.. thats it then move forward.

For PE: Start with chest, move to heart and then check extremities (specially lower ones)

If you practice like this you will find that performing a good focused PE will not take more than 2 minutes top.

IN acute emergency cases/ER cases counseling and closure is of extreme importance.. This is because most of these situations are either life threatening or cause a lot of discomfort to the patient.. and all they want is that you solve their problems NOW.

IN the event that you cant finish on time you have to apologize immediately and offer some hope or whatever... but if there are some cases in which you have to finish everything those are ER cases.

I hope i got my point across!
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Old 05-23-2013
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Hi.Thanks for your reply. I don't intend to prolong the case. Hopefully I'm done in 14 mins!
I understand your point, and it makes sense in the cases that you mentioned. But what if I got a motor vehicle case and he had hurt his head, abdomen and chest. The examinations of those systems would take forever and there is a possibility of running out of time. In such a situation (god forbid!) what would you say to get out of the room?
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Old 05-23-2013
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Originally Posted by megz2107 View Post
Hi.Thanks for your reply. I don't intend to prolong the case. Hopefully I'm done in 14 mins!
I understand your point, and it makes sense in the cases that you mentioned. But what if I got a motor vehicle case and he had hurt his head, abdomen and chest. The examinations of those systems would take forever and there is a possibility of running out of time. In such a situation (god forbid!) what would you say to get out of the room?
Hopefully you wont get a case like that! and if you did I would go to the most important organ! that is the HEAD! and then the chest (hard to triage this.. but well)..

If you really insist... I cant help you with what to say that is correct (maybe others can help) ..however I can help you in what NOT TO say

  • Dont say I've got another emergency (seriously what can be worse than a polytrauma patient?)
  • Dont say I will give you pain meds.
  • Dont say I have to go (Imagine being in such a pain and then the Doctor just says he has to leave...)
Im sorry if Im not more helpful than this...
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Old 05-23-2013
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Just say..........I need a beer and I'll be back with one for you too........

Jokes apart, I would say, Please excuse me while I go and instruct my staff (Nurse/Technician etc) to take your blood for testing /take an X-ray picture and I'll be back with the results.

Don't waste too much time since every second you spend in the room after the announcement is being deducted from the time for your PNs and you get no points for saying/doing anything after the announcement is made.

Also, if you are in the middle of an examination then you must replace/re-tie the gown back--don't leave them with the gown up/down & untied.
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Old 05-25-2013
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Thanks guys. Those answers really helped!
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