Dr. Jess hits on two things which I think are important. The first is one that is brought up often. That is: Its easy to second guess an ER Doc's decision the next day. (12 hours is a long time for a vague shortness of breath to declare itself NOT ACS). Things are much different during that moment in the ER. Things are murky. Stories are incomplete and we have to try and do whats best for patients.
Second, and this is spoken of less often: how much do we need to do in the ER for patients before we send them upstairs? This is less clear. Do we need to wait for the Cardiac Enzymes to admit a chest pain rule out? (probably) Do we really need to start the antibiotics on a pneumonia? (JHACO be damned!) And what about the sick patients? Do we have to place a central line in the septic patient? (Manny Rivers says yes, but does it have to be done in the ER or immediately in the ICU?) Like I said, I dont think the answer is clear.
One argument would say that once we've identified an admission, we need to get the patient upstairs so we can see more patients! But doesnt this further the ignorant belief that we're just triage nurses?
The other argument might be that we must fully stabilize every issue and come to a diagnosis regarding every complaint. While this allows many to show off their diagnostic and management skills, is it really feasible in a busy ER?
Alas, as with most things, the answer lies somewhere in between. Isnt that a Dave Matthews song?
2 comments:
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