Waiting room medicine

No not that waiting room medicine.

We’re all resus jockeys aren’t we?

#idratherbeinresus

Most of us in FOAMed community love resuscitation. We love the critically ill. We love the drama, the excitement. We love all the mr EMCrit has taught us.

I’m one of these people. Give me a full day in resus any day – bring on the sickies.

Unfortunately, if your ED is in the real world, you’ll realise that the vast majority of our customers don’t need resus. Our world is a seething waiting room of ambulatory patients with a bewildering variety of symptomatology.

How do you manage the waiting room? Most places have triage  – there is clinical justice with the sickest seen quickest (listen to this talk by my current boss.) Unfortunately if you get a lot of sick people and don’t have a system in place the lower triage acuity patients wait so long that they eventually leave. In the US this means your hospital doesn’t get paid. In our systems, we all breathe a sign of relief when patients do not wait to be seen. Not so much when they re attend twice as sick the next day, or are found dead.

Our traditional approach is rule out serious pathology. And we’re not bad at that. You’ve hurt your ankle, the x-ray shows no fracture – therefore we have accomplished our job as EPs.

Hmmm…

Once you’re in resus as a patient, you get lots of attention. Our spidey sense is immediately higher – purely because of your physical location in the department. I am much more likely to order certain tests when I am in resus because my mind is in a certain place. This is obviously a bit of  a problem.

One of the hardest things to do as an EP is to pick out both the serious pathology and the important diagnosis (because some really important diagnoses won’t kill people or even bounce back on us but will cause a  lot of morbidity for the patient) from the teeming mass of NSN (non-specific nonsense) that fills the waiting room.

Be careful with a diagnosis of soft-tissue injury

Be careful with non-specific abdo pain

Be careful with all the non-specific nonsense – a lot of it is really quite specific for something you’ve not heard of.

It’s a jungle out there guys. Tread carefully and good luck.