Norovirus

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GonnaBeADoc2222

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I have a newfound sympathy for patients who come in with this after vomiting and ****ting my brains out the past 24 hrs.

I understand why they feel like they're dying.
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I don’t. My ED has been full of patients for the past week with N/V/D abdominal pain that’s always nothing. I don’t do stool studies. Essentially people with zero coping skills. Can’t imagine going to the ED for it.
 
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GonnaBeADoc2222 said:
I have a newfound sympathy for patients who come in with this after vomiting and ****ting my brains out the past 24 hrs.

I understand why they feel like they're dying.
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Rekt said:
I don’t. My ED has been full of patients for the past week with N/V/D abdominal pain that’s always nothing. I don’t do stool studies. Essentially people with zero coping skills. Can’t imagine going to the ED for it.
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As indicated by each of your posts, I think there's a spectrum. I've certainly been on the utterly miserable side of things from noro (no PO tolerance >24 hrs, intermittent tetany of hands, likely from potassium shifting or some other crap) to the point that I would probably have considered going to the ER were I not a doctor and knew better.

I also think that the majority of noro patients that we see are simply people who either feel like they should never have to suffer the indignity of feeling unwell or are otherwise similarly whiny little brats.

I come out in the middle on this topic. I don't think most of them need to be in the ER, but neither do the ankle sprains or half of the other BS we see. I'm happy to give them their NS/Toradol/Zofran bandaid and send them home feeling a bit better.

Also, I've deliberately been trying to be less salty about patients lately. It's actually done wonders for my mood.
 
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Rekt said:
I don’t. My ED has been full of patients for the past week with N/V/D abdominal pain that’s always nothing. I don’t do stool studies. Essentially people with zero coping skills. Can’t imagine going to the ED for it.
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Agree i wouldn't go to the ED, but with the rigors I had, i kinda get why a lay person might
 
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I've been curled up on my bathroom floor from bad food and can definitely see why non-medical and/or low health literacy people want to be seen for a bad stomach bug.

Ditto to parents with sick kids. Took until I had a couple of my own to see why parents would bring in their kids with a fever, cough, or vomiting. It's a pretty helpless feeling when your kids are sick.

Also, these are the visits that pay off our loans and mortgages, and fund our retirements. The ER would be a pretty slow and quiet place of we only saw emergencies.
 
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They don’t need to be in the ER but the layperson gets extremely concerned about getting “dehydrated”. Honestly, these patients are easy and typically feel better after some fluids and meds. There’s bigger hills of patients that don’t need to be in the ER I’d rather die on.
 
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Rekt said:
I don’t. My ED has been full of patients for the past week with N/V/D abdominal pain that’s always nothing. I don’t do stool studies. Essentially people with zero coping skills. Can’t imagine going to the ED for it.
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Really? Puking more than 5 times with no end in site isn’t ED worthy?
Sure, isolated diarrhea, please stay home. Nonstop vomiting is a different story, it’s not like these people can self prescribe Zofran.
 
RuralEDDoc said:
Really? Puking more than 5 times with no end in site isn’t ED worthy?
Sure, isolated diarrhea, please stay home. Nonstop vomiting is a different story, it’s not like these people can self prescribe Zofran.
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No. Vomiting and diarrhea in a non third world country is not an emergency.
 
I've been thinking about this lately. I get frustrated with the masses of people coming in but recently I have realized, at least for the parents, when your kid is sick and you don't have a medical degree it can be scary. Hell I'll even talk to my PEM/peds friends when my kids have something that I probably know is benign. The adults with man-flu need to learn to adult.
 
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Lets be serious. The vast majority of kids who come in sick don't even SAY they are sick when I ask them. "Are you sick little Johnny? You feel GOOD, SO-SO, or BAD?" "I feel good!" they invariably say.

Parents who bring their kids into the ED for stupid shiit like superficial < 1 cm lacerations that don't need anything at all because they have already scabbed over, or fevers, or about 20 other things do so because either 1) the ER is free to them, or 2) they have so much money dropping $200 copay is nothing when they make > 1M / year.
 
These cases are perfect for Urgent Care, not ERs. IVF and zofran-- easy money for UCs and pts leave feeling better.
 
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Illness doesn't come with a label telling patients whether or not it's serious. Our job isn't JUST to treat emergencies, it's also to differentiate them from non-emergencies.
 
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Kryptocoin said:
Really? Complete opposite in my area. Big money maker.
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I've heard that but it never made sense to me outside of either a not very busy urgent care or one with lots of rooms. IV infusions take a decent bit of time. In the time it takes for 1 patient to receive a liter of saline I can usually see 3-4 patients. So sure, if there are 6+ exam rooms that's not a big deal. But I've yet to work UC that didn't always need more open rooms.
 
WilcoWorld said:
Illness doesn't come with a label telling patients whether or not it's serious. Our job isn't JUST to treat emergencies, it's also to differentiate them from non-emergencies.
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The UK and Australia have public health announcements telling patients not to go ER if they have certain illnesses, instead go to their PCP or UC. They have better health outcomes than we do.

Public education on the appropriate use of the ER is a good public health policy. We are failing miserably that, and our current trajectory is not sustainable.
 
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Kryptocoin said:
The UK and Australia have public health announcements telling patients not to go ER if they have certain illnesses, instead go to their PCP or UC. They have better health outcomes than we do.

Public education on the appropriate use of the ER is a good public health policy. We are failing miserably that, and our current trajectory is not sustainable.
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Agreed, but I suspect intractable nausea and vomiting of >24 hours duration leading to intermittent tetany isn't on said list. Also, both of those countries have public healthcare, making it possible for their citizens to see a PCP.

I'm not arguing that people should come to the ED for obvious non-emergencies. I'm arguing that being judgmental towards, and getting angry with the patients doesn't help the situation.
 
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WilcoWorld said:
Agreed, but I suspect intractable nausea and vomiting of >24 hours duration leading to intermittent tetany isn't on said list. Also, both of those countries have public healthcare, making it possible for their citizens to see a PCP/

I'm not arguing that people should come to the ED for obvious non-emergencies. I'm arguing that being judgmental towards, and getting angry with the patients doesn't help the situation.
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I agree.
 
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VA Hopeful Dr said:
I've heard that but it never made sense to me outside of either a not very busy urgent care or one with lots of rooms. IV infusions take a decent bit of time. In the time it takes for 1 patient to receive a liter of saline I can usually see 3-4 patients. So sure, if there are 6+ exam rooms that's not a big deal. But I've yet to work UC that didn't always need more open rooms.
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You don’t need a room, you just need a chair.
 
VA Hopeful Dr said:
That chair needs to be an an area with some amount of privacy, outside of dedicated infusion centers or overwhelmed EDs that typically involves a room.
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I don’t work UC, but in our fast track area we have 10 dedicated rooms and a larger curtained area that can accommodate another 10 patients. The workflow is to generally evaluate patients in one of the dedicated rooms and then transport them to the holding area pending dispo (unless it’s an immediate discharge). We will not uncommonly have patients receiving IV fluid boluses in this area.
 
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Jabbed said:
I don’t work UC, but in our fast track area we have 10 dedicated rooms and a larger curtained area that can accommodate another 10 patients. The workflow is to generally evaluate patients in one of the dedicated rooms and then transport them to the holding area pending dispo (unless it’s an immediate discharge). We will not uncommonly have patients receiving IV fluid boluses in this area.
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I've never worked at an UC (and I've worked in a somewhat embarrassing number of them) that had anything like that.
 
Rekt, if you want only emergencies go work in an ICU, not an ER. ER is for sick and injured people, not just dying people.
 
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