Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-settings.php on line 468

Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-settings.php on line 483

Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-settings.php on line 490

Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-settings.php on line 526

Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-includes/cache.php on line 103

Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-includes/query.php on line 21

Deprecated: Assigning the return value of new by reference is deprecated in /home/emerg18/public_html/blog/wp-includes/theme.php on line 618
» Does it really need to be this hard?

Does it really need to be this hard?

I saw a patient today who has become a semi-frequent flyer.  She has been in for chest pain, had MI’s ruled out, received, narcotics, reassurance, the run around, etc on several occasions.  When I first saw her come in I was planning to do more of the same.  After-all, we have tons of patients who complain of pain all over and no matter how big of a work-up they get, it usually turns out to be a fruitless waste of time and money.  None-the-less, whenever a patient mentions back pain, chest pain, and abdominal pain during the same visit I still wonder if it is being caused by an aortic dissection (or aneurysm).  I typically ask a few key questions, and the answers don’t often raise more red flags, which I feel lets me off the hook.

Sometimes I ask these questions grudgingly because I’m not sure I really want to know the answer, especially if I am nearing the end of my shift and trying to wrap up, get out on time, and not leave too many loose ends.  I ask anyway because I simply must if I want to put the idea of an aneurysm or dissection out of my head and sleep well at night.  This habit has made some colleagues and co-workers roll their eyes at the big and time consuming work-ups occasionally prompted by this practice habit, but when the tests do reveal potentially catastrophic conditions it seems to justify all the negative scans.  The problem is what happens next.

Today my patient turned out to have a major dissection of her aorta, which is potentially catastrophic.  It was fortunate that we caught it, but it was unfortunate that almost every hospital in the state of California was unavailable to help her.  Our hospital has no thoracic surgeon to manage this condition.  No hospital with a thoracic surgeon had an ICU bed where she could be admitted.  After 4 hours and 30+ phone calls, I realized why many doctors don’t bother looking very hard for these things.  While there is some gratification in catching a life threatening diagnosis, before it is too late, there is also tremendous negative reinforcement for this particular job well done.

For hours after my shift was over I found myself pleading with hospitals up and down the state, and wondering how full these ICU’s actually were.  Were there really no beds, or simply not enough nurses.  Had nurses been sent home (or not called in) to save money and as an added benefit the ICU could legally decline any transfer.  Who knows.  At the end of the day we did find a hospital with both an ICU bed and a thoracic surgeon.  After I invested so much, and went above and beyond on my own time I hope those surgeons do the same for her.  I also wonder what obstacles they may encounter attempting to do so.

221 Responses to “Does it really need to be this hard?”

  1. You know…. for starters, i must say, that is is really easy to get caught up in the frame of find that the frequent flyers are just full of bull. But then when common sence kicks in and we think, i really need to use the education that i worked so hard for and really work up this patient. I am sure that anyone that in your shoes will agree.

    I know this for a fact because I also have this mind set form time to time, and when you least exspect it… BAMM… its that patient that ends up as a train wreak and holds us up for hours on end trying to provide the quality medical care they deserve.

    I have tried to explain this to every student i get in the er and as they are training as a lvn or rn and here i am a tech, giving them this skill set that i can on the level of education that i have.

    let me tell you a little story i told one of my students recently…

    I had a medical clearence patient… treating the r.n. like crap… responded to me well and apperently there was a personality conflict with the patient and the nurse. to make a long story short, i had to finally ask the nurse to step out of the room and turn over the care to another nurse. Because in the end , regardless of the fact that the patient was a medical clearence, on his way to jail because he broke the law, he was still a patient, a human being, and had rights and deserved the best care we could give…..

    I say to you… great job… way to go and good work for doing the proper work up that was suppose to be done and pat yourself on the back..

    see you soon doctor…..


  2. Medicamentspot.com. Canadian Health&Care.No prescription online pharmacy.Special Internet Prices.Best quality drugs. Low price drugs. Order drugs online

    Buy:SleepWell.Prozac.Buspar.Female Cialis.Cozaar.Nymphomax.Benicar.Lasix.Aricept.Seroquel.Lipitor.Wellbutrin SR.Amoxicillin.Zocor.Female Pink Viagra.Advair.Lipothin.Acomplia.Zetia.Ventolin….


  3. CheapTabletsOnline.com. Canadian Health&Care.Best quality drugs.Special Internet Prices.No prescription online pharmacy. No prescription pills. Buy pills online

    Buy:Propecia.Viagra Soft Tabs.Levitra.VPXL.Cialis Soft Tabs.Maxaman.Tramadol.Super Active ED Pack.Zithromax.Viagra Super Force.Cialis Super Active+.Viagra.Cialis Professional.Soma.Viagra Super Active+.Cialis.Viagra Professional….


  4. NEW FASHION store. Original designers collection at low prices!!! 20 % TO 70 % OFF. END OF SEASON SALE!!!

    BUY FASHION. TOP BRANDS: GUCCI, DOLCE&GABBANA, BURBERRY, DIESEL, ICEBERG, ROBERTO CAVALLI, EMPORIO ARMANI, VERSACE…

  5. ████████►BUY VIAGRA◀███████…

    ████████▲▲▲▲▲▲▲▲▲████████…

  6. buy viagra canada

    Buygeneric drugs…

  7. zaditor dosage

    Buydrugs without prescription…

  8. dosage of amoxicillin for respiratory disorder

    Buygeneric drugs…

  9. cephalexin dosage for dogs

    Buygeneric drugs…

  10. abilify and siezures

    Buynow…

  11. Accutane@official.site” rel=”nofollow”>.

    Buywithout prescription…

  12. actonel@adverse.reactions” rel=”nofollow”>…

    Buygeneric meds…

  13. Aleve@official.site” rel=”nofollow”>..

    Buyit now…

  14. Aldactone@official.site” rel=”nofollow”>.

    Buygeneric drugs…

  15. Amoxicillin@official.site” rel=”nofollow”>…

    Buyno prescription…

  16. allopurinol@and.coumadin” rel=”nofollow”>…

    Buygeneric drugs…

  17. avodart@dosage.now” rel=”nofollow”>..

    Buygeneric meds…

  18. ashwagandha@supplement.now” rel=”nofollow”>…

    Buygeneric meds…

  19. Azor@official.site” rel=”nofollow”>…

    Buygeneric pills…

  20. atarax@and.hives” rel=”nofollow”>.

    Buygeneric drugs…

  21. Chantix@official.site” rel=”nofollow”>.

    Buydrugs without prescription…

  22. abilify@anxiety.now” rel=”nofollow”>.

    Buygeneric drugs…

  23. generic@Levitra.now” rel=”nofollow”>..

    Buyno prescription…

  24. Vitamin@B.now” rel=”nofollow”>.

    Buygeneric drugs…

  25. abilify@and.sleep.issues” rel=”nofollow”>.

    Buyno prescription…

  26. i@am.pregnant.how.often.can.i.take.25mg.of.phenergan.safely” rel=”nofollow”>…

    Buygeneric drugs…

  27. Abilify@official.site” rel=”nofollow”>…

    Buygeneric meds…

  28. Depakote@official.site” rel=”nofollow”>…

    Buyit now…

  29. Zyrtec@official.site” rel=”nofollow”>.

    Buynow…

  30. Depakote@official.site” rel=”nofollow”>.

    Buygeneric drugs…

  31. lisinopril aspirin interaction

    Buywithout prescription…

  32. side effects zyprexa overdose breathing autonomic

    Buyno prescription…

  33. zyban pill

    Buywithout prescription…

  34. xeloda information.gov

    Buyit now…

  35. what is the shelf life of zyrtec

    Buynow it…

  36. Zetia

    Buyno prescription…

  37. Clindamycin

    Buywithout prescription…

  38. zantac infant

    Buyit now…

  39. xopenex coupon

    Buyno prescription…

  40. zyprexa increase eps complaints

    Buyno prescription…

  41. Xalatan

    Buywithout prescription…

  42. Zyrtec

    Buyno prescription…

  43. Zofran

    Buygeneric pills…

  44. what is the difference between zocor and crestor

    Buygeneric drugs…

  45. can you take zoloft and blood pressure medication together

    Buynow…

  46. Lexapro

    Buygeneric drugs…

  47. Zyrtec

    Buygeneric meds…

  48. Zoloft

    Buynow it…

  49. Pyridium

    Buygeneric drugs…

  50. stopped taking prozac realized i like him

    Buygeneric drugs…

  51. Rogaine

    Buyno prescription…

  52. dermatological side effects of rogaine

    Buywithout prescription…

  53. Risperdal

    Buyit now…

  54. Prozac

    Buynow it…

  55. provera 10 days perimenopause

    Buygeneric drugs…

  56. Orlistat

    Buyit now…

  57. arthritis orlistat

    Buyno prescription…

  58. Synthroid

    Buygeneric pills…

  59. Rogaine

    Buygeneric meds…

  60. Seroquel

    Buywithout prescription…

  61. Prozac

    Buyno prescription…

  62. Synthroid

    Buywithout prescription…

  63. Seroquel

    Buygeneric drugs…

  64. Zyprexa

    Buyno prescription…

  65. lamictal with pamelor

    Buygeneric pills…

  66. Purim

    Buyno prescription…

  67. Rogaine

    Buygeneric meds…

  68. Retin A

    Buygeneric meds…

  69. Paxil

    Buygeneric drugs…

  70. Reglan…

    Buywithout prescription…

  71. Pyridium@Pyridium.Pyridium” rel=”nofollow”>…

    Buygeneric meds…

  72. Pulmicort@Pulmicort.Pulmicort” rel=”nofollow”>.

    Buynow it…

  73. Tetracycline@Tetracycline.Tetracycline” rel=”nofollow”>…

    Buyno prescription…

  74. Prozac@Prozac.Prozac” rel=”nofollow”>…

    Buynow…

  75. Purim@Purim.Purim” rel=”nofollow”>..

    Buynow…

  76. Pulmicort@Pulmicort.Pulmicort” rel=”nofollow”>..

    Buyit now…

  77. Sleep@Tea.now” rel=”nofollow”>..

    Buyno prescription…

  78. Prozac@Prozac.Prozac” rel=”nofollow”>…

    Buygeneric drugs…

  79. symbicort@official.us.website” rel=”nofollow”>…

    Buygeneric drugs…

  80. Strattera@Strattera.Strattera” rel=”nofollow”>…

    Buynow it…

  81. Singulair@Singulair.Singulair” rel=”nofollow”>.

    Buywithout prescription…

  82. Seroquel@Seroquel.Seroquel” rel=”nofollow”>..

    Buynow it…

  83. Cymbalta@Cymbalta.Cymbalta” rel=”nofollow”>.

    Buyit now…

  84. Provera@Provera.Provera” rel=”nofollow”>.

    Buygeneric pills…

  85. Prozac@Prozac.Prozac” rel=”nofollow”>.

    Buywithout prescription…

  86. Coumadin@Coumadin.Coumadin” rel=”nofollow”>.

    Buyno prescription…

  87. Synthroid@Synthroid.Synthroid” rel=”nofollow”>.

    Buynow…

  88. Cipro@Cipro.Cipro” rel=”nofollow”>..

    Buygeneric meds…

  89. Seroquel@Seroquel.Seroquel” rel=”nofollow”>..

    Buywithout prescription…

  90. Pulmicort@Pulmicort.Pulmicort” rel=”nofollow”>..

    Buygeneric meds…

  91. does@pristiq.cause.weight.loss” rel=”nofollow”>..

    Buygeneric meds…

  92. cms@coverage.of.pulmicort.respules.j7627” rel=”nofollow”>.

    Buygeneric pills…

  93. dapple@hydrocortisone.cream” rel=”nofollow”>…

    Buyit now…

  94. .

    Buygeneric pills…

  95. insulin@glargine.la” rel=”nofollow”>.

    Buygeneric pills…

  96. celexa@and.insulin.resistance” rel=”nofollow”>…

    Buyit now…

  97. pyridium@can.cause.low.blood.sugar” rel=”nofollow”>.

    Buygeneric drugs…

  98. reglan@black.box” rel=”nofollow”>…

    Buydrugs without prescription…

  99. cipro@causes.problems” rel=”nofollow”>.

    Buygeneric drugs…

  100. buy@acai.berry.supplement” rel=”nofollow”>.

    Buyit now…

  101. accutane@and.ototoxicity” rel=”nofollow”>…

    Buyno prescription…

  102. man@plan.a.and.b” rel=”nofollow”>..

    Buygeneric drugs…

  103. potassium@citrate.tablets” rel=”nofollow”>.

    Buydrugs without prescription…

  104. .

    Buygeneric drugs…

  105. Buygeneric pills…

  106. .

    Buygeneric drugs…

  107. motrin@for.61.pounds” rel=”nofollow”>…

    Buygeneric meds…

  108. otc@nasonex.alternative” rel=”nofollow”>…

    Buynow…

  109. coral@calcium.safety” rel=”nofollow”>.

    Buyit now…

  110. treatment@c.diff.flagyl” rel=”nofollow”>…

    Buyit now…

  111. abilify@does.it.work” rel=”nofollow”>.

    Buynow it…

  112. .

    Buyno prescription…

  113. calories@and.nutrition.in.boost.nutritional.energy.drink” rel=”nofollow”>…

    Buywithout prescription…

  114. wholesale@ginseng.root” rel=”nofollow”>…

    Buyno prescription…

  115. multiple@myeloma.gleevec.clinical.trials” rel=”nofollow”>.

    Buynow it…

  116. Buy@Cheap.Coral.Calcium” rel=”nofollow”>…

    Buywithout prescription…

  117. Purchase@Coral.Calcium.Online” rel=”nofollow”>…

    Buywithout prescription…

  118. Purchase@Abana.Online” rel=”nofollow”>..

    Buydrugs without prescription…

  119. Purchase@Cheap.Abana” rel=”nofollow”>…

    Buygeneric pills…

  120. pictures@of.abilify” rel=”nofollow”>..

    Buyno prescription…

  121. Order@Abilify.Without.Prescription” rel=”nofollow”>..

    Buynow it…

  122. Cheap@Generic.Abilify.5mg.10mg.15mg.20mg.30mg” rel=”nofollow”>..

    Buygeneric pills…

  123. Buy@Cheap.Acai” rel=”nofollow”>..

    Buydrugs without prescription…

  124. Get@Acai.Online” rel=”nofollow”>…

    Buygeneric drugs…

  125. Purchase@Coral.Calcium.Online” rel=”nofollow”>..

    Buygeneric drugs…

  126. Buy@Discount.Abana” rel=”nofollow”>..

    Buygeneric meds…

  127. Order@Cheap.Abana” rel=”nofollow”>.

    Buynow it…

  128. ..

    Buyit now…

  129. Buy@Abilify.5mg.10mg.15mg.20mg.30mg” rel=”nofollow”>…

    Buywithout prescription…

  130. Buy@Acai.Online” rel=”nofollow”>.

    Buynow it…

  131. Buy@Discount.Acai” rel=”nofollow”>…

    Buyit now…

  132. Order@Cheap.Acai” rel=”nofollow”>…

    Buywithout prescription…

  133. Order@Cheap.Acai” rel=”nofollow”>…

    Buygeneric drugs…

  134. Purchase@Acai.Online” rel=”nofollow”>…

    Buynow it…

  135. Purchase@Cheap.Acai” rel=”nofollow”>…

    Buyit now…

  136. Purchase@Cheap.Acai” rel=”nofollow”>..

    Buywithout prescription…

  137. Cheap@Acai.Online” rel=”nofollow”>..

    Buynow it…

  138. Buy@Generic.Acai” rel=”nofollow”>..

    Buydrugs without prescription…

  139. Buy@Cheap.Energy.Boost” rel=”nofollow”>.…

    Buygeneric drugs…

  140. Purchase@Accutane.Online” rel=”nofollow”>.…

    Buynow it…

  141. Cheap@Generic.Accutane.10mg.20mg” rel=”nofollow”>.…

    Buyno prescription…

  142. Cheap@Aciphex.Online” rel=”nofollow”>.…

    Buynow it…

  143. Cheap@Generic.Aciphex” rel=”nofollow”>.…

    Buygeneric drugs…

  144. Order@Acomplia.Online” rel=”nofollow”>.…

    Buygeneric meds…

  145. Order@Discount.Acomplia” rel=”nofollow”>.…

    Buygeneric drugs…

  146. Order@Generic.Actonel” rel=”nofollow”>.…

    Buyno prescription…

  147. Purchase@Cheap.Actoplus.Met” rel=”nofollow”>.

    Buygeneric drugs zfk…

  148. Purchase@Discount.Actos” rel=”nofollow”>…

    Buywithout prescription xiu…

  149. Purchase@Actos.Without.Prescription” rel=”nofollow”>..

    Buygeneric drugs krg…

  150. Cheap@Generic.Actos” rel=”nofollow”>..

    Buygeneric meds qmo…

  151. Purchase@Generic.Actos.15mg.30mg” rel=”nofollow”>..

    Buygeneric pills zdg…

  152. Purchase@Cheap.Adalat” rel=”nofollow”>..

    Buygeneric meds abx…

  153. Buy@Coral.Calcium.Online” rel=”nofollow”>…

    Buyit now oil…

  154. Purchase@Cheap.Coral.Calcium” rel=”nofollow”>..

    Buynow it vhx…

  155. Cheap@Abana.Online” rel=”nofollow”>..

    Buynow it tly…

  156. Get@Acai.Online” rel=”nofollow”>…

    Buynow it zdg…

  157. Order@Acai.Without.Prescription” rel=”nofollow”>.

    Buynow it lmg…

  158. Order@Generic.Accutane” rel=”nofollow”>…

    Buygeneric meds svb…

  159. Buy@Discount.Aciphex” rel=”nofollow”>..

    Buyno prescription wkp…

  160. Purchase@Aciphex.Online” rel=”nofollow”>…

    Buydrugs without prescription vrg…

  161. Purchase@Cheap.Aciphex” rel=”nofollow”>.

    Buygeneric drugs axm…

  162. Buy@Aciphex.Without.Prescription” rel=”nofollow”>..

    Buyno prescription tao…

  163. Purchase@Aciphex.Without.Prescription” rel=”nofollow”>.

    Buydrugs without prescription xab…

  164. Cheap@Aciphex.20mg” rel=”nofollow”>.

    Buyit now ojb…

  165. Buy@Generic.Aciphex.20mg” rel=”nofollow”>…

    Buydrugs without prescription jlg…

  166. Buy@Actonel.Online” rel=”nofollow”>.

    Buygeneric pills oir…

  167. Get@Advair.Online” rel=”nofollow”>.

    Buygeneric drugs hwi…

  168. Buy@Generic.Advair.Without.Prescription” rel=”nofollow”>..

    Buyno prescription jwi…

  169. Cheap@Generic.Advair.25mcg50mcg.25mcg125mcg.25mcg250mcg.50mcg500mcg.50mcg100mcg.50mcg250mcg” rel=”nofollow”>…

    Buygeneric drugs mby…

  170. Purchase@Albenza.Online” rel=”nofollow”>…

    Buydrugs without prescription ttp…

  171. abilify@and.gemfibrozil” rel=”nofollow”>.

    Buyno prescription…

  172. alphagan@refrigerated.buy” rel=”nofollow”>…

    Buygeneric drugs…

  173. arava@adverse.events” rel=”nofollow”>…

    Buygeneric meds…

  174. aciphex@muscle.pain” rel=”nofollow”>..

    Buygeneric pills…

  175. actos@side.effects.edema” rel=”nofollow”>..

    Buygeneric drugs…

  176. how@to.monitor.anafranil” rel=”nofollow”>.

    Buyno prescription…

  177. arjuna@pills.buy” rel=”nofollow”>..

    Buygeneric meds…

  178. alberta alcohol and drug abuse commission

    Buy_generic meds…

  179. viagra order uk

    Buy_generic pills…

  180. weight loss disclaimer law

    Buy_drugs without prescription…

  181. recipes for gastric bypass patients

    Buy_now…

  182. what are the trimesters of pregnancy

    Buy_generic drugs…

  183. percent of obese children in usa

    Buy_now it…

  184. weight gain stories feeders

    Buy_drugs without prescription…

  185. accutane birth defects

    Buy_it now…

  186. menstrual patterns in menopause

    Buy_no prescription…

  187. dependent disorder anxiety

    Buy_generic pills…

  188. weight loss doctors in memphis tennessee

    Buy_generic drugs…

  189. is flomax good for prostatitis

    Buy_generic meds…

  190. herbal flee collars for dogs

    Buy_generic pills…

  191. statistics on pregnancy in high school

    Buy_generic meds…

  192. cancer of spine

    Buy_without prescription…

  193. herbal essence coupon discount

    Buy_now it…

  194. stress from clinical duty

    Buy_without prescription…

  195. saline for nebulizer

    Buy_generic pills…

  196. high calorie diet for babies

    Buy_generic drugs…

  197. cures for fingernail fungi

    Buy_generic meds…

  198. bacterial staphylococcus aureus meningitis symptoms

    Buy_without prescription…

  199. how to get teens off drugs

    Buy_drugs without prescription…

  200. st joseph aspirin coupon

    Buy_generic pills…

  201. office of generic drug

    Buy_generic drugs…

  202. chronic bronchitis from marijuana

    Buy_now…

  203. decreased appetite during pregnancy

    Buy_generic drugs…

  204. maximum daily dose for venlafaxine

    Buy_it now…

  205. can a woman have colorectal cancer

    Buy_drugs without prescription…

  206. food low in cholesterol

    Buy_now it…

  207. hot spots or cancer

    Buy_without prescription…

  208. south beach diet foods to avoid

    Buy_no prescription…

  209. ayurvedic ashwagandha zyban

    Buy_generic pills…

  210. relief of skin itching

    Buy_now it…

  211. clinical diagnosis and medical records

    Buy_generic meds…

  212. altitude and pregnancy

    Buy_it now…

  213. glucophage powered by vbulletin version 2.2.1

    Buy_generic pills…

  214. eye drops canine paralysis

    Buy_now…

  215. medical nebulizer

    Buy_generic meds…

  216. cause for morning erections

    Buy_generic meds…

  217. drug citalopram side effects

    Buy_generic drugs…

  218. inpatient drug rehab sanford fl

    Buy_it now…

  219. air purifiers for allergies

    Buy_generic meds…

  220. acyclovir stada cream

    Buy_generic drugs…


  221. BUY CHEAP INDIAN DRUGS : -==== Anti Depressants Drugs ====-

    Purchase Unique Pills Now!…

Leave a Reply