Emergency Department

sunshinelady

Aloha everyone,

Saya di perantauan at the moment. Am currently undergoing Emergency Medicine training. InsyaAllah nak jadi part of the team in M'sia when I pass, InsyaAllah kalau kuat semangat.

Ada sapa-sapa sudi nak mengisahkan keadaan di emergency department di negara masing-masing? System ED sana. Macam mana dgn doctors & nurses & allied health kat sana. Waiting time. The cases u see in the ED. The medication support especially analgesia. Patients flow from ED to discharge or to the wards. Menda-menda tak puas hati kat ED e.g. kerja dgn nurses ke, patients yg tak berapa faham erti e.m.e.r.g.e.n.c.y. ke. Any mishaps yg pernah berlaku.

Saya ada byk cerita di sini. Stories will follow soon.

lazuardi_senja

patient yg terkena pisau luka 1cm panjang dan x dalam pun kat jari dtg emergency. sangat gediks

firdaruddin

patient yg terkena pisau luka 1cm panjang dan x dalam pun kat jari dtg emergency. sangat gediks
lazuardi_senja Post at 30-10-2009 01:26

Salam,

tapi kalau datang tu pun time tgh malam, tiada salahnya.

sunshinelady

3# firdaruddin

ada jugak salahnye coz tgh2 malam tu slalu busy with patients, so its slowing us down to triage, jumpa, assess, kasi nasihat, paperwork, blablabla, then in the end luka yg kasi bandaid je.
tapi ye la, kadang tu diorang ni kurang tau pasal luka tu kena jahit ke tak. so kena la educate diorang ni.
tapi kalau yg dtg tu hampas saja suka nak tarik perhatian org/ ngada2 tak nak jumpa GP diorang dulu tu memang rugi of resources la kan.

this weekend saya kerja night shift. hopefully takde la menda ngada-ngada cam ni. aduh.

blackmore

patient yg terkena pisau luka 1cm panjang dan x dalam pun kat jari dtg emergency. sangat gediks
lazuardi_senja Post at 30-10-2009 01:26

...a man came in with fever of 39.5 degrees and the family demanded for immediate attention...saying the man in critical condition...he was awake and alert...vital signs taken by the triage nurse was within normal range...sp02 pon above 95%...

...yang funny thing is that...blom jumpa dr dah family sendiri diagnosed him as being critical...

lazuardi_senja

3# firdaruddin

Kalau aku luka remeh camtuh aku manage sendiri kat rumah. Sangat gediks bazir masa dan resources kat ED. Dah la datang tgh hari. Dan luka tuh tak perlu jahitan pun. hanya letak plaster. tak rasional langsung gi ED.

sunshinelady

6# lazuardi_senja

tu la. gediks sungguh. hahahha.. mak-mak kita dulu bubuh daun lidah buaya, daun apa yg tanam pakai daun yg sejuk je tu start dgn s pas tu bubuh dlm buku, mcm2. kalau memang luka dalam darah berbaldi-baldi or other danger stuff baru gi clinic.

sunshinelady

5# blackmore

tu mesti family gediks yg kurang educated tu. takpe la, saya kesian koz kurang pengetahuan/ or buat-buat tak nak tau. still, apsal la diagnose sendiri critical ye? doctors blom jumpa lagi ye.

saya pon ada citer best. tapi ni tgh siap nak gi night shift ni. esok-esok insyaAllah i'll add sth. ciao.

sunshinelady

Woohooo.. gila byk assault cases last nite. Pas tu ED plak saturated, ada doc sakit plak tu. Hampes je, mentang2 la selasa ni cuti, dia amik cuti lebih plak >

gilaa aaaahhh.. nanti saya citer later. now nak tido.

sunshinelady

Bohsan betul yesterday. Shift yg tak membantu perkembangan my brain at all except for 1 interesting case. Reason being coz most of them tak tau wat it means by E.M.E.R.G.E.N.C.Y.!!!!!
Ada ke patut 1 of my these dodgy patients ckp.. "reason I came in coz I'm sick of everything. I've been short of breath all the time because of my heart failure because of my chemotherapy. I just feel unwell. I just feel sick." Nothing on examinations, nothing on ED investigations either. DIa dtg kat ED tu naik train, jalan from the train station (which usually takes ~15 minutes to the hospital) & while in ED no need to use oxygen either!! My boss plak, dgn baik hatinye gi suruh I order VQ scan blablabla, in the end, NAD!! buang masa! buang masa! wasting my brain cells gak! hisH GIve UP!!
Anyways, This 9 day old baby presented with jaundice & lethargy & dehydration. Kesian baby ni. So saya pon buat la IV, amik darah semua. Dia dpt lumbar puncture & being admitted for double ABs. Hopefully dia ok.
The rest of the cases I saw last night ... rugi masa & tenaga je nak type kat sini =P
Hopefully today okay.

blackmore

Bohsan betul yesterday. Shift yg tak membantu perkembangan my brain at all except for 1 interesting case. Reason being coz most of them tak tau wat it means by E.M.E.R.G.E.N.C.Y.!!!!!
Ada ke patut 1 ...
sunshinelady Post at 4-11-2009 07:37

...hehehe...takmolah bosan2 pagi2 nie...as for that cancer patient...korang tak refer dia to psychologist ke or social worker ke??...perhaps hes just feeling sick of everything yang dia telah lalui...his ca...his chemo...his prognosis...baik jugaklah your boss buat vq scan for him to rule out pulmonary embolism...at least dia cover his dept...

...have a more softer spot for ca patients ok sweetie...

AnitaSabrina

11# blackmore

I was thinking of the same thing.  

Its very easy for hospital staff to just brush off patients as being mengada-ngada'.  But I can tell you from the patients perspective that waiting at the A&E department can be a dehumanising experience.  You wait because the nurses etc at the triage tell you that cases will be seen according to severity.  So we wait and wait some more.  Thinking that perhaps the doctors are busy saving some other persons life who may be at death bed.  But that doesn't make the waiting any easier.  

We are there because we think something is wrong and we need expert opinion on the matter.  

Can not the front liners at A&E practise empathy when dealing with patients?  Its because of such attitude that patients are not treated with due care.  If you are not happy being in the A&E by all means get a transfer to another department where you don't come in direct contact with patients.

sunshinelady

11# blackmore

the cancer patient ni. memang dah refer to social worker dah. dia ada psych issue.. more of personality problem. seriously, cancer dia dah tak active for so many years & dia ni memang frequent flyer kat ED tu.
saya tak kisah kalau org gi ED tu memang betul2 sakit, tapi kalau cam ni yg memang nak cari perhatian org, & tak nak gi GP just because kena bayar kat GP tapi kat ED free, bosan betul la. memang dia ckp not happy to see her GP coz kena bayar. tu yg saya lagi berang tu.

sunshinelady

12# AnitaSabrina

my story di atas tu pasal exhausting patients yg buat2 cerita or simply coz they dont understand the word EMERGENCY.
for any sake at all, i am in emergency training & i love my job very much. and i believe that i have enuf experience to kno kalau patients buat2 story semata-mata mcm patient tadi tu la nak cari perhatian. i am very much emphatize patients yg dah lama tunggu coz worried about their symptoms, and each time i apologize kalau kena tunggu lama. tapi our emergency department kat sini (tak tau la kat M'sia cam mana kan) dah clogged up dgn patients yg tak perlu dtg ED. it makes the GPs job seem 'diperlekehkan' oleh some patients yg tak appreciate their GPs.. simply because... "i have to pay" or "my GP doesnt do anything" padahal bila call GP dia tanya more about patient ni the GP has done all the investigations/ referrals tinggal wats not je. and these patients kalau datang ED pun, there's nothing more we can do for them.

saya minta maaf la kalau terkasar bahasa or kalau u guys ingat saya ni kurang berhati perut dgn patients. citer-citer 'menarik' ni pasal wat ever happens in ED from our ED docs perspective & others as well. tapi tak dinafikan my colleagues yg terpaksa kerja ED tapi tak minat memang will be bitter all the time. for me I love my job! oh & saya nak dgr jugak cerita pasal ED in M'sia coz saya nak balik kerja kat M'sia bila dah abis training. thanks for ur opinions.

AnitaSabrina

14# sunshinelady

Thank you for taking the trouble to explain.  Greatly appreciated.    

My comments were not directed at you.  Its my experience with A&E. One time my son (10 years old at that time) had bad asthma attack.  Despite giving him ventolin as prescribed by his asthma doctors he still had difficulty breathing.  So we rushed to A&E.  The doctor on duty gave him adult dosage in his nebuliser.  Shortly after the nebuliser treatment my son started to retch non stop and it brought back his asthma with a vengeance.  He had to be admitted after the doctor's blunder.  

Another time, my MIL who had been complaining of severe headache at the back of her head.  My sister in-law took her to A&E and she was told its a migraine.  After 3 weeks the headache was as bad as ever.  I took her to another hospital's A&E (it was on Saturday when I visited her).  There we found out she actually was having bleeding in the brain.  Stroke?  She's now left with permanent damage to her vision.  I wonder if the earlier doctor had discovered that MIL had stroke perhaps the severity could have been reduced or at least her suffering would not be prolonged.  

I do have lots of other experience with A&E.  But suffice these 2 for now.  But whatever my experience, I still hold people within the medical profession in high esteem.  It cannot be easy handling to a myriad of patients problems.  Thank you!

blackmore

11# blackmore

the cancer patient ni. memang dah refer to social worker dah. dia ada psych issue.. more of personality problem. seriously, cancer dia dah tak active for so many years & dia ni mema ...
sunshinelady Post at 4-11-2009 09:23

...ohhh...treatment kat emergency department is free ek??...kalau kat sini...kena bayar at least $75 per visit...tapi...ini pon tak stop some pple with common flu and fever to come to emergency dept...heh...

firdaruddin

3# firdaruddin  

Kalau aku luka remeh camtuh aku manage sendiri kat rumah. Sangat gediks bazir masa dan resources kat ED. Dah la datang tgh hari. Dan luka tuh tak perlu jahitan pun. hanya letak pl ...
lazuardi_senja Post at 31-10-2009 01:07

Salam,

I'm talking by referring to the malaysian's latest mentality.

tomcat201

11# blackmore

I was thinking of the same thing.  

Its very easy for hospital staff to just brush off patients as being mengada-ngada'.  But I can tell you from the patients perspective that wa ...
AnitaSabrina Post at 4-11-2009 08:37

Sgt2 bersetuju.

Kakak saya pregnant 3 month n keluar darah. selepas dpat surat dr private clinic yg advice ke ED. so pegi ler ED.
tapi just "duduk" selama 3 jam. that tym die sgt lemah dan mengadu sakit kat bahagian perut. bayangkan wanita hamil yg mungkin akan kehilangan bayinye harus menunggu selama itu. perhaps nak tunggu die pengsan atau darah dah keluar membuak2 ..barulah di beri rawatan segera. hmm dari situ kita dapat lihat..sebagai seorang yg bodoh dalam perubatan. di pandangan mata saya..tak ke tindakan itu sebenarnye yg membahayakan pesakit??? (in my sister case)...tell me if am wrong.

tapi yang saye pelik..ade plak katil kosong (setelah die sendiri yg panggil nurse dan beritahu kesakitan nye).

n yg menghairankan jugak.."patient yg bole dikatakan boleh berjalan sendiri" di panggil dulu. mungkin die dtg dulu kott.. yelaa since orang yg bole berjalan tu dikategorikan tak nazak kan....
hmm mungkin kalo dah berlaku..mcm2 alasan yg keluar. yelah goverment. ape2 pon orang awam akan bersoal jawap dengan goverment..bukan dgn staff kat situ.

kalau kite tanye setiap orang yg ade exp kat ED mmg tak akan habis. orang awam ni semua tahu mmg kamu semua tu sibuk yang amat nak selamatkan nyawa.

dat from real exp ..happen in front of my eyes. sorry..no offen to u all..just sharing some exp here .

dvotes20

hmm kat my hosp kena treat pt as a cust...pernah 1 day ada 1 adult pt nie komplen direct terus ke pengarah...yg sakit atinye komplennye high fever semate2..tunggu nak tgk doc kat er 3 jam katenye.triage semua dah...bila org atasan dpt tau terusla bombak kitorang then senior doc tnyala macam2 what happened dat day...bla bla bla...kena wat report segala bagaila...at last yg salah our team gak...siap kena baca skripla sekarang if nak triage pt..tp sy x ikut pon...what 4?nonsense betolll!!!geramnyeee..

the latest lak ada sorang mak nie bawak anak 12yrs old with fever 38.3C.disebabkan tgu x sampai setengah jam dah mengamuk kaw2 dpn triage room marah kat my fren coz my fren kata myb ur anak punya turn roughly around half to 1 hr time...dia pon naik hangen membebel depan kaunter..ok shortkan citer...msk wad then kat wad bising lg nk paeds dtg tgk anak dia cpt2.dat time 1 pg...semua org atasan turun semate2 nk pujuk maknye..now kalau dia dtg hosp kitorg kena alert...cust care pon kena escort dia kalau ada appoiment ngan specialist..

purple_orchid

kisah aku lak..
masa tuh kitaorg wat restart server..so dah mentioned pihak spital specially kat ED akan mengalami down time system for half an hour pada kul 2 pagi..so, aku standby aje di ED kut2 docs ke nurses perlukan khidmat kami..yela, dah biasa online..tetiba kene pakai manual..(borang etc)..

dlm kul 3pg, patients makin ramai kat luar. doc bertugas hanya 2 org..tak sewenang2 patient masuk sorang demi sorang maki2 doc..tp sorang doc tuh aku salutela...walaupun tekanan tinggi time tuh, dia masih polite menjawab soklan dr pesakit yg tak sabau menunggu...

aku lak, blah ar dr bilik doc..rasa rimas..so lepak depan kaunter....tetiba sorang mamat nih (patient yg masuk bilik doc yg maki2) tuh wat pengumuman..."jom semua...kita pakat2 blah dr ED..lembab la..etc la...."

dlm hati nak gelak je sbb sblm mamat tuh kuar dr bilik doc dan wat pengumuman tuh..doc tuh ade bgtau.."kalo servis spital ..... lmbt, u just go another hospital la...tak pun, u pegi jer mana2 klinik swasta....(according that sakit nyer takdelah nazak sgt bg aku...)"

sudahnya, mamat tuh masih menunggu dan menunggu la his turn....

anyway, aku setuju la ppl should be educated about pi emergency for Really emergency cases....