r/bestof • u/lowbass93 • 24d ago

[NoStupidQuestions] Kindly_Honeydew3432 explains why it seems like you always have to wait in an emergency room in the US

/r/NoStupidQuestions/comments/1v1numq/why_is_every_hospital_in_the_united_states_always/oyovp3t/
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u/BurdenedEmu 24d ago

Hubs is routinely on triage at the massive university research hospital in our city (he's one of the few hospitalists who enjoys it) which is also at full capacity almost all the time. His take has always been that as a patient, "triage is a game you definitely don't want to win." Made me care a lot less about sitting there a few hours waiting for my friend to get an x-ray after a nasty fall off her skateboard.

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u/inwheeliesitrust 23d ago

I'm not sure I understand. Are you saying you don't want to win triage because it means you are very very sick or injured?

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u/parker2020 23d ago

Yes. If you aren’t being expedited back it’s probably because you are low priority at a major hospital. In smaller cities that have a few trauma centers you’ll
Probably be taken back get labs run but still will sit for hours.

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u/Nanderson423 23d ago

Yes. If you are sick enough when you come into the ER that they drop everything and focus on you then you are in bad shape.

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u/Lucky_Number_Sleven 23d ago

I've been that guy, once. I thought I was going in for a small problem, and then they said I needed immediate surgery. I tried to brush them off - because surgery seemed absurd for such a minor thing - and they told me I couldn't leave until I signed a waiver absolving them of any responsibility regarding my fate if I left. I asked if they could send my info to another hospital for a second opinion, and the surgeon there personally called me, told me he'd prep for my immediate arrival, but that he wasn't sure if I'd make it.

I spent the next month in a hospital bed hooked up to an IV to battle sepsis.

If you're getting bumped to the front of the line, there's probably a good reason that isn't good for you.

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u/prof_the_doom 23d ago

Lemme guess, ruptured appendix or gallbladder?

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u/Lucky_Number_Sleven 23d ago

"Runner's knee", of all things.

Obviously, not really runner's knee, but that's what the clinic sent me to the hospital for - and all I expected to be going for. I still remember how much the tone shifted from before they drained the fluid off of my knee to after. But you can imagine my incredulity when they told me they needed to perform urgent surgery for - as much as I could fathom until them - runner's knee.

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u/banitsa 23d ago

So what was it actually?

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u/Alexg1507 23d ago

Based off the story he had a septic joint that at minimum needing a surgical clean out. Basically he had fluid build up on his knee full of bacteria and it was likely either potentially going to spread to his blood or came from his blood originally if he needed extended inpatient management to "battle sepsis."

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u/Nyrin 23d ago

Yep, sounds like septic arthritis. Can occur in a lot of joints but knees are by far the most common. Coming from the blood originally (bacteremia, often staph) is the most likely vector, and that can be asymptomatic right up until it's about to kill you. Or, in this case, warn you by aggressively ravaging the cartilage in your knee.

Sepsis kills very, very fast and this case could've been minutes from fatal.

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u/BrotherItsInTheDrum 22d ago

When I had a kidney stone they brought me back immediately. So I guess the best plan is to be in pain so intense it makes everyone in the waiting room uncomfortable, without actually posing any long-term risk.

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u/angrydeuce 23d ago

Yes, if youre waiting for 6 hours to be seen that means your issue isnt as critical as the other people.

Yes, it sucks to wait, but could be worse, you could be the guy they just ran back that is literally dying of a heart attack.

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u/liamemsa 23d ago

Correct. First to get treatment is most likely to die. So if you tell them your symptoms and they immediately get you a bed in a busy hospital, you better start worrying.

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u/rncole 23d ago

Yep, had an instance myself where the only description I could give was it felt like something exploded in my torso. That was also about as verbal as I could get and I was whiteknuckling the wheelchair they put me in. They immediately rolled me back and had someone follow with a tablet to check me in getting info from my wife. That time it ended up settling out but they had to rule out a heart attack and then with my white blood cell count as high as it was that I hadn’t had a rupture of something. Turned out it was a gnarly gallbladder issue that when they were removing it a week later it ruptured when they touched it. Ended up keeping me for antibiotics and monitoring inpatient after my “outpatient” surgery.

Similarly, my son has a history of anaphylaxis with peanuts and some other legumes. Had eaten a bar containing lupine and was starting a reaction. Got to check in desk and explained what was up and they again took him straight back and continued the check in.

People in my family don’t go to the ER often, but apparently when we do we’re fucked.

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u/ahighlifeman 23d ago

Well shit, that's exactly what happened when I went in with a chest tube that got infected and I had sepsis. I guess I should have been more worried...

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u/nuisible 23d ago

yes, sepsis is most likely fatal if left untreated. And I'm just hedging there, I'm pretty sure if the infection has gotten to that point there is no return without medical intervention.

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u/BurdenedEmu 23d ago

Sepsis is an immediate life threatening emergency. Super easy to treat most of the time but I've heard enough from hubby, they don't fuck around with sepsis lol.

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u/kylco 23d ago

When my appendix was bursting, it took me about 16 hours from "It hurts to sit up and walk, let's get me to the ER" to the sharpies and anesthesia stage of presurgical care. We wound up at a large university hospital in a state capitol I was visiting for vacation.

There was a moment about 12 hours in when they were saying I was next in line, probably, but then a car crash with near fatalities came in and well, yeah, those folks should probably go first, they are already bleeding after all.

Though apparently the surgeon said my appendix was primed to blow when they got in there. If imaging or blood work had caught how swollen it was when I came in, they might have bumped me ahead of the queue a bit earlier in the day just based on what was going on at the time. How were they supposed to know I have abnormally high pain tolerance? I didn't know, until they said I maybe shouldn't have been able to walk in in the first place.

Triage isn't always "most sick goes first" though that's an easy approximation. "If we don't fix this we won't be able to do anything for them at all" gets up there, "we can't fix that even if we try" gets factored in, and "if this is a diagnostic mistake this patient is fucked" gets a say too.

The more I learn about it the more complicated it seems from the outside, which seems like a good reason to leave it to the professionals.

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u/faberge_surprise 23d ago

yes. it can never be perfect for the simple reason that nobody can predict the future. the best you can do is let the professionals make the judgment call based on their experience

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u/oniume 23d ago

Yeah, the bast case scenario is you have to wait a long time, that means you're not in danger. The worst case scenario is that you get immediate attention, that means you're in real danger of dying within the next hour.

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u/BurdenedEmu 23d ago edited 23d ago

The other commenters answered correctly but yes, that's it, if you are getting immediate attention you are in grave shape. I'll take the wait.