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Posted on: Sat, 04/12/2003 - 1:15pm
MommaBear's picture
Joined: 09/23/2002 - 09:00

(oooooooooooooo........... a CANDLE. I bring my wings ever so close.)
Link entitled:
"How Emergency Rooms Work"
Disclaimer: I do not guarantee the accuracy or content of the link in this post.
[i]Question: [/i] [b]What priority does the patient who arrives by ambulance receive?[/b]

Posted on: Sat, 04/12/2003 - 1:18pm
MommaBear's picture
Joined: 09/23/2002 - 09:00

Darth (if I may call you that?),
(pouring two glasses)
[i]Toast? [/i]
MommaBear [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]

Posted on: Sat, 04/12/2003 - 10:40pm
Anonymous's picture
Anonymous (not verified)

Question: What priority does the patient who arrives by ambulance receive?
I've seen patients brought in by ambulance, waiting as long as those who *walked* in. Difference is, they have a bed.
Changes were recently made in our city because so many hospitals were *closing* ER's. They were not actually closed - but overcrowded to the point that no new patients were accepted. Ambulances were being diverted, but patients who walked in were accepted. When it cost someone their life they made some changes that life/death patients would be accepted at the nearest emergency room.
Cindy, I can't agree with you on this one. If a person goes to the hospital with hives and vomitting, that is not necessarily the top priority in that waiting room. Definitely they need to have someone keep a close eye on them (i.e. don't put that patient in a curtained room in the corner and forget about them for a few hours), but at that point a doctor does not need to be taken away from another patient.
I always considered anaphylaxis when a person was having difficulty breathing and so I always thought I'd only been through it a few times. However, if anaphylaxis is when two or more symptoms are present, well, I've lost count. Definitely MOST of the times with me were not top priority for an ER. But, the two times it was - I was seen IMMEDIATELY.

Posted on: Sat, 04/12/2003 - 10:42pm
darthcleo's picture
Joined: 11/08/2000 - 09:00

Momma > I'd prefer Cleo to Darth, if you don't mind.
My doctor told me to always go to hospital by ambulance, because triage is done *in* the ambulance itself, and they usually take more than 2 minutes to assess the situation. You end up having a better triage. Not necessarily a higher level, but you get a more thorough examination to decide the triage

Posted on: Sun, 04/13/2003 - 2:12am
Anonymous's picture
Anonymous (not verified)

Anna Marie, Jesse's last reaction in December month was anaphylactic but with no breathing difficulties (I actually find this strange, especially for a PA child with asthma). As I've posted here, I was completely stunned by his last reaction, because it was anaphylactic but it was SO different than his previous two anaphylactic reactions. That's kinda left me with the feeling, even three or four months later, that even though I thought I knew what to expect with an anaphylactic reaction, with my child, I don't. I have to admit that scares the bejesus out of me.
His symptoms were chest constriction (which he, at 7, confused with breathing difficulties and asked the school for asthma puffers), vomiting, big red blotches on his face and then whole body hiving (the hives were very small).
And again, the puzzling thing for me about this particular reaction, was despite it being anaphylactic, it halted itself, with an Epi-pen being administered and also before he was given Benadryl at the hospital.
Now, if I look at that reaction, yes, I can see why we would be considered Level II. The time I took him in where he almost died, we were quite obviously treated at Level 1.
He had already received an Epi-pen shot from us (oh how I wish we knew then what we know now [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] ) but he required another shot immediately and he did get one.
I think the main concern here, and please remember, I posted this on behalf of another PA.com member, is that what if the symptoms progress really quickly. I know when Jesse had the reaction where he almost died, the symptoms of anaphylaxis progressed really quickly. What if it is a first reaction where the parent doesn't know what's going on and will there be staff available in our over-crowded hospitals to recognize what's happening and get an Epi-pen into the child?
(Remember, it's a first reaction I'm talking about so the parents wouldn't have an Epi-pen).
I see another question..... [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
Okay, Anna Marie, I see your point clearly, for me. I'm a *seasoned* PA parent, if you will, so the last time we went to emergency, despite Jesse having an anaphylactic reaction and me knowing it, he was not the same as he was when he nearly died. And what I did was sit there, scared to death, but with my own Epi-pen in my hand ready to administer it should I have to.
But what if this was his first reaction and I didn't know he was PA? What if the reaction didn't halt itself and he didn't have a parent sitting there with an Epi-pen in their hand? I know that hospital personnel at this particular hospital weren't really keeping an eye on us because they were extremely busy with other people in the emerg (again those over-crowded situations - I've explained why we have them here).
Momma Bear, you have again raised an excellent question that might do well on it's own outside of this thread - how many of us have had children with anaphylactic reactions arrive by ambulance and how was this treated? Was it treated any differently than if the child was walked or driven in? Interesting question. I'd like to see an answer to that.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]

Posted on: Sun, 04/13/2003 - 2:30am
darthcleo's picture
Joined: 11/08/2000 - 09:00

When a patient situation degrades, it's up to the patient or the people with him to ask for a reassessment.
It's quite possible to pass from Level 2, to level I. Even in an overcrowded ER, a level 2 will be seen quickly, then possibly put under observation. But it's up to the patient to cry for help in case of degradation. It's not the best of world, but as long as we don't fix the system, it's the best we can hope for, I guess.

Posted on: Sun, 04/13/2003 - 3:07am
MommaBear's picture
Joined: 09/23/2002 - 09:00

Quote:Originally posted by darthcleo:
[b]Momma > I'd prefer Cleo to Darth, if you don't mind.
Cleo is a beautiful name. [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img] (Darth was just so mysterious) [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]

Posted on: Sun, 04/13/2003 - 10:00am
darthcleo's picture
Joined: 11/08/2000 - 09:00

Technically darth is a title. Like Darth Vader.
So calling me darth is akin to calling someone Mrs, instead of calling them by their name.
Yet again, no one would dare call Darth Vader by his name only, except of course the emperor himself! LOL

Posted on: Sun, 04/13/2003 - 10:10am
Anonymous's picture
Anonymous (not verified)

I would dare --- Anakin [img]http://uumor.pair.com/nutalle2/peanutallergy/tongue.gif[/img]
I agree with what darthcleo said - it is up to the patient/parent to let staff know if/when the situation becomes more serious.
Even if it is a parents first experience with an allergic reaction. You see hives, you go; oh my, what's this. Another symptom (diarrea, vomitting, whatever) you go; what the ?? is going on. By the third symptom (assuming still not breathing difficulty) you might be headed to the ER. When you get there and get put in a waiting room, then, you notice breathing difficulty you will holler. No need to actually walk up to the triage desk at that point. Just let out a yell, and I'd think that would be your instinct anyway (or am I some kind of weirdo)?

Posted on: Sun, 04/13/2003 - 10:55am
cooper's picture
Joined: 12/20/2002 - 09:00

Cindy, I can tell you how my son's reaction at school was handled, when he was transported to the ER by ambulance (in the US). I happened to be at school that morning, and he came out in the hall to tell me. We walked around the corner to the nurse's office, the nurse gave him the epi and called 911. DS was reporting that his throat "hurt" and was tight, he began to pant and sort of make choking sounds, his mouth was swelling, he was pale, nauseated, and talking in a very hoarse manner. This was a walnut exposure.
DS was evaluated in the ambulance, and by then he said he felt a little better. At the hospital, he was taken to a curtained area and seen immediately by the ER doctor and assessed. They put him on a heart monitor, gave him the mist treatment, some cortisone and benedryl. He didn't need another epi at any time. The ER staff took everything very seriously and they were extremely attentive, and while my son was obviously scared, he was always alert and oriented. After about 90 minutes, we were admitted to a room upstairs for another 6 hours just for observation. The staff said they'd keep him until we were comfortable taking him home. Even tho the experience was horrible, I was very glad to see that the school was so responsive and did the right thing, and that the ER staff knew what was going on.
Your point about the varying symptoms of a reaction is one that I feel very strongly about. Our allergist is extremely clear that vomiting is a sign of anaphylaxis for my son. (Before his dx he did vomit after an exposure.) I would never expect my vomiting son to be able to accurately report each symptom during a reaction, I can only imagine the panic and physical trauma he must be going through. I do appreciate that everyone is different and so will be managed differently. I think it may very well be up to us at times to make sure the severity of our kids symptoms is taken seriously. I just want to be sure to get my 2 cents in about the individual nature of reactions.
So, that's what happened. My son hadn't had a reaction in 4 years - I'm glad I happened to be there when he needed me. And I'm really glad the nurse gave the epi!!


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