Focused vs. Thorough

Tue, 06/29/2010 - 6:13am

I get emails, and one which caught my interest was this recent one from loyal reader Nurse J (lightly edited):

"Do you assess everybody that comes into your ER for everything, or do you just assess the complaint?

I am a newish critical care nurse at A Great Big Hospital, and my wife is a sixth year ICU nurse at a Smaller Hospital. They reviewed a case of an older female who presented with and complained of "flu-like" symptoms. She got treated for said complaint, then also casually mentioned some chest pain......and you know the rest. Stat EKG, ST elevation, elevated cardiac enzymes, and on the way to A Great Big Hospital we go. Only now her door-to-cath lab time was shot.

So, do you only assess to the complaint in the ER? Is that the ER standard? As an ICU nurse, I look at every square inch of my patient at least once or twice a shift, and of course, different patients also require different focused assessments. I loved my rotations in the er, but many times, if the patient seemed stable, I would see nurses not even assess each patient. If you (ER peeps) do have a policy or guideline about only assessing to the chief complaint, then that makes sense. Unless someone is Bleeding, Pulsatingly Bleeding, or has a case of Extra Holes, you don't really need to rush in, the doc will be in in just a minute."

The first thing I would like to draw attention to is the wonderful invention of "Extra Holes" syndrome -- I will be stealing that lovely phrase in the future, I promise you.

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