From the CDC:
During 2003, approximately 16 million ambulance transports were made to emergency departments (30 per minute); 37% of patients transported were admitted to hospitals.
Ten primary diagnosis groups accounted for approximately one third of all transports.
And, what were those ten categories?
- Chest pain
- Contusion with intact skin
- Nonischemic heart disease
- Sprains and strains of the neck and back
- Convulsions
- Syncope and collapse
- Abdominal pain
- Pneumonia
- Drug dependence and non-dependent abuse of drugs
- Fractures, excluding lower limb
I wonder how many of those were inter-related: Cocaine abuse causing chest pain and convulsions, followed by syncope, awakening with a big bruise, finger fracture and a wicked neck strain, a non-Q wave MI and abdominal pain, with aspiration pneumonia caused by the convulsion.
Yeah, I saw that patient, recently. Everyone in the ED has, apparently.
The Top 10 For My Location
1) I’m lonely
2) It hurts right, uhm, here. Yeah, thats it. Got any morphine?
3) A spider bit me (really!)
4) I was in a car crash, & my lawyer wants me checked out
5) I ran out of (insert your favorite drug/antibiotic here)
6) I can’t see my personal care provider for 3 weeks!
7) My folks are out of town, no cell phone, and I have an owie
8) I’ve been hurting for ___ days, and decided to call at 3 a.m.
9) My cerebral palsy son is agitated
10) I’m too drunk to take care of myself, homeless/friendless, and there’s no detox in this stinking town
What?
No Toothache?
The CDC obviously don’t know jack!
1) “Grandma just isn’t herself-can you admit her until Monday?”
2) “After 3 weeks I just couldn’t take (insert complaint) anymore”
3) Ambulatory,self-extricated driver, low speed rear-impacted, remembered commercial he saw for tough, smart lawyer that afternoon and developed neck pain after fender-bender
4) Saw dentist yesterday but they wanted $200 up front
5) 2 year old “lethargic, throwing up and not eating for 5 days”, spontaneously devouring Fritos on the stretcher with Fanta-purple lips and tongue
6) “Patient’s regular hospital is on drive-by”
7) “These three guys just (insert method of assault here) me…”
8) “Chest pain…again, but different than last week…”
9) “I think I might be pregnant”-young woman who may or may not have missed her menses but did have unprotected intercourse within the last 48 hours
10) “No way I’m pregnant”-young woman who may or may not have missed her menses but is either a)dilated and effaced or b)crowning
Have I missed something? I’m having a hard time trying to figure out what your guy’s complaint is. Why is it unusual for someone to have a chief complaint in the ER of “chest pains?” Or even many of the other’s complaints listed? I just don’t believe that that anyone woudl show at the ER with the chief complaint of “I’m lonely.” If they did then that might be their verbal complaint but the bigger picture would likely be their mental health.
Levity, mca. Levity.
BTW, if you don’t understand the chest pain issue you can find abundant discussion of it at any of several medical and public health blogs.
Let’s also remember that people who care for other people also have to practice “defensive” care. Try explaining to someone why you DIDNT take Grandma/child to the ER because you thought everything was fine and it wasnt.
The “I’m Lonely” cheif complaint comment refers more to minor issues which are brought to the ED as an excuse to be treated. The patient does not outright state “I’m lonely”, the patient gives some minor, or contrived ill as their cheif complaint.
that’s not the key thing we get in our local ER(I say ER because it’s not big enough to be an ED)but that’s likely what Eric meant.
mca, you have missed something. Apparently you have never worked in an ER.
1. “chest pain” after being taken into custody for shoplifting.
2. “chest pain” after breaking up with boyfriend
3. “chest pain” after smoking methamphetamine/cocaine
4. “chest pain” while in court.
5. “chest pain” after running out of xanax/percocet etc.
6. “chest pain” because “I am lonely”
7. “chest pain” after family fight at Thanksgiving dinner.
8. “chest pain” after unable to get heroin fix
9. “chest pain” so I can get triaged and seen faster.
10. “chest pain” for the hundredth time even though I continue to smoke, weigh 350 lbs, sit on the couch, and eat Big Mac’s three times a day.
I rode in an ambulance once.
I fractured my right ankle and couldn’t get up, let alone drive. My kid was six, (he called the ambulance.)
From my experiences as a former ED patient registrar in an urban trauma center:
1. Car vs. Pedestrian
2. Bike vs. Pedestrian
3. Car vs. Bike
4. Drunk
5. We were coming home from church and this one has an earache, that one has a sore throat, I have a sore back, and he has a sore head.
6. FBV (If you can’t figure it out – I’m not helping ya!)
7. Chest Pains/Shortness of Breath
8. Sickle Cell Crisis
9. Headache (I’m not knocking 7-9, or necessarily any of these – but we did see them a lot!)
10. And my personal favorite…no Chief Complaint, but a long list of things that are wrong: “I have a fever. I’ve been fatigued for 3 months. My chest does hurt. I have been short of breath. I have a hangnail on my right toe.” (You get the idea…)
Oh how I miss my ED days! ;)
And please…for the love of anybody…please don’t ride bikes in the city!
My only personal ambulance transport was because I was at figure skating practice and fell right on the back of my head/neck. Ow.
One of my favorite observations about the proliferation of the complaint of, specifically, “chest pain” to near-ubiquity: the grammatical about-face that patients perform when they have this particular complaint (or are adding this complaint to their true complaint in the interest of “getting it checked out while I’m here”.) I mean, pick a part of the body-any part like, say, the thumb-and think about how you would convey the experience of pain in said thumb to a doctor or midlevel. I would probably say something like “my thumb is killing me” or “my thum really hurts.” These or similar phrases are how most people convey most complaints of pain. We all see patients who should not have been advanced past the 2nd grade because of their positively atrocious language skills. Somehow, however, our patients have become very conversant with the locution of the documenting professional. Most of us would probably not colloquially say “thumb pain” or “toe pain” or “knee pain” or “eye pain” if asked “what brings you to the ER today?” but more often then not at my hospitals, patients will respond not with “my chest really hurts” or “there’s a lot of pressure in my chest” but will immediately say the words “chest pain.” Interestingly, I have anecdotally found an inverse correlation between the use of the term “chest pain” as the vocalized chief complaint and the presence of active MI or ACS.
(In case I have to spell it out, this is more levity, mca.)