I am starting to develop a list of custom syndromes for the varying patient presentations I see in the ED. Recently I have been dealing a lot with the multiple complaint syndrome, which I am positive most of you who work in the medical field will be able to instantly identify.

During quieter nights and when there's not much going on, the charge nurse will sometimes let me do the triage thing. Even though I am not yet at a point where I can be the triage nurse, it's a great experience for me because it helps me practice on how to get triage information, patient histories, and all that. Usually, the charge nurse or someone more experienced will be there with me initially to make sure the patient is stable enough to hang out with me in the triage room for a short time.

A couple of weeks ago I lost my first patients. Since I started working as an ER nurse I have seen patients die, and been part of that event, as in the case of The Vigil, but this was the first time that the patients I lost my were my own.

Two nights ago we had a patient pass away in our ER. There's nothing unusual about this. What made this case worth mentioning is the manner in which the events transpired and the lessons about human frailty that are embedded in it.

The patient was 56 year old female in the terminal stages of pancreatic cancer. She had been diagnosed 3 months prior and her family had made the decision in the last month to place her on hospice. She had home hospice nurses who would come to see her, and the family knew the end was near.

One of the things that I've observed so far working in the ER is that there are very few truly unique stories. Sometimes it feels like we're dealing with the same old suspects again and again in varying shapes and forms. If this is indeed true, then it seems to me that there should be a way to reduce the number of ED and hospital visits and improve general health by using preventative measures or by some form of public health initiative.

... walks like a duck, and quacks liks a duck, it may not be a duck.

A 56 year old male patient, moderately overweight, presented to the ED with all the classic symptoms of an acute MI (myocardial infarction, AKA a heart attack). He was diaphoretic, short of breath, hypertensive, tachycardic, and complaining of chest pain which felt like "someone was sitting on his chest". The pain was radiating to his jaw and down his arm.

Things are starting to settle down, no one in the waiting room, several admitted patients in the ED all waiting for beds and admission orders, and the usual suspects in the Psych corner, either sleeping off their alcohol/drug binge, or waiting to be evaluated by the psych staff.

Presenting Symptoms: Severe abdominal pain
Onset: 1 week ago

This was all I picked up from the triage screen before I walked in to do my assessment. We see our fair share of abdominal pain so that I didn't think anything of it. I hadn't received report yet but I wanted to at least eyeball my patients and do a quick assessment because the nurse giving me report was tied up with a patient.

This is a summary of our conversation:

Me: Hi, my name is ernurse and I will be taking over from other ernurse.

A 2 year old patient presented in our ED today with a runny nose and a fever of 102.1F, with no other symptoms. She was cranky, snotty, and tearful. The mother stated that her daughter had had this fever on and off for four days, and that she had been medicating her with Tylenol as instructed to by her doctor, but that the fever had been coming back and not subsiding.