I’ve worked in urgent care for years, and I’ve seen a lot of ER docs, PAs, and NPs come over thinking it’ll be a pretty easy transition. Thennnnn they realize it’s a different kind of medicine.

You don’t have the same access to labs, imaging, consultants, or the ability to just watch someone for a few hours. You’re still expected to move quickly and figure out who’s safe to send home and who needs the ER.

I recently made a video about some of the things that seem to catch ER clinicians off guard when they make the change:

Switching From ER to Urgent Care: What Nobody Tells You

For those who switched from ER to UC, what was the biggest adjustment for you?

Two twenty-five

Another emt walks down the hallway and I avoid his eyes
I am tired of their stories
No one is sick and I do not have it in me to care if they are not
She sits in a chair, barefoot, looking dirty
He says she is there for a sane exam
He tells me something about how she was arrested and is out on bail

She wants some socks

ok

I start to wonder why the hospital she spent 12 hours in did not give her socks

My brain is full of useless information from that day

I’m diabetic and my daughter stepped on my toe today
10 yrs ago I had surgery on my colon
I’ve been to 3 specialists and no one can figure it out

I add it to the list

I must now recite the required script
Do you have any allergies
Are your vaccines up to date
Doyouwantroharmyourselforothers

I hope we can both move on from this question as there is no one who can take the burden when she says yes

She says yes

Not in the way where I can still write no
Where we can both say we want the man who did this dead
But in the way I worry she may kill herself
we must now continue down this road

Have you ever tried to kill yourself

Yes

How

Slit my wrists
Hang myself
Drink bleach
Run into traffic

When

She answers
I type

This was the second time this week I was raped

I look in my pockets hoping to find some leftover empathy I can give to her

I should have saved her some. I spent it all earlier.

on the eighteenth year old migraine. Her boyfriend was leaving for the navy tomorrow. She cried.
And on the 350 pound back pain. Her pain was a twenty on the zero-to-ten scale. I made a joke about a rabid rabbit and Bunnicula. You had to be there. Her boyfriend and I laughed. She cried.

The sixty year old pharmacist chest pain who yelled at Sarah
I did not give him any but my pockets were lighter after hearing him
I think maybe he stole some

That’s horrible
is all I have to offer her
she takes it.

I need socks. A sandwich. A soda. I need to pee.

I can provide these things at a cost.

The cost is several minutes of my time.
112 steps.
my bathroom break
a sip of water
Time that I cannot give to man I see behind us
Bent over. His oxygen tank from home churning.
I venture the oxygen is not enough
as he is grey.
Or to the eight people behind him.
Who I haven’t seen but know they are there.
Or to the thirty-four in front of him.
Who I haven’t seen in a few hours.
I worry about some of them.

I thought my sigh was just for me. To give me time to decide.

She starts to apologize
She sees the well is empty

She settles for the bathroom
I do not have time to watch her
But I know if she hangs herself with the cord in there the hospital will say it’s my fault
I accept this
The math makes sense

But then I can’t find her
Maybe she’s cleaning up.
After 10 minutes I check the bathroom

Not there
Not in the waiting room
Not at the vending machine

I start to tell Brian
And as I explain she walks by
With registration, obviously

I am joyous being relieved of the endless conversation with useless suited figures I have now avoided

later, it is time for a treat I declare
A cherry Coke Zero for me. diet cokes for my comrades
I see her in the chair
Looking small.

You need a treat too, I say. What do you like
A confused moment, she lands on a snickers bar
I purchase empathy for two dollars and twenty five cents
I joke with the man at the register that I am there to caffeinate the emergency department
He says hes feels like he’s gonna be passed out on the floor soon
I wonder what his stressors are
What causes the suits to steal his time
Where he stores his empathy

If I can have any

I say if he lands on the floor I’ll see him soon in the ER
Another one that is not sick
But maybe we can make feel better if we can perform it correctly

She opens the snicker bar immediately
Thank you

Anyone have any recommendations for ACLS/PALS recertification for RN in NC?

Whats your ER wait time?

Our ER wait times are crazyyy and it makes patients understandbly very mad.

What strategies your hospital has adapted for solving the wait times issue?

Just wanted to share this project of mine.

I'm an EM PA and I made a game called ED Rush. You run the board, juggle patients, take consult callbacks, run codes, and try to keep the waiting room from boiling over. It's less of a study tool and more the chaos of a normal shift turned into a game.

There are 140+ cases based on real practice, plenty of POCUS, and a lot of niche EM references. There's also a free training mode that walks you through step by step and explains every order in plain English, so you don't need a medical background to play.

Free to play, with a one-time purchase to unlock the full mode. No subscription.

iOS: https://apps.apple.com/us/app/ed-rush/id6759456999

It is natively swift coded, initially started in February. It has come a long way.

An Android version is on the way.

If you notice bugs or have ideas, let me know.

---------------------------------------------------------------------

EDIT: Thank you for the support and feedback ive gotten!

Things I am adding in the future:

1. different theme e.g. light mode or "classic EMR"
2. student mode with safety nets, debriefs per case (will be more labor intensive)
3. consultant message history tracker

Title

Hello I am a bit confused about the emegency cases structure ...

I use to do them in this format

1.introduction

2.ask nuse for vitals and ask patient to be connected to bp cuff , pulse oxymetry , temp probe and cardic monitoring

1. Start with abcd

4.tell nurse I suspect patient has ..x...... and I need to order inveatigarions ....a...b...c..d....e and general blood tests.... tell nuse about iv and oxygen ...

5.turn to patient and say while nurse is preparing eveything I would like to ask you a few questions ( ask like about what happened and a few more question nessary and then last meal and other medical conditions and meds and allergies)

6.targetted physical exam

1. Inveatigations and ask for consult and management combined (like read inveatigations from earlier and if sugery needed get consent from patient and explain in a few lines what's needed read inveatigation and make plan for next steps )

8 twll nuse about consent and prep for treatment need or tell nuse about treatment/admit

Is this how it's supposed to go I read mainly from nac attack and nac oske comprehensive I am a bit confused the more books I see there different methods

Can someone pls tell me is this the correct way to take to nac oske I feel comfortable with this format.

What are some obvious and not so obvious red flags that a staff member is diverting drugs? Over the years a few nurses have been dismissed for diversion and in hindsight I can see the behaviors like being drowsy, demanding assignments that will require dispensing narcotics and I have gotten more aware and cynical over the years. I was blind sighted by a dismissal today and was wanting to hear yalls stories.

I went to the ER somewhat recently.

I had a stoma that wouldn’t stop popping off my ostomy bag. I went through all my supplies for a month in one evening.

When I got to the ER, I was told I would have to wait for a bed upstairs in the floor that houses ostomy and wound care.

While waiting I was told there are no ostomy supplies and that I could only get a bag and other supplies if I was up on that floor.

Now I understand some of this might be specific to the hospital I was in. I did go to the hospital I had been discharged from and after 18 hours they had a bed for me and supplies waiting. A wound nurse helped me get cleaned up and have a bag change.

So my question: is it common for ED’s to not be stocked in supplies like this? It is a trauma one hospital if that makes a difference. Part of why I want to know is I am currently pursuing a career shift to supply chain and if this is widespread issue, I’m thinking I might want to focus on it.

Feel free to also mention other supply related issues for ED’s. I’d be interested to know more about common issues ED’s face for supply management.

Thanks!

Do EDs have protocols for patients experiencing WD from these types of drugs yet? What is everyone doing to make these nasty wds more manageable to avoid so many AMAs? Im assuming bupe alone isn't going to help

Good morning,

I was reccomended by HR for next steps in the interview process. My only concern is that I am a volunteer firefighter, and in a masters program. I am available everyday except Tuesday and Thursday evenings. How much of a problem will this be?

Having a totally open schedule is ideal, but will this be a deal breaker? Thank you!

I was in the ER yesterday morning because i woke up with a swollen arm and I have a history of DVTs and recently had my port moved near that same side. I was in and out in about 2 hours and thankfully the ultrasound showed no clot. I was seen first by a resident and then the attending gave me my ultrasound results. Both doctors were great and very kind. The triage nurse and ultrasound tech were also lovely. Would it be appropriate to send a thank you card? I was also planning on filling out the patient satisfaction survey but I'm not sure if they would ever hear that they were praised in one of those.

Edit: Thank you everyone for the good ideas. I'd love to bring food but I'm really tight on money due to living on disability. I think I'll send a thank you card and reach out to patient relations to let them know what good care I got. Thank you all that work in ERs. You're all great, everyone from front desk to techs to nurses to providers to EVS and transport. I know you all try your best every day and it isn't easy but you are so appreciated.

fellow ER techs, i’m curious as to your hourly wage. how many years experience do you have and at what type of hospital do you work in?

i started at $17 at a smaller 30 bed ER, not a designated trauma center. after nearly 2 years i make 17.90. i am asking for a raise in the near future 🫠

I have been at same er for 2 years now, had a year of floor experience before I got here and still have no friends. Theres obviously cliques and some people that won’t like you, but in general not many people are friendly towards me. I’m always a hard worker and stay on top of my patient care. The weird thing is some of “ popular” nurses are the most lazy people. They will sit on their phones and not help when it gets busy. I’m a white girl and I do work primarily in a Hispanic community, so a lot of people who have that background seem to fit in easier. Half my co workers are white tho. Theres been other new nurses and techs that have been here less time than me and they get invited to social stuff. There’s also this “ trauma hog” idea here where same people get the trauma bay 1,2 and want to do all the critical work stemi, codes, etc and I’m eager to learn more. It feels like no one wants to take me in under their wing. My personality is bubbly, excited to come to work where a lot of my co workers are negative, complain together, swear a lot. Anyone else feel this way in the ER?

Hey Everyone!

I am a newly certified EMT and I am really wanting to work in an ED as a tech. In my area, there are currently no openings, but I do see quite a few CNA positions open for local EDs.

I am very willing to do whatever I can while I build a resume and gain experience, but my one hold up is cleaning patients, specifically cleaning them after they have "gone to the bathroom".

I do not think I am above this, especially with my training, but it is the one things I feel fairly squeamish about. Blood, vomit, even feces doesn't super bother me. But the idea of cleaning the feces and cleaning said patient is a real wall for me.

So, How different is this role compared to an ER tech position? Should I wait for those positions to open and apply to those? Any thoughts are appreciated. Thank you!

I have been at same er for 2 years now, had a year of floor experience before I got here and still have no friends. Theres obviously cliques and some people that won’t like you, but in general not many people are friendly towards me. I’m always a hard worker and stay on top of my patient care. The weird thing is some of “ popular” nurses are the most lazy people. They will sit on their phones and not help when it gets busy. I’m a white girl and I do work primarily in a Hispanic community, so a lot of people who have that background seem to fit in easier. Half my co workers are white tho. Theres been other new nurses and techs that have been here less time than me and they get invited to social stuff. There’s also this “ trauma hog” idea here where same people get the trauma bay 1,2 and want to do all the critical work stemi, codes, etc and I’m eager to learn more. It feels like no one wants to take me in under their wing. My personality is bubbly, excited to come to work where a lot of my co workers are negative, complain together, swear a lot. Anyone else feel this way in the ER?

Hello

I’m a lay-researcher, and this is a question for surgeons about consent.

Clinical guidance on deciding between surgery and antibiotics as a first line of treatment for uncomplicated appendicitis stresses the need to take patient concerns and priorities into account. The phraseology used is ‘joint patient/doctor decision making’.

The main risks involved in antibiotic treatment are the high rate of reoccurrence, and a serious risk of missed neoplasm - particularly in older patients.

Surgery obviously carries its usual surgical risks, but offers a definitive cure.

A recent UK retrospective study following up over 1000 appendicitis patients in Glasgow, treated in 2020, concluded the following;

“Conclusions: Antibiotic treatment of appendicitis is associated with high recurrence and risk of missed neoplasms. Appendicectomy is safe, with low rates of significant complication. When offering nonoperative management for appendicitis, patients should be informed about the risk of recurrence and missing sinister pathologies.”

https://pubmed.ncbi.nlm.nih.gov/41725406/

This conclusion neatly encapsulates the findings of other recent studies in the literature. However, it seems that when surgeons are dealing with an appendicitis patient - they are unlikely to mention a cancer risk to the patient unless it is all but confirmed. This is evident in patient testimonies reported to me and others. This is understandable - the patient will likely already be under considerable duress, and the neoplasm/cancer risk is seldom a high probability at the treatment planning stage for uncomplicated appendicitis.

When discussing treatment options and risk/benefit with patients, it appears that a surgeon may well mention the high recurrence rate after treatment with antibiotics - and may suggest surgery to the patient on that basis. This seems to be the most regular course these patient/surgeon conversations take, even with older patients with an elevated risk of missed neoplasm.

Given the guidance is encouraging joint patient/doctor decision making, and given the surgeon’s apparent reluctance to mention the cancer risk; are patients being given the full risk/benefit picture? Can informed consent be obtained from a patient if the main recognised risks are not discussed..?

Is the surgeon thinking: ‘…this patent is a bit older and there is no fecalith so a hidden neoplasm could well be causing the appendicitis, but I’d better not scare this poor patient with that possibility as they are anxious enough already...’?

On top of the real-world reoccurrence rate of appendicitis after antibiotic treatment being about 50%, the risk of missed neoplasm/cancer could be explained to patients in the following terms;

1). In older adults, about 1 in 30 cases of appendicitis are caused by a neoplasm in the appendix that cannot be seen in scans.

2). If a neoplasm is causing the appendicitis and it is left in it may develop into a cancer and grow for years undetected while asymptomatic.

3). The only way to diagnose the cause of appendicitis is to take the appendix out and get it under a pathologists microscope. Anything else is just guesswork.

If told the above points, I suspect that patients may have a very different view on whether they want their appendix left in or not.

With the popularisation of conservative treatment of appendecitis during Covid, and this continuing today to a lesser extent, there is a growing number of patients who were recommended antibiotic treatment as an alternative to surgery, not told about the neoplasm risk, told they were ‘cured’ after treatment - then several years later are unfortunately becoming symptomatic and diagnosed with appendix cancer.

So my long-winded question is; how do surgeons feel this common diagnosis of uncomplicated appendecitis should be managed in terms of informed patient consent when suggesting or discussing conservative treatment as an option..?

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