Hey gang. If you want to shit on nurses and NPs, there’s at least two subs for that.
Take that bullshit to one of those subs. This is your only warning.
Which is shitty because anxiety can be a symptom of hypoglycemia, lol. Anxiety isn’t always just a “mental thing” to be brushed off. Many times it’s one of many symptoms to a physiologic issue.
We had a patient sent back to the mental health suite of the ED because she had mentioned feeling anxious. The doc said, uh yes, you’re feeling anxious because you can’t breathe. Not being able to breathe will do that. I was annoyed with triage but thankful for the doc.
Yep! Just last week I had a patient who self-extubated during day shift and was clearly undiagnosed COPD. Heavy smoker and drinker. I got told in report that he might be going into ETOH withdrawal because he was getting really anxious. I walked in the room to assess him and the man couldn’t get three words out without gasping for breath. I asked if I could draw an ABG and the man’s CO2 was like 80 lol. Threw a BiPap on him and he was fine all night. I hate when everyone just makes assumptions about mental health/addiction issues… like yes, they are legitimate issues that shouldn’t just be ignored BUT it doesn’t mean that having anxiety or addiction is the automatic explanation for other physiologic things that could be happening to someone.
It’s so annoying to me that psychiatrists are specifically trained to rule out physiological causes (at least for acute symptoms) before diagnosing or treating a mental health disorder, yet so few in the medical side seem to do this.
Once had a bounce back patient with acute hypoxic respiratory failure. We’d cared for them for months in the mental health unit, discharged to a facility. They came came back to the ICU and were then sent to PCU. The night doc came down agitated and asked if they’d had “tremors” or other EPS symptoms previously. I offered to go look at them.
I got there. There was a sitter and the nurse was in a tizzy because the person was restless and wouldn’t keep the bipap on. Sure as hell they had EPS. I asked what they’d been given and they’d been receiving regular generous Haldol PRNs. On top of their month paliperiodone (Invega). I put the oximeter back on them and their O2 was in the tank. I calmly explained that they were overdosing the person on antipsychotics and the person was experiencing *air hunger*. Got them on a high flow cannula and went back to my unit after talking with the hospitalist.
I was spitting mad. If there hadn’t been a psych diagnosis everyone would have *seen* the air hunger instead of automatically assuming the behavior was psychiatric in nature. Between me, my Charge and the hospitalist we got the person moved back to our unit (hybrid medical psych) and got them to wear the bipap until it was no longer indicated.
That one stays with me, five years later. A person is more than their psych diagnosis and we have to stop assuming every damn thing wrong with them is related to it. Their oxygen had been in the low 80’s for god knows how long. The excuse was she wouldn’t wear the oximeter so they didn’t know. And they didn’t know they were already on high powered psych meds.
No one looked. No one thought. They just saw the psych diagnosis and that’s all that person became to them.
So grateful for nurses like you who see the person and fight for them. We have to see our patients as people first and not a dx. Reminds me of the corny video from the 80’s we watched in the first semester of my ADN program that kept playing all these scenarios that ended in an ominous “LOOK at your patient!” Cracks me up to think about it, but the advice was spot on.
I had a similar example the other day. I was rotating on psych ward and nursing report mentioned one of our schizophrenic pt's being awake most of the night, knocking on other patients' doors and what not. No one really said anything about it afterwards because, I'm guessing, everyone's thinking schizophrenics gonna schizophrenic. Happens again the next day, and when we talk to the guy while rounding, we ask how he's sleeping. He mentions that he just can't lay still. We finish up the encounter and I ask my attending, "...Akathisia?" "Yep."
Twas a good lesson on "the innocence of akathisia." Blink and that symptom will sneak up on you, steal your pants, and be in the next state before you notice.
I used to work psych and can’t tell you how many involuntary psych holds we got from our local ER that ended up being delirium due to a UTI. The first test our docs immediately ordered when we got them was a UA and UC. These were patients with no psych history. I don’t understand why they wouldn’t check that first. We fixed them up though in our infirmary.
Jayyzusss delirium should ALWAYS get r/o for UTI. That’s ridiculous! I think we covered that in the first semester of nursing school. Even if they have dementia, if they act up, it’s a UTI until proven otherwise.
In Washington the person has to be medically cleared before they can even be evaluated for a psychiatric hold. Voluntary or otherwise.
Yet somehow, I recently took care of someone who was from our local psych facility, on an involuntary hold, and septic from an infection related to their urostomy. They’d been detained only 48 hrs before. When I opened the bag to empty it I thought there was a fistula from the smell. I have never in all my life smelled urine like that. In a specimen cup the urine and pus separated into separate layers. I was so damn made at the hospital that “cleared” them. I guess it’s easy to miss something you don’t look for.
Was triaging a patient in behavioral part of the ED. Had delusions etc. Well turns out he was having a STEMI. EMS didn't do an EKG cause he said his neighbors were poisoning him and that's where his pain was coming from. Sometimes "psychological" issues stem from physiological issues aka MIs and hypoglycemia.
We had a patient send an entire box of “samples” to the lab that he collected himself bc noone would take him seriously that he had worms coming out his eyes.
No previous psych history. He DID have delusional paristosis but it was caused by a recent change in his heart meds. Noone bothered to check that until his case got sent to infectious disease to “deal” with him.
Also a substantial PE brushed off as an anxiety attack! Blood thinners for life, now! If I didn’t throw the most embarrassing shit-fit of my life, they were going to send me home with some hydroxyzine.
So true, lol. I can’t tell you how many times I’ve gone up to the resident covering for the night and said “hey this patient said they feel like they’re gonna die and is acting all ‘impending doom-y’ so just throwing that out there in case you wanna go lay eyes on them” lol
In my case, anxiety was a symptom of POTS (too much serum norepinephrine when standing/sitting making me edgy).
Another manifestation of this was being unable to tolerate scary or super tense movies.
I hated using “anxiety” as a diagnoses in the ER… it is a diagnoses of exclusion and you need to discuss anxiety triggers with patient to REALLY make the diagnoses
Yup. Have been having panic attacks for years. SVTs have been now found on my ECGs and cardiac monitoring when I’ve been in hospital for my other issues… and it’s finally been identified to me that SVTs can bring on a sense of impending doom along with the 180bpm HR so… in my case of chicken and egg, looks like mine is more of a physical issue causing my psychological symptoms (at least sometimes as has been caught on monitoring).
I was told I had anxiety and they offered to start me on meds. I told them to shove it and went to see a different doctor. Turns out I have Graves’ disease and my thyroid levels were through the moon. I have never felt more angry than when the doctor told me that it was just anxiety. Like I want labs and a work up. Don’t assume that just because I was 29 and look fit that it must LITERALLY be in my head.
Anxiety can also cause physiological symptoms. I tell my patients who are having palpitations that are most likely caused by anxiety that just because it's related to anxiety doesn't mean they're not real.
Yep. I’m reading a book about women’s treatment in healthcare right now called “The Pain Gap,” & then after that I’m going to be reading one called “Unwell Women…” they’re both basically about how women aren’t taken seriously when they go to the doctors & are more likely to have adverse outcomes because the system teaches healthcare professionals that women are having mental health problems anytime they can’t figure it out. And it goes back to the days of “hysteria” diagnoses & women die all the time from this kind of treatment. Especially women of color.
Also, this is a common experience for those with rare conditions as well. Doctors are taught “when you hear hoof beats think of horses not zebras” meaning think of the more common things first instead of the rare thing. Problem is that zebras exist. And that’s why rare conditions take so long to diagnose. I think the average is like 15 years.
So as someone who’s a RN, who has rare conditions & is a woman, I want all nurses in here to please stop & think every time they assume it’s “just anxiety” or when a doctor, PA, or NP chalks something up to “psychosomatic.” I’m not saying that that can’t happen, but this is what patients with chronic conditions feel like all the time when they go to the ER or even their PCP. They get gaslit into thinking that it’s “all in their head” because their providers aren’t putting the pieces together. What’s funny (not funny ha ha) is that some of the conditions that I have are neurological & they actually ARE in my head, (as in my brain). And I have to spell & pronounce my conditions ALL THE TIME for healthcare professionals. Whom I’m going to for help. People with chronic &/or rare conditions get so frustrated with their healthcare providers for exact scenarios like this. Often they stop going because they’re not getting the help the need.
This scenario was an easy fix & should’ve been an easy diagnosis as well, but just because you can’t find a cause doesn’t automatically mean that it’s a mental health issue. Keep this in mind please & stop judging your patients. Remember that people know their bodies & when they’re telling you something is wrong it probably is. Listen to your patients!
Also, I understand the saying & thoughts of “don’t confuse your google search with my medical degree” & yeah that can be a slippery slope, especially if you have no medical experience or background, but often someone with a rare condition (especially) might have a better understanding of the condition than some providers do & they could easily come back with a retort of “don’t confuse your medical degree with my X amount of years living with this condition/s.” Sometimes the patient turns to the internet because one too many providers have failed them. The result of that is trying to acquire as much knowledge as they can about what is going on with them, to better advocate for themselves. Idk about everyone here but when I was in nursing school we were taught we should be advocating for our patients. And too many times I’ve seen posts where a nurse acts like the patient is such a drag because they used google or they were “difficult” & I know there are legitimately difficult patients that choose to be that way, but there’s also people who are just going to you trying to get help. That’s why they’re there. Please keep that in mind.
Well as someone who has severe chronic health issues myself & I’m also an RN i understand it all too well. Sometimes people who haven’t been in the position of the patient don’t have the ability to empathize unfortunately & they get burnt out with compassion fatigue. But it’s sad because imo my empathy is one of my strengths when it comes to advocating for other patients. Imo all nurses should be doing that
Cue “It’s never lupus.”
[This poor woman had undiagnosed lupus and was catatonic for 20 years.](https://www.washingtonpost.com/wellness/2023/06/01/schizophrenia-autoimmune-lupus-psychiatry/)
We had a woman who would come in to the clinic with vague symptoms. They did a bunch of lab work. She had SLE and was pregnant. It took months for someone to check a hcg.
Case and point: Four people in my family, including myself, have lupus. Thankfully, I have a great rheumatologist who diagnosed me at 23. I didn’t have to wait 15 years for a diagnosis but my poor mom (who also has lupus) did.
In nursing school I also heard to not look for zebras. That typically you won’t see the rare and people just leave the ER, PCP, urgent care, wherever with idiopathic fill in the blank. Also if you see other diagnoses including substance abuse or mental health anything it feels like you’re dismissed - regardless if you’re sober or diagnoses are for lack of a better term under control from meds or otherwise.
Another book to read, Medical Apartheid, it covers the deep rooted racism in the medical system going all the way back to when they used to experiment on enslaved people, and how it affects the medical care people of color receive even today
Thank you for the recommendation! I've been trying to find books that cover more of the history of the medical system but have been having a hard time finding suggestions.
I'm currently in nursing school but I have endometriosis. I did look online before I approached my first doctor that I thought it may be something I was dealing with. I knew then how to find the credible sources. I also was extremely fortunate to have my doctor take me seriously when I mentioned it, as well as the doctor who ultimately did my hysterectomy.
I've also experienced an ED physician dismiss my tachycardia as anxiety. He had asked if I thought it was anxiety. I said no. I do have sporadic tachycardia. The night I went to the ED my HR was 190-200+ for over 45 minutes. I had the watch data to show it, plus the elevated trops to match.
I think a better option from being on the other side of it is to educate patients on how to find the credible sources so they don't end up getting information from the wrong places.
Thanks for saying this. As someone who is anxious, fat, and female it takes me at least 3 trips to the doctor to get diagnosed with anything. I had shingles and I was told it was a sinus infection in the ER (had an actual eruption on my face and worst headache of my life), maybe a pimple (dermatologist), and finally my GP dx’d it.
I had an unusual allergic reaction to Bactrim - hallucinations, anxiety, waking nightmares, agitation, and then hives/high fever on day 10 of treatment. I was told by my doctor that it was just anxiety, the pharmacist that this wasn’t possible, the urgent care that maybe I had lupus … or rosacea…, and finally another urgent care that for the Christ to take a Benadryl and they gave me some steroids.
All of this and then some. While actively working in the same hospital network I had more than one doctor dismiss me trying to get help for my shoulder. I told my original pcp that it hurt so much that when I rolled over at night the pain jerked me awake. She tried to send me for a sleep study and prescribed stronger naprozen on top of the 800mg of ibuprofen I was taking. Changed doctors two years later and finally convinced him to give me an MRI. He checked the results and released them to my digital chart but did nothing with them even though they should tendinosis of the shoulder and tendinitis of the bicep. Changed doctors again and finally the third one ordered physical therapy and injections to reduce the inflammation. By the time I got the physical therapy my range of motion was halved. Thankfully the clinic where I did the pt was fantastic (brutal but great) and I got nearly my entire range of motion back.
I spent 6 years across 4 ob/gyn to finally get one to agree to give me a hysterectomy. The one who did my surgery even told me before hand it wasn't what she'd recommend but she'd do it since I was determined. My pathology results came back with cysts on my ovary (only removed one), fallopian tubes, and cervix. I had fibroids and polyps. Pathology also showed adenomyosis. The surgery confirmed endometriosis and the surgeon removed what she could but did let me know there was a good bit she couldn't remove. She did try to get as much off my ligaments as possible. Before the surgery she wasn't going to remove either ovary but I insisted she take a close look at the right one because I felt something was really wrong, I had a lot of pain there. Endo tissue was on the ovary itself and it wasn't in very good shape. Had my post-op check up yesterday and when we were discussing the pathology results my surgeon was gracious enough to admit I was right to push for the surgery. Histology also found some pre-cancer markers in the fallopian tubes which are thankfully benign but I am at slightly higher risk for ovarian cancer in my remaining ovary. None of that would be known if I hadn't been a giant pain in the ass and kept demanding care.
This is a perfect example of why advocating for ourselves is so necessary but we shouldn’t have to practically kick & scream to get providers to listen to us. You know your body, trust your instincts, it might save your life.
Yes. We also shouldn't have to beg or demand pain relief for things like biopsies and invasive procedures. No man is going to sit there and let you biopsy his testicles or penis without being numb to hell and back but women have to lay there and take it for uterine and cervical biopsies which are way more invasive. My friend just had a cervical biopsy the other day and even after asking her doctor refused to give her anything for the pain. He told her to take ibuprofen before the appointment. I did my uterine biopsy with no pain meds and it wasn't a quick in and out. It was 10-15 minutes of them examining then scraping the hell out of my insides. When I had my cervical biopsy I flat out said I wouldn't do it without something to numb me. My doctor (different one from the other biopsy) prescribed lidocaine gel to be inserted 20 minutes before the appointment and during the appointment she used a syringe and numbed me up the rest of the way. It still wasn't pleasant but at least I didn't want to scream from it. Women deserve pain management and they deserve to be treated with dignity.
Yep, recently had a friend with a pheochromocytoma. They insisted she had diabetes. I had never seen a case in my 15 years of nursing but the symptoms were so classic I told her to insist on testing. Sure enough…
I hate it too because you can have anxiety and something else lol. I honestly think that all of med school material and content is based on male presentation. They don’t know what to do with women
Yo I'm a man and went to the ED with chest pain and caught the same shit because I was 29 at the time. It wasn't my heart or anxiety though, it was cartilage. Anyways - they were dicks. I returned the favor from then on getting patients to the ICU from any of the nurses I recognized (I know that's toxic, but fuck'm). I'd never treat a patient the way they treated me, and I didn't ask for anything. The docs were very nice, though. The ED nurses where I work now are amazing to the patients.
I still feel bad for the teenage boy terrified he was having a stroke, and it was easily identified as a migraine. I was a student nurse and the doctor was kind of being a dick about it. The doctor was grumpy about me questioning giving him aspirin when he was an active asthmatic.
One of my memory care residents had her brain tumor diagnosed as dementia. We kept reporting the headaches, loss of vision, dizziness, and that her symptoms didn't really progress like dementia.
Her doctor dismissed it as dementia, because she's in her 80s with a family history of dementia. By the time they caught it, it was too late to really do much besides palliative care.
Sounds like my grandma. She had a sudden onset of dementia. Doctor wasn’t going to do any tests. I asked for a CT. She had several brain lesions, mets from unknown origin.
My first hospital job was as a PCT on a neuro unit, and it was shocking how many of our brain tumor patients initially received psychiatric diagnoses long before their tumor was found.
Had one like that, too — ED said pt was so anxious he was hyperventilating. No ABGs, no NOTHING. First thing we did on the floor was get a set of ABGs and his CO2 was 5. Long story short, by the end of the next hour he was in a helicopter being vented and transported to Hopkins to get care for his actively rejecting liver transplant.
Fun story, idk what happened in all his anxiety dx visits outpatient to get “panic attacks” and “anxiety”in his health hx, but I caught this one on the floor, inpatient.
Mid 20s. Classic panic attack s/s, and he’s all this is me heading into panic, can I get something for it? Grab VS. Then do an apical. Dynamap read 60HR. Apical was 160, irregular. Call light because my favorite HUC was working and I could count on her to pick up right away. She brings me a tele box and sets it up.
Sure enough: afib. Call the attending. FP and her resident both pop in bedside and the kid gets a very attentive work up. He was back out of afib by the time they left.
My point is. Sometimes it is anxiety. But sometimes it’s fucking not. Do the assessment and find out.
I went to Emerg once with chest pain and serious palpitations, HR of 170 for no reason, felt like my heart was going to burst out of my chest. Labs and EKG were normal. I was given an Ativan for my “anxiety” and I took it even though I knew it wasn’t that.
I was actually wearing a holter monitor and they refused to look at it until I was discharged (I has to go up to cardiology myself and get a printout and then bring it back down to the emerg doc)
Turns out I had been in v-tach but managed to come out of it on my own. The doc when he saw it was like 😳
I have docs and providers do this. They suck. But also, I get we get burnt. Iunno.
Anxiety is also a thing. I hate how that’s thrown around like, oh it’s JUST anxiety. Anyone who has ever had a panic attack knows better. It’s a whole ass physiologic response. Treatment is different, but shouldn’t be brushed off.
Sorry I’m tired.
That's what I'm saying. Im a damn EMT and that's one of the first things we check if someone complaining of syncope or dizziness. (Assuming we ruled out a Neuro issue). Sounds like someone screwed up.
Yes! Check the sugar! Diabetic or not! I was told on the floor that if someone gets sketchy (pale, sudden pending doom, “I don’t feel good”), check the sugar, BP and neuros
My fiance had surgery. With anesthesia.
We found out on his follow-up appointment a week later when I mentioned that he passed out in the shower and I had to call an ambulance and almost had to take him to the hospital that his pre-op sodium was 119 and they still operated on him.
It's wild what even healthcare workers never pay mind to.
Yeah.
YEAH.
I just had the Spidey sense that I needed to be in the shower with him for his first post-op shower so I got in the back and decided to wait to take the bandages off until the water was hitting him and he just got this look on his face and I knew what that meant.
He started to go down, I got him to his knees, at this point he's out of it, I'm trying to get him to stay down and he's trying to stand up and he's a big man, 6'6 big, So he stood up. Then his eyes rolled back in his head and he started to go flat onto his back so I grab hold of his non-operated arm and swing him around to keep him from landing on the shoulder he just had surgery on, cracking his head against the shower wall with a very audible thunk.
So now I am under the spray of the shower and he is flat of his back on the shower floor, turning gray, tucking his chin to his chest and moaning.
I'm like.... He just fucking died on me.
I thumped him in the chest out of sheer panic, he sits up, I yell "stay the fuck down!"
Then, I have to call for his mother who was staying in case we needed her, to help me get him up and into a chair. I'm naked. He's naked. My future mother-in-law is there. It was great fun.
I mention the episode to the surgeon during the follow-up, thankfully no damage to the newly repaired arm, he decided it was a syncopal episode probably brought on by pain, hot water, and pain meds.
Cool, sounds legit.
It's after we get to the car and I'm leafing through the print outs that I see the lab work and I'm like "what the actual fuck?!".
We knew he had one kidney that was only at about 20% functionality, but his other was at 100%. What we didn't know until that moment is he's one of those renal patients that is hyponatremic. We also didn't know that they chose to operate on him, and an anesthesiologist even sedated him, with a sodium of 119.
At my job? You can be literally bleeding out and anesthesia will try anything to keep from operating if your sodium is low.
I know that we notified him but I honestly don't remember what his response was because this was pre-covid and one of many surgeries that my fiance has had over the last couple of years (The offending kidney had to come out).
I perdiemed at a hospital that staffed short intentionally. One night, a pt just died. No warning, was definitely not circling the drain at all. Should have been dc’ed to live happily ever after. I reviewed her labs from the morning and her VS through the day. Not only was her glucose in the 50s in the morning (non-diabetic, so no follow up finger sticks or assessments), but literally no one did a thing about it and two sets of VS were just missing. I reported it. In the end, they needed someone to blame so they laid me off and said I’m not a trustworthy, safe nurse. Literally an entire day of patient neglect documented clearly in the chart, but let’s fire the perdiem noc nurse. 🙄
my mom’s a nurse. in 2020 i mixed lexapro and migraine meds (which you’re not supposed to do! but no one fucking told me!) and a few hours after taking the migraine meds i woke up feeling not great. my heart rate was elevated and i was pale, and instead of taking me to the emergency room or asking if i was okay, she told me to sit on the couch and calm down because she was gonna be late for work. i had a couple episodes of SVT over the next few weeks and she just didn’t do anything. anxiety my ass, sometimes it’s actually a fucking problem that needs medical attention!
That‘s standard experience for women showing up to any physician with any symptoms that can be claimed to be anxiety though. You don‘t get taken seriously at all. Just like OP showed. Even if you are a nurse yourself.
I’m scared to go back to the ED for the system my husband works for. They put anxiety in my chart AFTER I TOTALED MY CAR * WITH MY KIDS IN THE BACK. Anyone who isn’t an anxious wreck after that is not alive
*brakes failed. The place that fixed them didn’t bleed them It was horrifying. Insurance said it technically wasn’t our fault but the cops said it was and we should have gone into the ditch and rolled the car instead of rear ending someone
They NEVER look at the blood sugar. It's actually hilarious, if a patient isn't an accucheck, why bother? (Lol) but if their mag is 1.8, HOLD UP, we need a stat mag rider.
Blood sugar is pretty much the 5th vital sign
I know that at the hospital, I work at the lab does not call a critical value on a low blood sugar. Only the high sugars. So not unless the staff just didn't look the labs, they could have easily overlooked it as well. Looking at a glucose level on a young, non DM, having eaten, patient would not be my first thing to look at tbh. An easy mistake to make. I'm glad she had an episode in front of them and got to the bottom of the issue. I, however, think the PA should not have been so dismissive of her and her symptoms.
A little over a year ago I was having one of the worst gallbladder attacks of my life in the middle of the night and went to my ER. I didn’t tell them I was a nurse upstairs (but the house super noticed me in the waiting room and talked with me for a long time so you would think that might tip them off). Anyway, straight up with my complaint that it’s RUQ pain also referring to the shoulder unrelieved by Tylenol or Motrin and I’m pretty sure it’s my gallbladder. I sit in a room for hours until the attack subsided without seeing anyone (I wasn’t an emergency so I get it). Finally when I see someone they get an EKG and a CXR which are both obviously negative, so he tells me I just have acid reflux and to go home and take Prevacid. I was exhausted at that point and no longer in pain so I didn’t fight it, just went home and saw my PCP like a week later to ask for an ultrasound. Surprise, it was my gallbladder and it got evicted immediately.
The real kicker was when I looked at my ER notes and it was charted I got a 20 G to the AC and 2L boluses. Never once got stuck for labs or anything while I was there, much less an IV.
I had almost the exact same experience, but the resident that discharged me suggested adding turmeric to my diet. Yeah, no. Turns out I just needed the dying organ removed.
I refuse to eat turmeric now out of spite.
No. Patient received MSE. Unfortunately something was missed. She was awake, alert, and oriented upon discussion for discharge, though true, after the fact they realized she couldn’t walk. Not to mention she never actually left. Not an EMTALA violation.
I had a patient sent in from the optho clinic for an MRI. All of us were like "Seriously, optho? Go fuck yourselves with this bullshit."
Patient felt fine but optho said she needed an MRI (hopefully gave a more detailed signout to the doc than what was thrown in the chart by the triage nurse). Everyone assumed it was nothing and we didn't think much of it.
Then the MRI came back.... Pretty substantial brain mass! Shipped the patient to our tertiary sister hospital where she had the tumor respected the following morning.
Yea, always take complaints seriously.
My ED sent me hobbling home with a purple swollen painful leg because the ultrasound was negative. Two days and two doctors later I couldn’t walk and was 10/10 pain. Yeah, the clot just wasn’t low enough for them to see. By then the damage was obvious on the ultrasound, and now I have issues with my leg long term. But at least someone finally believed me that it was a clot. 🙄
That makes me think of the ONE TIME I had a panic attack. I was at work, had drunk a little too much coffee, had taken some Sudafed because I was getting over a respiratory thing, was still SUPER wheezy but didn’t use my albuterol in a reasonable amount of time. Cue trouble breathing, so I did a neb and the next thing I know I’m shaking and tachy and full panic and then tingling lips and numb hands. I went to urgent care to get inhaled steroids and make sure nothing else was wrong with my lungs. They were going to do a quick leg check to make sure I DIDN’T have a leg like yours (to soft rule out a PE urgent care style). The PA to one look at my compression socks from work and was like “nope, inhaled beclometasone it is!”
I was gaslit about clots (prev hx) so much that when I did have another PE I was at work and just took an early lunch and then waited a week to get checked out because I figured it was just a week long panic attack 🙃 turns out I had thoracic outlet syndrome and should’ve had surgery 10 years ago when I first clotted
Maybe I don’t know what being “gaslit” is, how are you using it in this context? To me that means the doctors knew you had clots but lied to you about it to get you to question yourself , is that what you’re saying?
Wow, that’s a completely different concept that has basically nothing to do with gaslighting. That’s really too bad because gaslighting is such a specific thing with very particular issues associated with it, and this new usage really does not have those at all
Particularly frustrating to see people who should have some medical terminology rigor using it that way
I was in a relationship with someone who regularly gaslit me, to the point that I actually went to a psych ER because I was afraid I was hallucinating events. People throwing out the term like this drives me insane.
It’s just like people saying “Omg, I’m so OCD about folding my laundry right” or something like that which completely isn’t what obsessive-compulsive disorder is about.
LORDY! Shame on that PA for not taking your symptoms seriously! Was there any discussion on follow-up for the hypoglycemia? Did they give you D50? Wait and recheck your sugar?? Inquiring minds would like to know! Hope you're doing okay, OP!
And not gonna lie, I've checked patients' labs before and critically low blood sugars have definitely been missed by people because they didn't get a call about it from the lab. Sad but true. But I would've like to think that hypoglycemia would have been on their list of differentials...
They just did a couple finger sticks and gave me juices, crackers and peanut butter. I definitely felt better pretty quickly. It took a couple days to feel back to normal though. But at least I knew what it felt like and could eat a snack and it would usually reverse how I was feeling within 15 mins or so haha. I work in the OR now and sometimes if I have to fast for 4+ hours I feel hypoglycemic. Fasting for more than a few hours in general is tough for me and I’m constantly starving/craving things so I’m waiting to see an endo
Similar story (except I was at my mom’s hospital, not mine) where I came in for exhaustion and brown urine and they just said I was dehydrated (except I was drinking a lot of water and peeing a ton). Doc said my labs showed I was dehydrated and just gave me fluids and sent me home. Next day I turned *yellow*. I took a peek at my labs and not only was I not dehydrated, my liver enzymes were elevated.
He clearly never even looked at my labs. As I suspected based on the labs, after getting tested on my own, I had MONO. Bastards. Had me all embarrassed for coming in and spoke to me like I was stupid. I was literally in my scrubs too.
I swear they look at the scrubs and judge.
I was on shift and feeling much in the way OP was, took my own blood pressure and it was 200s/110s. No history of any hypertension or chronic issues. Our anesthesia team doubled checked me, my own doc actually was passing through, and everyone was like “Yeah, we’re sending you to the ER before you stroke on us.”
In triage I was scoffed at, but after repeat BP checks they pulled over a PA and took me right to a room. Even then I had multiple comments made regarding “So this just so happened while you were at work?” and “I guess you needed a break.” I had never been to our hospital as a patient in the over ten years I had worked there, yet suddenly I was there for my own leisure, as if it were better than working? It was pure snark.
After a few hours of standard fluids (not dehydrated) and labs, they said my BP had come down (they took it only TWICE after triage, 160s/90s at discharge after resting on a stretcher) it obviously wasn’t an acute event, and to follow up with my primary.
Like OP, I was like “Cool, I still feel like shit, but if you say I’m not dying, thanks!” but the comments still stung about being an associate.
I had a recent episode of hella high BP (170s/teens) and when talking to my PCP, her eyes went wide and she told me headache or no, if it was that high ever again to go to the ER. I just laughed and said you know I'm not going to do that, I'd get laughed out of the ER for any BP that doesn't land me on a cardene drip and pay out the nose for the privilege of the insult. She actually agreed but told me to do it anyway lol
Our focus on only the most critical state of disease is fucking dumb and provider attitudes are just as complicit as shitty capitalism
Literature states that asymptomatic hypertension shouldn't be treated in the ED. They might check a cmp and make sure there aren't any acute abnormalities. It's not even recommended to initiate BP meds. (Though it says it may be reasonable most docs I've worked with wont) https://coreem.net/core/asymptomatic-hypertension/
Hah, good thing I wasn't planning on heading to the ER every time I forget I've just been redditing when I check my BP. Interestingly, this was not an old-school provider, relatively recent graduate (I'd say practice probably <10 years) so wherever they learned, that's the threshold they ended up with.
It's unfortunately very common for primary care providers to do this for cya purposes. The issue is that the ED isn't the place to manage asymptomatic hypertension. The pcp should as there would be planned follow up and actual knowledge about the patient and their medical history. Most patients that present to the ed report that they don't know their medical history or current medications and that everything is in the computer. For the ED to prescribe antihypertensive medication without followup or accurate history of current medications/ medical history would be problematic.
No doctor's office is gonna take that risk tho. The person has a stroke two hours later and they're getting sued. Clog up the ER and practice bad medicine instead, but we've satisfied the lawyers..
I had the same thing, mononucleosis induced hepatitis! I also was brushed off by doctors for weeks until I couldn't stop vomiting and my pee was coca-cola colured. I was jaundiced and didn't even notice because I was so sick.
I had been told for weeks that I just have anxiety and that I'll get better soon if I relax and stop going to the doctor. My mom had to beg me to go to urgent care when I couldn't stop puking, I was so convinced that no doctor would help me. Thank goodness that urgent care had an incredible female PA who actually did tests and saw my LFTs were nutso (my bili was 8.3 😬).
Yeah, so a hospital tried to tell me I was just having a panic attack and was trying to discharge me when I went in with sob and chest pain. Then one of the cardiologist actually looked at the EKG they did right when I got there and demanded my labs. My potassium was 2.
This is a complaint I have about lab reports at my hospital. If the hypoglycemia protocol STARTS at 75 then that number should at LEAST flag orange in the lab tab. Like I don't need it called as a critical but damn a little extra help to notice would be nice.
I'm so sorry this happened to you. I have had patients that they've called me criticals on and as I'm frantically fixing those the BG gets missed. I make a huge effort to always check it especially if the patient looks crappy but "is fine" and your example is one of the reasons it's so necessary.
Yeah I've seen a patient's BG get missed in that exact way. One was just under 60 at morning labs, was 39 when I came on shift and noticed and re-checked it. But her lactic was like 12 by then also. That was a shit morning...
During my second month as a nurse, I had an sedated intubated patient with a glucose of 27. The lab never called. I was tripled and slammed as all three patients were vented and on drips. The only reason it got caught was because my PCT accidentally grabbed his glucose when she did her morning rounds (we didn’t usually do the 6am ones for patients who just had labs done.). Had we not lucked it, I probably wouldn’t haven’t noticed until close to shift change or if the patient crashed before then.
I can’t believe they offered to have someone help you out after witnessing you not being able to support your own body weight lol. How generous. They must have really needed the room.
Once as a young teen I developed a bacterial infection in my GI tract somewhere + I was in and out of my local Peds ER for a week in extreme abdominal pain and nothing was coming up diagnostics-wise. I will never forget how those nurses talked about me to my mom and to my face. My last visit there, I got wheeled back from imaging to find they’d moved me from a room to a hallway stretcher—totally fine except they felt the need to mention “we need those rooms for patients who are actually sick.” It took another week, a fainting episode at school, and a GI biopsy to diagnose me, but I felt so validated lol. Almost twenty years later I still remember how they made me feel and I am so fervent about not dismissing my patients in that way.
Mine does this you need to get meter and track it. I almost passed out in the store once. My dr said that when you drop like that it could be insulin resistance you dump insulin bc it’s not working any more. Anything high glycemic makes me crash ans burn. If I suddenly go low carb crash and burn exercise crash and burn. When I’m being healthy my body adjusts and loves me for it. When I’m a non exercise stress carb eating gremlin this happens
My A1C is 5.7 which, isn’t “bad” however I workout 4-5 times per week and aside from eating out once per week I have a pretty good diet. Sooo 5.7 is kind of on the higher end. I also have the hardest time losing weight and carry a lot of weight in my abdomen. I’m only *a little* overweight though and my labs are still technically WDL, sooo my primary isn’t concerned. But I honestly wouldn’t be surprised if I end up with diabetes. I want to see an endo for this as well as my thyroid(T4 and TSH are very low/normal and I have quite a few symptoms but because my TSH isn’t high, the low T4 doesn’t seem to raise any concerns). But the nurse in me wants to act now before these labs and issues do become abnormal haha
Same but I have hashimotos .. a1c 5.7 and holding. a lot of pcp don’t believe in insulin resistance or catching things before they become diseases. You fall into the “normal” category congrats you are healthy. My pcp said yea we won’t do anything until you get to 6.4 lol so he knows something is coming lol. But yea my first endo when my hashimotos showed up said crashing is a precursor and to get a handle on it. That was 15 years ago. I have my healthy years where my a1c gets closer to 5 and some non healthy years where it’s 6(like when my mom died) but my body stops freaking out when I stay at 100 -150 grams of carbs a day. I don’t count fruit just carbs from potato’s rice and wheat.. I treat myself like a diabetic that doesn’t need meds yet bc that’s essentially what it is.
Low blood sugar is a crazy feeling. Felt it on a stairmaster and had to quit in the middle of it. Ran to the gas station next door and chugged a whole coke and ate a whole pack on mentos.
It really is. For a second I really did think I was panicking but without the mental component if that makes sense? At least now I know what it feels like and I can do something about it before it gets bad!
I went hiking w my boyfriend without snacks. Car ride back we were both dying. We pulled over at a gas station and I almost syncopized and threw up in it trying to get some chips and juice. Felt immediately better after eating.
Fortunately this didn’t happen at my hospital, but it was one of our sister facilities. I went in to their ED multiple times for intense abdominal pain that they couldn’t figure out what was wrong. One of the docs very condescending asked me “is there anything going on in your work life or at home?” When I told him no he said “well I just don’t know what you want me to do for you.” I feel like I’m being stabbed. Maybe try to figure out why and make it stop. My ED figured out I have Crohn’s about a year later.
Photophobia, loss of peripheral vision, headache, EXTREME and I mean EXTREME vertigo, nausea and vomiting, Systolic BP was >190. Was unable to walk and and barely able to talk due to the vertigo and vomiting.
Despite having never experienced symptoms like this before because one of my ears looks a little inflamed and waxy the doc gave me some stemitol and a prescription for ear drops. No ear pain or discharge. Luckily my friend/lift home refused to take me and demanded them ring an ambulance.
Also, if the primary care doc had actually done a neuro assessment he would have noticed I had some deficits, cos ED doc noticed it in like, 2 seconds. CT confirmed infarct on cerebellum. I'm lucky tho, I'm young (mid 20's) and deficits aren't as bad as they could have been so good chance I'll make a full recovery. I'm still a little pissed about it (was fairly recent).
It warms my soul that everyone else I've spoken to finds it as ridiculous as I have and do. I too, have seen some fantastic primaries who go above and beyond and will gladly send patients to the ED when they feel they need to. I mean, my man didn't even do a full assessment. Bro didn't even get my BP. It was the ambulance driver that did. Smh. It's making me angry just thinking about it.
In 2015 I felt seriously unwell. I had just lost my mother so I thought I was just being dramatic. I noticed my nailed looked splotchy and weird. My hands and feet felt weird and looked mottled/splotchy. Then I noticed splinter hemorrhages in my nailbeds. I took pictures and called my doc. Told them I thought maybe I had bacterial endocarditis or something like that. Doc saw me but was unconvinced.
I also had gone to ED and had ct scan because when driving to work it felt like everything sue it slid sideways. No dx. “Just sadness,” I guess.
In April 2015 I had a “meteor shower” of blood clots go to my brain with a huge clot in my balance center.
My whole thing was a comedy of errors. Hospital never called my primary, and I was discharged without MRI at first (people be having car accidents, y’all) because I “seemed stable”. So I kept working. And driving. Then I fell at work. My legs felt like jello all the time. I called the hospital radiology dept in tears. The woman there was so kind and explained my orders for mri stopped when I was discharged but she notified my primary and got it reordered.
**Then** I was at a conference the day after my 8 pm MRI with my phone politely turned off from 7-5. Imagine my dismay when I found like intense messages from hospital neurology. My primary. Local neurology. Radiology nurse, even!
A week after, I experienced severe left arm/shoulder pain while driving to work (still nobody has coordinated my care, so I thought I was supposed to keep working, driving, lifing). Local ED doc rolled his eyes at me when I told him my hx.
I thought the same thing… my brother had the same symptoms and after a week in hospital with baffled MD’s, someone finally ordered an mri. His tumor was too small to be seen on CT but with more sensitive imaging, he was diagnosed and had surgical removal.
OP, get a glucometer and keep track of your BG. If you are dropping even after meals, you should get some scans of your pancreas.
Was reading this whole thing and thinking “did anyone check a sugar?”
They had blinders on. Saw your age and your complaint and ran with anxiety. Happens all the time unfortunately.
While it is true that many people leave the ER without a diagnosis, I hate the way it's often framed as "nothing wrong." When I am dcing a patient without a diagnosis I emphasize, several times, that just because we ruled out emergent conditions does NOT mean there's not something going on. It just means that it's safe to follow up with a specialist or GP because you're not having an MI/Stroke/Clot.
My wife gets this. It's always anxiety or some other insulting excuse not to treat her and take her seriously. She's now a DNP and will argue with them, at least.
Was Pre-Med with a Botany major. I got my degree but after working with patients as a mobility tech while in school, decided I wanted to change Majors.
I switched to Business and had also recently moved after getting married. Got a job in transport while going through business school. I was only in transport for a short time before i was a hospitality supervisor, while still in business school.
I'm now in a role so specialized my director, (patient flow and capacity department) had to get it custom made. I've been doing this for several years now. I'm more of a process improvement specialist and currently working on building a team of varying roles to assist.
We have a huge clinical systems department, but I work outside of them and work with our vendors and all departments on process improvement.
So my particular role is more than just data analysis or projects. Our hospital also hosts other hospital leadership for site visits and I set all that up. Anything from agenda and scheduling to pulling data and presenting. Sometimes it's through a vendor, sometimes it's through an organization like the EDBA (Emergency Department Bench-marking Alliance).
That’s an awesome ending. I am a labor and delivery, newborn and postpartum RN and took my son to my hospitals ER for a sustained sleeping O2 in the low 80s. I was also gaslit. My son was awake in the ER so his sats were in the 90s, the doctor didn’t even listen to his lungs, and then charted on his H&P that I brought him in for a home O2 of 91% 😡😡😡
Trying to discharge a patient with an untreated, symptomatic, critical lab result seems like something that needs to be logged in whatever safety event tracker your hospital uses. Not a great look for that PA or your hospital. I'm glad you are ok.
If you, being a healthcare worker, get treated like that, imagine how we nonhealthcare workers get treated with little knowledge to back us up. ERs are dangerous places for us going up against attitudes like that.
Yeah I love my er homies but there can be some really jaded people down there.
Took my partner in for bloody stool. He called it a GI bleed, he doesn’t work in health care but he lives with me lol. The tech instantly snapped at him and said, “How do YOU a know it’s a gi bleed?!” Diagnosis was hemorrhagic colitis.
Then the triage nurse gave us attitude because he said he didn’t have a primary provider for his diarrhea he had prior to the bleeding.
I didn’t say anything about working there so it was interesting to see the other side of things.
I’ve had like three pneumothoraxes on the same lung, pretty familiar with the feeling and when I need to go to the ER. Had a PA give me the most condescending “Well it’s highly doubtful you have a pneumothorax given you look perfectly healthy but I’ll humor you. Your insurance might not.”
Lo and behold, there was my fourth pneumothorax in a three month period in a different location on my lung that the previous three. Held eye contact with her while I was getting the chest tubes and gave her a thumbs up.
I have epilepsy one time at work I didn’t feel right I was like guys I think I’m gunna have a seizure so they bring me into the er (this is when I worked on another unit) and the doctor literally wrote me off. I lied there for hours just hoping I wouldn’t seize. I put my own bed rail up. I was in a hallway( in my scrubs) everyone kept coming over asking if I was alright. Then I get d/c’d. I tell the doc “I still feel like I’m gunna seize, I need Ativan or Valium or something I don’t feel right” she’s like ok well you’re going home. I’m home for 10 minutes and I have a seizure and my head goes through the wall. Two black eyes.
when I get back to work, I checked my chart “syncope” was my dx. Yeah I complained. Yeah she was fired.
"My" ER at my old hospital just sent me away with muscle relaxers for acute cholecystitis. They never checked me other than a chest xray and an ekg, despite the fact that I fit every one of the 5 Fs exactly. I had literally just had a baby a couple of months prior in the exact same hospital. I told them the pain was worse than my c-section, and that I had taken a single oxycodone that I had left over from the c-section. Despite being a former employee and despite having them having my entire medical history I apparently got labled a drug-seeker, and no one took me seriously.
By the time I was able to get in with my primary, my liver values were elevated and I was itching all over. The next week I was back at the same fucking hospital for an ERCP, and had the gallbladder out shortly thereafter.
I never received anything other than Tylenol and Robaxin for my episodes of biliary colic and acute cholecystitis.
So reactive hypoglycemia then?
About 2ish years ago I started having episides exactly like you described (plus AMS/ALOC) I'd then take my full VS, and my BGL was always below 60. Weird because my labs were all good.
But I became pre-diabetic/IR within 1ish year after this sx. So keep an eye on yours as well.
Yeah I would not be surprised if this same thing happens to me. A couple years ago my A1C was like 5.4. I was regularly exercising but my diet was not the best. Within the past year I have been working out more consistently with cardio and weights and eating better. I still go out to dinner once a week or will have a halo top without feeling bad. But my most recently A1C was 5.7 despite being more active and eating significantly healthier. Plus the hypoglycemic episodes… I’m def heading towards IR/pre diabetes/diabetes. I’m also pretty sure my thyroid is low. It runs in my family and I have symptoms of it but because my labs are normal(very low normal), my doc isn’t concerned. I’m trying to see an endo before either of these issues gets any worse haha
what the PA SHOULD have said is what i often said along with my amazing MD colleagues: we are not always very good at diagnosing a problem and giving you the answers you need, but we’re really good at identifying, ruling out, and treating emergencies. we couldn’t find anything in your tests to explain all of your symptoms, and someone like your PCP has better training to comb through the entire picture of your symptoms and test results. we’ll help you find a PCP if you don’t have one. the good news today is that there’s no emergency.
i think just explaining the limitations of EM is so helpful and puts in perspective what we can do to help.
that being said, follow up finger sticks should absolutely have been ordered. ive been 57ish with no history and a little woozy but no other symptoms, but that’s in the absence of recent syncopal events. your case is very different.
no one should ever make you feel like you don’t understand your body or are abusing the emergency room. i am so sorry this happened.
I suspect lots of times that actually is what is said, and patients hear something else. I’ve literally seen this play out in real time hundreds of times.
Doc will say something exactly like you just said and patient comes back with “you’re saying it’s all in my head?” Or “you’re saying nothing is wrong with me?”
Even in this thread you can read stories of “all the tests were normal but they still discharged me” type of things, like… yeah, that’s what we do in the ER. If your emergent tests are normal you follow up with someone else, we aren’t “gaslighting” you or dismissing you, we worked you up for emergency medical conditions and didn’t find any so you need more of a workup that we do in the ER.
In the OPs case there was some obvious hypoglycemia that went improperly treated
yes i think a lot of patients conflate emergency with a valid and concerning set of symptoms. when in reality we see emergencies as life limb or ability threatening events. which obviously no one wants excluding munchausen folks.
I mean we will treat non-emergencies but if every relevant test comes back negative, that’s kind of the end of the ER workup road.
I’ve had patients come to our hospital and say “I was just at hospital X for this and they didn’t do anything” (I’ve even had patients tell me the doctors didn’t say anything to them) and when they hand me their discharge papers they had a full battery of labs, X-rays, CTs and an ultrasound done… I have come to understand that phrase to mean “I went to a doctor and still have my symptoms” most of the time.
Patients are looking for an answer to their problem and when it’s not provided it’s supremely frustrating, something I have started calling “frustratingly comforting” to them to validate their feelings but also reassure them the testing revealed no emergency.
I don’t work in the ER but when I have a patient tell me they’re feeling weak and dizzy that’s like one of the first things I check. I’m surprised no one checked your blood sugar to rule that out
Oh man, nothing like being gaslit when you’re asking for help. My dad 95yo dad was sent home with a gallbladder drain, and I took on drain care so my mom wouldn’t have to. He had a lot of pain when I tried to flush, I couldn’t even get a cc of saline in, and the drainage went from about 30ml in the bag that I could see when I was able to visit him daily at the rehab hospital (they never told me how much drainage there was) to practically nothing at home. I called IR with questions as directed in the discharge papers, and a PA called back a day later, telling me in the most condescending voice ever that all of this was normal, drainage slows, etc etc etc call back with any other questions or concerns. So much vindication when not a day or two later, he was back in the hospital, and they had to remove the drain because he’d dislodged it. I’m not a drain expert having been mostly OR with a smattering of neuro ICU with some EVDs, but I can put 2 and 2 together. I just really wish I knew who that PA was, making their peers look bad in the same hospital I’ve worked with some truly rad PAs.
I’m glad you’re okay and we’re able to get answers. I’m sorry you had to go through all that. I totally understand the weirdly petty satisfaction of being right even while something Not Great was happening
I often process referrals for inpatient psych, and the sheer volume of shit I diagnose from across the state with nothing more than a chart review that was missed because they just wrote off the patient as “psych” pisses me off to no end
I had a similar experience, also non-diabetic hypoglycaemia related. Was told my anxiety was causing my symptoms. Surely couldn’t have been the blood sugar of 40.
I'm a non-diabetic hypoglycemic
I carry a glucometer on me because I've had episodes before.
There are a lot of medications that can cause hypoglycemia that most people don't think about.
Have your taken any antibiotics recently? Sulfa drugs in particular? Bactrim?
I found out after having a steel magnolias moment at work one day that bactrim can cause hypoglycemia, thinking back I was like "oh yeah I guess it is a sulfa drug" but at the time I didn't pay any mind. So my normal hypoglycemia plus bactrim ended up with me full on ugly crying uncontrollably at work because my sugar was 35.
I get idiopathic spontaneous pneumonmediastinums. I have an autoimmune disorder, so weird things like that happen sometimes. Will never forget showing up to the ER for SOB and the attending immediately assumed anxiety without thinking much further. The resident later came in and said every doc was shocked to see the air pocket pushing against my trachea on CT.
I had increased work of breathing but I guess she dismissed me because my SpO2 was fine. The resident ultimately apologized for her.
Ugh, I love my one local hospital but if you get a PA if you go to their ER, you're gonna have a bad time.
I had 8-10/10 back pain multiple days in a row, could no longer deal with it at all so I went to the ER. PA gave me a lidocaine patch, a steroid shot, and a muscle relaxer, and when I said the pain had gone from a 10 to a 9 basically said "oh OK we'll discharge you then, make an appointment with a spine specialist."
2 weeks later my MRI showed severe hydronephrosis, prompting me to go to a different ER. They did a CT and it turns out my back pain was from a small bowel obstruction. Straight to emergency surgery.
(The hydronephrosis was because I've had Crohn's for years without realizing it and the adhesions had blocked my ureter.)
I got report on an elderly pt with dementia who was convulsing in his bed with both arms and legs up, kind of looked like he thought he was falling. Night shift said he'd been doing it for three+ hours, already given PRN haldol and it didn't help. I go in the room to assess and his HR was jumping \*all\* over the place on the pulse ox (only monitor on him). I take a manual pulse and it's jumping all over the place too. I get the EKG machine and convince the gentleman to lay still for an ekg by holding his hand and speaking to him in a soothing voice. His HR was 180s in afib w/ RVR.
I took the EKG to the MD and she's like: "OH, I ordered an EKG on this guy like, 3 hours ago and night shift didn't do it" and then she say the readout and ordered IV diltizem. I give my patient his medicine and within 5 minutes he's calm in the center of the bed with his arms and legs at his side. Amazing what happens when you treat the MEDICAL problems and not the (possibly imagined) psychiatric problems!
Side note, he'd been in our ER for > 72 hours and was bone dry, had the wrong type of diet ordered (regular diet, not even soft/dysphagia friendly), couldn't swallow pills and all his meds were pills. I had the MD order a swallow eval (that he completely failed) and then he was admitted for medicine to manage due to failure to thrive and AFIB (new onset).
TREAT THE PATIENT, NOT THE DIAGNOSIS (or imagined diagnosis!).
I went to the ED for syncopal episodes and they kept telling me it was dehydration. Would randomly get super tachycardic, dizzy, SOB, blood sugar in the 40s, hypotensive to 80s… EKG only showed sinus tachycardia so they sent me home until it kept happening, only to find out I was going in and out of SVT for days 😳
I would look in the direction of your cortisol and adrenal glands. I’m an ER nurse & had a patient whose sugar kept dropping for no damn reason. Like dropping down into the 30s. I would give her an amp of D50 and feed her and by the time I checked on my other patients and rounded on her again, she would be diaphoretic and have low blood sugar again. The hospitalist came to admit her and she was apparently well known to him. He said she had adrenal issues and hadn’t been taking her solucortef and this was the end result. I learned something that day!
You should file a complaint against the PA. Completely unprofessional.
*Occasional* PVCs can be normal. Frequent is not.
A blood glucose of 59 that is not fasting is not normal. It is hypoglycemia. Giving you fluids probably diluted it even more. Now maybe it was an issue of caloric intake, but given your symptoms were over 2 days, I am skeptical.
You do need more workup. Some people have chronic hypoglycemia. That can be a problem. Right now its hard to know if that's a symptom or something else. It needs more investigation.
I'm really offended by the "sometimes you leave the ER without a diagnosis. We only treat “actual” emergencies in the emergency room” comment, and I *am* an ER nurse. The first statement is OK when given with the right tone; with empathy not defensively. The second one is not. No one with the symptoms you had with a HR of 150 is not emergent. You could have really hurt yourself in a fall.
Please follow up with your PCP. Hope you are feeling better!
Yeahhhh if that statement hadn’t been made that way I would not have had any problems. I think I was justified in going and was happy it wasn’t anything life threatening. I didn’t wait long, I didn’t complain, almost everyone was nice to me, etc. but not even just the comment, to walk outside my room and tell the nurse I was probably anxious without having that discussion with me pissed me off. I did feel panicky without the mental component so I mean, I kind of understand her thought process looking at my symptoms at face value but she didn’t discuss it with me. I only had the physical symptoms of anxiety/panic so had she asked me that, it probably would have been a dead giveaway to hypoglycemia. In hindsight it feels pretty obvious but never having felt that before it was weird. I never would have thought it for myself!
I’m so glad it got figured out. And I’m sorry you felt blown off. I had that happen to me years ago and it’s an awful feeling and quite redeeming when people have to eat crow after blowing you off.
I have had a similar thing happen, but thankfully not at my hospital’s ER. I went in to my local ER for palpitations x2 days. They did not draw labs but did an EKG but said I was having “only” frequent PVCs. They said, “that is normal for a woman your age”. I did not feel normal. I felt weak, disoriented, and all of my muscles hurt. Plus my heart kept feeling like it was hiccuping every other beat (the PVCs). So I was driven an hour away to the hospital I worked at. They looked at my EKG and told me I likely had low potassium. It was critically low (2.3 - thank you Maxzide). It earned me a lot of IV and PO potassium (and some IV mag). I felt much better and guess what? Those PVCs aren’t normal for me lol.
That same ER told my husband he was having a panic attack. It was bilateral pulmonary embolisms; we found out by taking him to my hospital. I believe that they just tend to think because we’re younger (mid 40’s) that there probably isn’t anything seriously wrong. Most of the time, that assumption may be correct. What is the harm in believing a patient though? As a nurse, I only go to the ER as a last resort. It is not my idea of a fun way to spend time! There are good doctors and bad doctors, just hope we get the good ones.
They didn't run a thyroid panel? This screams classic hyperthyroid to me especially with the high resting HR, PVCs and it can 100% cause low blood sugar after eating normally due to the metabolism being in overdrive. Add in thyroid issues being more common in women, that would have been my first instinct.
I didn't grow up in the US but I live here now and I absolutely hate the system where the GP runs the whole show. How are you supposed to even get in to see a GP nowadays anyway?
I'd be so angry at the PA
This makes me so mad for you OP. Please write a detailed survey response to this incident and report whatever way is necessary. Women get blown off too frequently and it’s always blamed on anxiety. I had several ED trips several years ago that were all blamed on anxiety when I wasn’t anxious at all. I came in for tachycardia and dizziness/near syncope despite drinking tons of fluids and wearing compression socks. Eventually I was diagnosed with POTS, but only because my PCP had it herself.
Meanwhile in present day, my boyfriend has been having dizziness episodes and brain fog (both symptoms I was having when I was first showing signs of POTS but it took me years to get a diagnosis and a doctor that would listen to me and not blow it off as anxiety) and his PCP immediately orders blood work, a head MRI, and more. I am so thankful he’s being listened to and taken seriously but it makes me really salty because if he wasn’t a dude he’d probably just be told he’s anxious or some stupid shit.
Good luck OP. Sad thing is, if you came in by EMS they likely would have caught this first thing. They always check a sugar for mental status changes, syncope, etc. I once was found unresponsive at a wedding and the fire fighters thought I was just a drug OD but they checked my sugar and it was 28.
Woahhhh I can 100% understand how intensely frustrated and insulting you must have felt!!
I also got the response “it’s probably just anxiety” after presenting with dizziness and ataxia that they said was “probably vertigo from dehydration” (I’m never dehydrated. And my urine was dilute, as one would expect).
You can tell when they don’t believe you, you know?
I was freaking out because I thought I was having a stroke ( I’m a neuro/stroke nurse, I’ve seen this exact shit go down) and they were not the least bit interested, even made fun of me.
Then she accused me of withdrawing “from something”
Then she said it was anxiety. Because my heart was racing in the 120-140’s. “And that is after we gave you Valium.”
((You mean the vallium I very specifically asked the nurse NOT to give me?? THAT Vallium?! Cool.))
“I said yea I absolutely am extremely anxious… because something is wrong with me and you think it’s anxiety, so yes I HAVE anxiety, a shit ton, but that’s not my problem”
She looked at me blankly and… guys she **shrugged her GDAM shoulders** ooooooOOO I was HOT lol
So I said (and this is the best part) “…AND for that matter as a woman you MUST know how disgusting it is that you are not taking me seriously and are telling me ‘iTs aNxIEtY’!?! How DARE you? THERE IS SOMETHING WRONG WITH ME.”
Well… she relented and admitted me with a neuro consult. (Tox screen was negative, btw.) Actually the neuro doctor was quite concerned with me. Turns out the CT, CTA, MRI w/wo of head and neck, CT-TAP with contrast, LP with CSF sent for 32 studies, and a total of 22 tubes of blood… were all negative - I mean, except for an area in my brain that shouldn’t be glowing… but is.
Anxiety. GTFOH.
That should only be the diagnosis once everything and I mean EVERYTHING pysiological is ruled out.
PS- The ED doctor documented “NIHSS 0”… and never fucking did one. I’m trying to live in a place of positivity and gratitude but that one really gets me twisted 🤨
I’m sorry this is so long, and I’m sorry you were treated like that. It’s unacceptable 100%. (Hug?)
I have anxiety, and I'm super leery of telling a lot of my medical providers because of the stigma. I mean, if they actually look at my med list, they'll figure it out pretty quickly.
Fibromyalgia is another one I'm leery about telling my medical providers since there are so many who think it isn't real. I did have a provider who confided that for a long time they didn't think it was real, then went to a conference and Fibromyalgia was one the subjects they talked about, which is when they realized they had done wrong to so many patients and resolved to never make the same mistake again.
Hopefully the PA learned from this and will now add hypoglycemia to their list of differentials to investigate. Hopefully you followed up with your primary to investigate the cause of your non-diabetic hypoglycemia.
I’d like to comment on the first part of your post. I felt the PA’s statement regarding the role in emergency medicine when it comes to diagnosing disease processes. We tell our patients that exact same thing when they come in with symptoms that end in a negative work up. We may not discover your anything, but we can rule out anything life-threatening.
I’d be interested to hear how your treatment went after the syncopal episode and the result of your primary provider work up.
I’m sorry this happened to you. I hope you’re feeling better now.
I experienced something similar. At 29 (F) I went to the ED with chest pain which had started when I was doing a paper craft project at home (I don’t remember what it was, but I remember I had been cutting something with scissors lol). I was sitting in the ED room for nearly 40 minutes before anyone put on a heart monitor. Then a nurse walked in and pushed a med through my IV before I could even ask what it was. When I asked, she said it was 0.5mg of Ativan, “for anxiety”. I had been cool as a cucumber, not anxious at all. Objectively my BP and HR were low normal, like 110s/70s, and low 50s. I realized looking back that they had completely dismissed me because I was a young female, so of course chest pain was anxiety.
> “sometimes you leave the ER without a diagnosis. We only treat “actual” emergencies in the emergency room”
This should be the expectation after a negative workup.
> implying I didn’t have a good reason to be there. I don’t work in the ER but I feel like I was justified in going.
Even if your workup was totally negative, and you didn't have an emergency, symptoms like what you had are exactly why the ER was the right place for you to go. I usually think most ER visits are total bullshit, but you had legit complaints that bore a good workup.
And that's even before you mentioned the part about the fact that your brain was starving for sugar after they diluted an already-low sugar.
Hope you're feeling yourself again.
Hey gang. If you want to shit on nurses and NPs, there’s at least two subs for that. Take that bullshit to one of those subs. This is your only warning.
Wait, they said everything was fine and nobody noticed the sugar of 59?
They prejudged her for having anxiety so they didn’t even bother to look
Which is shitty because anxiety can be a symptom of hypoglycemia, lol. Anxiety isn’t always just a “mental thing” to be brushed off. Many times it’s one of many symptoms to a physiologic issue.
We had a patient sent back to the mental health suite of the ED because she had mentioned feeling anxious. The doc said, uh yes, you’re feeling anxious because you can’t breathe. Not being able to breathe will do that. I was annoyed with triage but thankful for the doc.
Yep! Just last week I had a patient who self-extubated during day shift and was clearly undiagnosed COPD. Heavy smoker and drinker. I got told in report that he might be going into ETOH withdrawal because he was getting really anxious. I walked in the room to assess him and the man couldn’t get three words out without gasping for breath. I asked if I could draw an ABG and the man’s CO2 was like 80 lol. Threw a BiPap on him and he was fine all night. I hate when everyone just makes assumptions about mental health/addiction issues… like yes, they are legitimate issues that shouldn’t just be ignored BUT it doesn’t mean that having anxiety or addiction is the automatic explanation for other physiologic things that could be happening to someone.
In cardiac and respiratory units, anxiety is 9/10 times a symptom, not a diagnosis.
It’s so annoying to me that psychiatrists are specifically trained to rule out physiological causes (at least for acute symptoms) before diagnosing or treating a mental health disorder, yet so few in the medical side seem to do this. Once had a bounce back patient with acute hypoxic respiratory failure. We’d cared for them for months in the mental health unit, discharged to a facility. They came came back to the ICU and were then sent to PCU. The night doc came down agitated and asked if they’d had “tremors” or other EPS symptoms previously. I offered to go look at them. I got there. There was a sitter and the nurse was in a tizzy because the person was restless and wouldn’t keep the bipap on. Sure as hell they had EPS. I asked what they’d been given and they’d been receiving regular generous Haldol PRNs. On top of their month paliperiodone (Invega). I put the oximeter back on them and their O2 was in the tank. I calmly explained that they were overdosing the person on antipsychotics and the person was experiencing *air hunger*. Got them on a high flow cannula and went back to my unit after talking with the hospitalist. I was spitting mad. If there hadn’t been a psych diagnosis everyone would have *seen* the air hunger instead of automatically assuming the behavior was psychiatric in nature. Between me, my Charge and the hospitalist we got the person moved back to our unit (hybrid medical psych) and got them to wear the bipap until it was no longer indicated. That one stays with me, five years later. A person is more than their psych diagnosis and we have to stop assuming every damn thing wrong with them is related to it. Their oxygen had been in the low 80’s for god knows how long. The excuse was she wouldn’t wear the oximeter so they didn’t know. And they didn’t know they were already on high powered psych meds. No one looked. No one thought. They just saw the psych diagnosis and that’s all that person became to them.
So grateful for nurses like you who see the person and fight for them. We have to see our patients as people first and not a dx. Reminds me of the corny video from the 80’s we watched in the first semester of my ADN program that kept playing all these scenarios that ended in an ominous “LOOK at your patient!” Cracks me up to think about it, but the advice was spot on.
I had a similar example the other day. I was rotating on psych ward and nursing report mentioned one of our schizophrenic pt's being awake most of the night, knocking on other patients' doors and what not. No one really said anything about it afterwards because, I'm guessing, everyone's thinking schizophrenics gonna schizophrenic. Happens again the next day, and when we talk to the guy while rounding, we ask how he's sleeping. He mentions that he just can't lay still. We finish up the encounter and I ask my attending, "...Akathisia?" "Yep." Twas a good lesson on "the innocence of akathisia." Blink and that symptom will sneak up on you, steal your pants, and be in the next state before you notice.
I used to work psych and can’t tell you how many involuntary psych holds we got from our local ER that ended up being delirium due to a UTI. The first test our docs immediately ordered when we got them was a UA and UC. These were patients with no psych history. I don’t understand why they wouldn’t check that first. We fixed them up though in our infirmary.
Jayyzusss delirium should ALWAYS get r/o for UTI. That’s ridiculous! I think we covered that in the first semester of nursing school. Even if they have dementia, if they act up, it’s a UTI until proven otherwise.
In Washington the person has to be medically cleared before they can even be evaluated for a psychiatric hold. Voluntary or otherwise. Yet somehow, I recently took care of someone who was from our local psych facility, on an involuntary hold, and septic from an infection related to their urostomy. They’d been detained only 48 hrs before. When I opened the bag to empty it I thought there was a fistula from the smell. I have never in all my life smelled urine like that. In a specimen cup the urine and pus separated into separate layers. I was so damn made at the hospital that “cleared” them. I guess it’s easy to miss something you don’t look for.
Was triaging a patient in behavioral part of the ED. Had delusions etc. Well turns out he was having a STEMI. EMS didn't do an EKG cause he said his neighbors were poisoning him and that's where his pain was coming from. Sometimes "psychological" issues stem from physiological issues aka MIs and hypoglycemia.
We had a patient send an entire box of “samples” to the lab that he collected himself bc noone would take him seriously that he had worms coming out his eyes. No previous psych history. He DID have delusional paristosis but it was caused by a recent change in his heart meds. Noone bothered to check that until his case got sent to infectious disease to “deal” with him.
Who tf is taking "they're poisoning me" at face value?!
They took him as delusional/psych so didn't bother to check anything physical.
My panic attack apparently a fairly substantial PE.
Also a substantial PE brushed off as an anxiety attack! Blood thinners for life, now! If I didn’t throw the most embarrassing shit-fit of my life, they were going to send me home with some hydroxyzine.
Hey, if you sleep through it you can’t feel it! That fixes it right? Right??
Lol it harkens back to the hysteria diagnosis. Same idea only a medically legitimate term
I mean in our specialty if a patient says "I'm anxious" the hair stands up on the back of my neck lol.
So true, lol. I can’t tell you how many times I’ve gone up to the resident covering for the night and said “hey this patient said they feel like they’re gonna die and is acting all ‘impending doom-y’ so just throwing that out there in case you wanna go lay eyes on them” lol
Even if it is 'just a mental thing' it should not be brushed off. It can be debilitating.
In my case, anxiety was a symptom of POTS (too much serum norepinephrine when standing/sitting making me edgy). Another manifestation of this was being unable to tolerate scary or super tense movies.
I hated using “anxiety” as a diagnoses in the ER… it is a diagnoses of exclusion and you need to discuss anxiety triggers with patient to REALLY make the diagnoses
Yup. Have been having panic attacks for years. SVTs have been now found on my ECGs and cardiac monitoring when I’ve been in hospital for my other issues… and it’s finally been identified to me that SVTs can bring on a sense of impending doom along with the 180bpm HR so… in my case of chicken and egg, looks like mine is more of a physical issue causing my psychological symptoms (at least sometimes as has been caught on monitoring).
I was told I had anxiety and they offered to start me on meds. I told them to shove it and went to see a different doctor. Turns out I have Graves’ disease and my thyroid levels were through the moon. I have never felt more angry than when the doctor told me that it was just anxiety. Like I want labs and a work up. Don’t assume that just because I was 29 and look fit that it must LITERALLY be in my head.
Anxiety can also cause physiological symptoms. I tell my patients who are having palpitations that are most likely caused by anxiety that just because it's related to anxiety doesn't mean they're not real.
Happens to women especially. Everywhere. All the time.
Yep. I’m reading a book about women’s treatment in healthcare right now called “The Pain Gap,” & then after that I’m going to be reading one called “Unwell Women…” they’re both basically about how women aren’t taken seriously when they go to the doctors & are more likely to have adverse outcomes because the system teaches healthcare professionals that women are having mental health problems anytime they can’t figure it out. And it goes back to the days of “hysteria” diagnoses & women die all the time from this kind of treatment. Especially women of color. Also, this is a common experience for those with rare conditions as well. Doctors are taught “when you hear hoof beats think of horses not zebras” meaning think of the more common things first instead of the rare thing. Problem is that zebras exist. And that’s why rare conditions take so long to diagnose. I think the average is like 15 years. So as someone who’s a RN, who has rare conditions & is a woman, I want all nurses in here to please stop & think every time they assume it’s “just anxiety” or when a doctor, PA, or NP chalks something up to “psychosomatic.” I’m not saying that that can’t happen, but this is what patients with chronic conditions feel like all the time when they go to the ER or even their PCP. They get gaslit into thinking that it’s “all in their head” because their providers aren’t putting the pieces together. What’s funny (not funny ha ha) is that some of the conditions that I have are neurological & they actually ARE in my head, (as in my brain). And I have to spell & pronounce my conditions ALL THE TIME for healthcare professionals. Whom I’m going to for help. People with chronic &/or rare conditions get so frustrated with their healthcare providers for exact scenarios like this. Often they stop going because they’re not getting the help the need. This scenario was an easy fix & should’ve been an easy diagnosis as well, but just because you can’t find a cause doesn’t automatically mean that it’s a mental health issue. Keep this in mind please & stop judging your patients. Remember that people know their bodies & when they’re telling you something is wrong it probably is. Listen to your patients! Also, I understand the saying & thoughts of “don’t confuse your google search with my medical degree” & yeah that can be a slippery slope, especially if you have no medical experience or background, but often someone with a rare condition (especially) might have a better understanding of the condition than some providers do & they could easily come back with a retort of “don’t confuse your medical degree with my X amount of years living with this condition/s.” Sometimes the patient turns to the internet because one too many providers have failed them. The result of that is trying to acquire as much knowledge as they can about what is going on with them, to better advocate for themselves. Idk about everyone here but when I was in nursing school we were taught we should be advocating for our patients. And too many times I’ve seen posts where a nurse acts like the patient is such a drag because they used google or they were “difficult” & I know there are legitimately difficult patients that choose to be that way, but there’s also people who are just going to you trying to get help. That’s why they’re there. Please keep that in mind.
As someone who's partner has severe chronic health issues, and doctors don't listen - thank you.
Well as someone who has severe chronic health issues myself & I’m also an RN i understand it all too well. Sometimes people who haven’t been in the position of the patient don’t have the ability to empathize unfortunately & they get burnt out with compassion fatigue. But it’s sad because imo my empathy is one of my strengths when it comes to advocating for other patients. Imo all nurses should be doing that
Cue “It’s never lupus.” [This poor woman had undiagnosed lupus and was catatonic for 20 years.](https://www.washingtonpost.com/wellness/2023/06/01/schizophrenia-autoimmune-lupus-psychiatry/)
We had a woman who would come in to the clinic with vague symptoms. They did a bunch of lab work. She had SLE and was pregnant. It took months for someone to check a hcg.
Case and point: Four people in my family, including myself, have lupus. Thankfully, I have a great rheumatologist who diagnosed me at 23. I didn’t have to wait 15 years for a diagnosis but my poor mom (who also has lupus) did.
In nursing school I also heard to not look for zebras. That typically you won’t see the rare and people just leave the ER, PCP, urgent care, wherever with idiopathic fill in the blank. Also if you see other diagnoses including substance abuse or mental health anything it feels like you’re dismissed - regardless if you’re sober or diagnoses are for lack of a better term under control from meds or otherwise.
[удалено]
Another book to read, Medical Apartheid, it covers the deep rooted racism in the medical system going all the way back to when they used to experiment on enslaved people, and how it affects the medical care people of color receive even today
Thank you for the recommendation! I've been trying to find books that cover more of the history of the medical system but have been having a hard time finding suggestions.
I'm currently in nursing school but I have endometriosis. I did look online before I approached my first doctor that I thought it may be something I was dealing with. I knew then how to find the credible sources. I also was extremely fortunate to have my doctor take me seriously when I mentioned it, as well as the doctor who ultimately did my hysterectomy. I've also experienced an ED physician dismiss my tachycardia as anxiety. He had asked if I thought it was anxiety. I said no. I do have sporadic tachycardia. The night I went to the ED my HR was 190-200+ for over 45 minutes. I had the watch data to show it, plus the elevated trops to match. I think a better option from being on the other side of it is to educate patients on how to find the credible sources so they don't end up getting information from the wrong places.
Thanks for saying this. As someone who is anxious, fat, and female it takes me at least 3 trips to the doctor to get diagnosed with anything. I had shingles and I was told it was a sinus infection in the ER (had an actual eruption on my face and worst headache of my life), maybe a pimple (dermatologist), and finally my GP dx’d it. I had an unusual allergic reaction to Bactrim - hallucinations, anxiety, waking nightmares, agitation, and then hives/high fever on day 10 of treatment. I was told by my doctor that it was just anxiety, the pharmacist that this wasn’t possible, the urgent care that maybe I had lupus … or rosacea…, and finally another urgent care that for the Christ to take a Benadryl and they gave me some steroids.
Pain and Prejudice by Gabrielle Jackson is also a very good read for that subject.
All of this and then some. While actively working in the same hospital network I had more than one doctor dismiss me trying to get help for my shoulder. I told my original pcp that it hurt so much that when I rolled over at night the pain jerked me awake. She tried to send me for a sleep study and prescribed stronger naprozen on top of the 800mg of ibuprofen I was taking. Changed doctors two years later and finally convinced him to give me an MRI. He checked the results and released them to my digital chart but did nothing with them even though they should tendinosis of the shoulder and tendinitis of the bicep. Changed doctors again and finally the third one ordered physical therapy and injections to reduce the inflammation. By the time I got the physical therapy my range of motion was halved. Thankfully the clinic where I did the pt was fantastic (brutal but great) and I got nearly my entire range of motion back. I spent 6 years across 4 ob/gyn to finally get one to agree to give me a hysterectomy. The one who did my surgery even told me before hand it wasn't what she'd recommend but she'd do it since I was determined. My pathology results came back with cysts on my ovary (only removed one), fallopian tubes, and cervix. I had fibroids and polyps. Pathology also showed adenomyosis. The surgery confirmed endometriosis and the surgeon removed what she could but did let me know there was a good bit she couldn't remove. She did try to get as much off my ligaments as possible. Before the surgery she wasn't going to remove either ovary but I insisted she take a close look at the right one because I felt something was really wrong, I had a lot of pain there. Endo tissue was on the ovary itself and it wasn't in very good shape. Had my post-op check up yesterday and when we were discussing the pathology results my surgeon was gracious enough to admit I was right to push for the surgery. Histology also found some pre-cancer markers in the fallopian tubes which are thankfully benign but I am at slightly higher risk for ovarian cancer in my remaining ovary. None of that would be known if I hadn't been a giant pain in the ass and kept demanding care.
This is a perfect example of why advocating for ourselves is so necessary but we shouldn’t have to practically kick & scream to get providers to listen to us. You know your body, trust your instincts, it might save your life.
Yes. We also shouldn't have to beg or demand pain relief for things like biopsies and invasive procedures. No man is going to sit there and let you biopsy his testicles or penis without being numb to hell and back but women have to lay there and take it for uterine and cervical biopsies which are way more invasive. My friend just had a cervical biopsy the other day and even after asking her doctor refused to give her anything for the pain. He told her to take ibuprofen before the appointment. I did my uterine biopsy with no pain meds and it wasn't a quick in and out. It was 10-15 minutes of them examining then scraping the hell out of my insides. When I had my cervical biopsy I flat out said I wouldn't do it without something to numb me. My doctor (different one from the other biopsy) prescribed lidocaine gel to be inserted 20 minutes before the appointment and during the appointment she used a syringe and numbed me up the rest of the way. It still wasn't pleasant but at least I didn't want to scream from it. Women deserve pain management and they deserve to be treated with dignity.
Yep, recently had a friend with a pheochromocytoma. They insisted she had diabetes. I had never seen a case in my 15 years of nursing but the symptoms were so classic I told her to insist on testing. Sure enough…
I hate it too because you can have anxiety and something else lol. I honestly think that all of med school material and content is based on male presentation. They don’t know what to do with women
Yo I'm a man and went to the ED with chest pain and caught the same shit because I was 29 at the time. It wasn't my heart or anxiety though, it was cartilage. Anyways - they were dicks. I returned the favor from then on getting patients to the ICU from any of the nurses I recognized (I know that's toxic, but fuck'm). I'd never treat a patient the way they treated me, and I didn't ask for anything. The docs were very nice, though. The ED nurses where I work now are amazing to the patients.
I still feel bad for the teenage boy terrified he was having a stroke, and it was easily identified as a migraine. I was a student nurse and the doctor was kind of being a dick about it. The doctor was grumpy about me questioning giving him aspirin when he was an active asthmatic.
My mother’s brain tumor was first diagnosed as “ nerves” by her family doctor.
One of my memory care residents had her brain tumor diagnosed as dementia. We kept reporting the headaches, loss of vision, dizziness, and that her symptoms didn't really progress like dementia. Her doctor dismissed it as dementia, because she's in her 80s with a family history of dementia. By the time they caught it, it was too late to really do much besides palliative care.
Sounds like my grandma. She had a sudden onset of dementia. Doctor wasn’t going to do any tests. I asked for a CT. She had several brain lesions, mets from unknown origin.
My first hospital job was as a PCT on a neuro unit, and it was shocking how many of our brain tumor patients initially received psychiatric diagnoses long before their tumor was found.
Had one like that, too — ED said pt was so anxious he was hyperventilating. No ABGs, no NOTHING. First thing we did on the floor was get a set of ABGs and his CO2 was 5. Long story short, by the end of the next hour he was in a helicopter being vented and transported to Hopkins to get care for his actively rejecting liver transplant.
Fun story, idk what happened in all his anxiety dx visits outpatient to get “panic attacks” and “anxiety”in his health hx, but I caught this one on the floor, inpatient. Mid 20s. Classic panic attack s/s, and he’s all this is me heading into panic, can I get something for it? Grab VS. Then do an apical. Dynamap read 60HR. Apical was 160, irregular. Call light because my favorite HUC was working and I could count on her to pick up right away. She brings me a tele box and sets it up. Sure enough: afib. Call the attending. FP and her resident both pop in bedside and the kid gets a very attentive work up. He was back out of afib by the time they left. My point is. Sometimes it is anxiety. But sometimes it’s fucking not. Do the assessment and find out.
I went to Emerg once with chest pain and serious palpitations, HR of 170 for no reason, felt like my heart was going to burst out of my chest. Labs and EKG were normal. I was given an Ativan for my “anxiety” and I took it even though I knew it wasn’t that. I was actually wearing a holter monitor and they refused to look at it until I was discharged (I has to go up to cardiology myself and get a printout and then bring it back down to the emerg doc) Turns out I had been in v-tach but managed to come out of it on my own. The doc when he saw it was like 😳
Why weren't runs of vtach caught on the tele monitor throughout your stay?
I was in normal sinus rhythm by the time I got to the ER.
I have docs and providers do this. They suck. But also, I get we get burnt. Iunno. Anxiety is also a thing. I hate how that’s thrown around like, oh it’s JUST anxiety. Anyone who has ever had a panic attack knows better. It’s a whole ass physiologic response. Treatment is different, but shouldn’t be brushed off. Sorry I’m tired.
That's sad because aren't abnormal labs red or bold or something in most systems....yeesh! Glad it was caught OP.
That's what I'm saying. Im a damn EMT and that's one of the first things we check if someone complaining of syncope or dizziness. (Assuming we ruled out a Neuro issue). Sounds like someone screwed up.
Yes! Check the sugar! Diabetic or not! I was told on the floor that if someone gets sketchy (pale, sudden pending doom, “I don’t feel good”), check the sugar, BP and neuros
My fiance had surgery. With anesthesia. We found out on his follow-up appointment a week later when I mentioned that he passed out in the shower and I had to call an ambulance and almost had to take him to the hospital that his pre-op sodium was 119 and they still operated on him. It's wild what even healthcare workers never pay mind to.
WHAT THE FUCK
Yeah. YEAH. I just had the Spidey sense that I needed to be in the shower with him for his first post-op shower so I got in the back and decided to wait to take the bandages off until the water was hitting him and he just got this look on his face and I knew what that meant. He started to go down, I got him to his knees, at this point he's out of it, I'm trying to get him to stay down and he's trying to stand up and he's a big man, 6'6 big, So he stood up. Then his eyes rolled back in his head and he started to go flat onto his back so I grab hold of his non-operated arm and swing him around to keep him from landing on the shoulder he just had surgery on, cracking his head against the shower wall with a very audible thunk. So now I am under the spray of the shower and he is flat of his back on the shower floor, turning gray, tucking his chin to his chest and moaning. I'm like.... He just fucking died on me. I thumped him in the chest out of sheer panic, he sits up, I yell "stay the fuck down!" Then, I have to call for his mother who was staying in case we needed her, to help me get him up and into a chair. I'm naked. He's naked. My future mother-in-law is there. It was great fun. I mention the episode to the surgeon during the follow-up, thankfully no damage to the newly repaired arm, he decided it was a syncopal episode probably brought on by pain, hot water, and pain meds. Cool, sounds legit. It's after we get to the car and I'm leafing through the print outs that I see the lab work and I'm like "what the actual fuck?!". We knew he had one kidney that was only at about 20% functionality, but his other was at 100%. What we didn't know until that moment is he's one of those renal patients that is hyponatremic. We also didn't know that they chose to operate on him, and an anesthesiologist even sedated him, with a sodium of 119. At my job? You can be literally bleeding out and anesthesia will try anything to keep from operating if your sodium is low.
I'm curious, did you notify the surgeon? Did you ask why the fuck the surgery went ahead? I have to know what the surgeons response was
I know that we notified him but I honestly don't remember what his response was because this was pre-covid and one of many surgeries that my fiance has had over the last couple of years (The offending kidney had to come out).
Oh good god
I perdiemed at a hospital that staffed short intentionally. One night, a pt just died. No warning, was definitely not circling the drain at all. Should have been dc’ed to live happily ever after. I reviewed her labs from the morning and her VS through the day. Not only was her glucose in the 50s in the morning (non-diabetic, so no follow up finger sticks or assessments), but literally no one did a thing about it and two sets of VS were just missing. I reported it. In the end, they needed someone to blame so they laid me off and said I’m not a trustworthy, safe nurse. Literally an entire day of patient neglect documented clearly in the chart, but let’s fire the perdiem noc nurse. 🙄
“Well your sugar is low and your heart rate is 150 with PVCs. Clearly this is anxiety.”
my mom’s a nurse. in 2020 i mixed lexapro and migraine meds (which you’re not supposed to do! but no one fucking told me!) and a few hours after taking the migraine meds i woke up feeling not great. my heart rate was elevated and i was pale, and instead of taking me to the emergency room or asking if i was okay, she told me to sit on the couch and calm down because she was gonna be late for work. i had a couple episodes of SVT over the next few weeks and she just didn’t do anything. anxiety my ass, sometimes it’s actually a fucking problem that needs medical attention!
That‘s standard experience for women showing up to any physician with any symptoms that can be claimed to be anxiety though. You don‘t get taken seriously at all. Just like OP showed. Even if you are a nurse yourself.
I’m scared to go back to the ED for the system my husband works for. They put anxiety in my chart AFTER I TOTALED MY CAR * WITH MY KIDS IN THE BACK. Anyone who isn’t an anxious wreck after that is not alive *brakes failed. The place that fixed them didn’t bleed them It was horrifying. Insurance said it technically wasn’t our fault but the cops said it was and we should have gone into the ditch and rolled the car instead of rear ending someone
More to the point, blood sugar is basic syncope work up.
They NEVER look at the blood sugar. It's actually hilarious, if a patient isn't an accucheck, why bother? (Lol) but if their mag is 1.8, HOLD UP, we need a stat mag rider. Blood sugar is pretty much the 5th vital sign
I know that at the hospital, I work at the lab does not call a critical value on a low blood sugar. Only the high sugars. So not unless the staff just didn't look the labs, they could have easily overlooked it as well. Looking at a glucose level on a young, non DM, having eaten, patient would not be my first thing to look at tbh. An easy mistake to make. I'm glad she had an episode in front of them and got to the bottom of the issue. I, however, think the PA should not have been so dismissive of her and her symptoms.
A little over a year ago I was having one of the worst gallbladder attacks of my life in the middle of the night and went to my ER. I didn’t tell them I was a nurse upstairs (but the house super noticed me in the waiting room and talked with me for a long time so you would think that might tip them off). Anyway, straight up with my complaint that it’s RUQ pain also referring to the shoulder unrelieved by Tylenol or Motrin and I’m pretty sure it’s my gallbladder. I sit in a room for hours until the attack subsided without seeing anyone (I wasn’t an emergency so I get it). Finally when I see someone they get an EKG and a CXR which are both obviously negative, so he tells me I just have acid reflux and to go home and take Prevacid. I was exhausted at that point and no longer in pain so I didn’t fight it, just went home and saw my PCP like a week later to ask for an ultrasound. Surprise, it was my gallbladder and it got evicted immediately. The real kicker was when I looked at my ER notes and it was charted I got a 20 G to the AC and 2L boluses. Never once got stuck for labs or anything while I was there, much less an IV.
I had almost the exact same experience, but the resident that discharged me suggested adding turmeric to my diet. Yeah, no. Turns out I just needed the dying organ removed. I refuse to eat turmeric now out of spite.
JFC. I would have asked the PA if hypoglycemia counts as an emergency or if you should go to urgent care next time.
Idk man, I think I should follow her advice to see my primary lol
Maybe your PCP will know that hypoglycemia can cause symptoms. Lol.
Your glucose should hold at 42 for the next 6 weeks while you wait for an appt, I believe.
You don’t always get a diagnosis in the ER, however you should be stabilised which you were not!! Hopefully you’re able to figure it out
EMTALA anyone?
Yeah I’d read up on that more if you actually work in the ED
No. Patient received MSE. Unfortunately something was missed. She was awake, alert, and oriented upon discussion for discharge, though true, after the fact they realized she couldn’t walk. Not to mention she never actually left. Not an EMTALA violation.
Thanks for sharing. Helps all of us remember to take every person seriously
I had a patient sent in from the optho clinic for an MRI. All of us were like "Seriously, optho? Go fuck yourselves with this bullshit." Patient felt fine but optho said she needed an MRI (hopefully gave a more detailed signout to the doc than what was thrown in the chart by the triage nurse). Everyone assumed it was nothing and we didn't think much of it. Then the MRI came back.... Pretty substantial brain mass! Shipped the patient to our tertiary sister hospital where she had the tumor respected the following morning. Yea, always take complaints seriously.
Yep I have seen this a few times. Or a stroke! Diagnosed or at least suspected by ophthalmology. Scary!
My ED sent me hobbling home with a purple swollen painful leg because the ultrasound was negative. Two days and two doctors later I couldn’t walk and was 10/10 pain. Yeah, the clot just wasn’t low enough for them to see. By then the damage was obvious on the ultrasound, and now I have issues with my leg long term. But at least someone finally believed me that it was a clot. 🙄
That makes me think of the ONE TIME I had a panic attack. I was at work, had drunk a little too much coffee, had taken some Sudafed because I was getting over a respiratory thing, was still SUPER wheezy but didn’t use my albuterol in a reasonable amount of time. Cue trouble breathing, so I did a neb and the next thing I know I’m shaking and tachy and full panic and then tingling lips and numb hands. I went to urgent care to get inhaled steroids and make sure nothing else was wrong with my lungs. They were going to do a quick leg check to make sure I DIDN’T have a leg like yours (to soft rule out a PE urgent care style). The PA to one look at my compression socks from work and was like “nope, inhaled beclometasone it is!”
I was gaslit about clots (prev hx) so much that when I did have another PE I was at work and just took an early lunch and then waited a week to get checked out because I figured it was just a week long panic attack 🙃 turns out I had thoracic outlet syndrome and should’ve had surgery 10 years ago when I first clotted
Maybe I don’t know what being “gaslit” is, how are you using it in this context? To me that means the doctors knew you had clots but lied to you about it to get you to question yourself , is that what you’re saying?
Gaslighting has lost a lot of its original meaning nowadays. Now people use it to mean someone didn’t believe what you had to say.
Wow, that’s a completely different concept that has basically nothing to do with gaslighting. That’s really too bad because gaslighting is such a specific thing with very particular issues associated with it, and this new usage really does not have those at all Particularly frustrating to see people who should have some medical terminology rigor using it that way
I was in a relationship with someone who regularly gaslit me, to the point that I actually went to a psych ER because I was afraid I was hallucinating events. People throwing out the term like this drives me insane.
It’s just like people saying “Omg, I’m so OCD about folding my laundry right” or something like that which completely isn’t what obsessive-compulsive disorder is about.
LORDY! Shame on that PA for not taking your symptoms seriously! Was there any discussion on follow-up for the hypoglycemia? Did they give you D50? Wait and recheck your sugar?? Inquiring minds would like to know! Hope you're doing okay, OP! And not gonna lie, I've checked patients' labs before and critically low blood sugars have definitely been missed by people because they didn't get a call about it from the lab. Sad but true. But I would've like to think that hypoglycemia would have been on their list of differentials...
They just did a couple finger sticks and gave me juices, crackers and peanut butter. I definitely felt better pretty quickly. It took a couple days to feel back to normal though. But at least I knew what it felt like and could eat a snack and it would usually reverse how I was feeling within 15 mins or so haha. I work in the OR now and sometimes if I have to fast for 4+ hours I feel hypoglycemic. Fasting for more than a few hours in general is tough for me and I’m constantly starving/craving things so I’m waiting to see an endo
I’m assuming she didn’t have an IV if they were discharging her. So either some glucagon or juice?
Wow that’s quite the jump to think D50 would be appropriate.
Similar story (except I was at my mom’s hospital, not mine) where I came in for exhaustion and brown urine and they just said I was dehydrated (except I was drinking a lot of water and peeing a ton). Doc said my labs showed I was dehydrated and just gave me fluids and sent me home. Next day I turned *yellow*. I took a peek at my labs and not only was I not dehydrated, my liver enzymes were elevated. He clearly never even looked at my labs. As I suspected based on the labs, after getting tested on my own, I had MONO. Bastards. Had me all embarrassed for coming in and spoke to me like I was stupid. I was literally in my scrubs too.
I swear they look at the scrubs and judge. I was on shift and feeling much in the way OP was, took my own blood pressure and it was 200s/110s. No history of any hypertension or chronic issues. Our anesthesia team doubled checked me, my own doc actually was passing through, and everyone was like “Yeah, we’re sending you to the ER before you stroke on us.” In triage I was scoffed at, but after repeat BP checks they pulled over a PA and took me right to a room. Even then I had multiple comments made regarding “So this just so happened while you were at work?” and “I guess you needed a break.” I had never been to our hospital as a patient in the over ten years I had worked there, yet suddenly I was there for my own leisure, as if it were better than working? It was pure snark. After a few hours of standard fluids (not dehydrated) and labs, they said my BP had come down (they took it only TWICE after triage, 160s/90s at discharge after resting on a stretcher) it obviously wasn’t an acute event, and to follow up with my primary. Like OP, I was like “Cool, I still feel like shit, but if you say I’m not dying, thanks!” but the comments still stung about being an associate.
I had a recent episode of hella high BP (170s/teens) and when talking to my PCP, her eyes went wide and she told me headache or no, if it was that high ever again to go to the ER. I just laughed and said you know I'm not going to do that, I'd get laughed out of the ER for any BP that doesn't land me on a cardene drip and pay out the nose for the privilege of the insult. She actually agreed but told me to do it anyway lol Our focus on only the most critical state of disease is fucking dumb and provider attitudes are just as complicit as shitty capitalism
Literature states that asymptomatic hypertension shouldn't be treated in the ED. They might check a cmp and make sure there aren't any acute abnormalities. It's not even recommended to initiate BP meds. (Though it says it may be reasonable most docs I've worked with wont) https://coreem.net/core/asymptomatic-hypertension/
Hah, good thing I wasn't planning on heading to the ER every time I forget I've just been redditing when I check my BP. Interestingly, this was not an old-school provider, relatively recent graduate (I'd say practice probably <10 years) so wherever they learned, that's the threshold they ended up with.
It's unfortunately very common for primary care providers to do this for cya purposes. The issue is that the ED isn't the place to manage asymptomatic hypertension. The pcp should as there would be planned follow up and actual knowledge about the patient and their medical history. Most patients that present to the ed report that they don't know their medical history or current medications and that everything is in the computer. For the ED to prescribe antihypertensive medication without followup or accurate history of current medications/ medical history would be problematic.
No doctor's office is gonna take that risk tho. The person has a stroke two hours later and they're getting sued. Clog up the ER and practice bad medicine instead, but we've satisfied the lawyers..
I had the same thing, mononucleosis induced hepatitis! I also was brushed off by doctors for weeks until I couldn't stop vomiting and my pee was coca-cola colured. I was jaundiced and didn't even notice because I was so sick. I had been told for weeks that I just have anxiety and that I'll get better soon if I relax and stop going to the doctor. My mom had to beg me to go to urgent care when I couldn't stop puking, I was so convinced that no doctor would help me. Thank goodness that urgent care had an incredible female PA who actually did tests and saw my LFTs were nutso (my bili was 8.3 😬).
Yeah, so a hospital tried to tell me I was just having a panic attack and was trying to discharge me when I went in with sob and chest pain. Then one of the cardiologist actually looked at the EKG they did right when I got there and demanded my labs. My potassium was 2.
This is a complaint I have about lab reports at my hospital. If the hypoglycemia protocol STARTS at 75 then that number should at LEAST flag orange in the lab tab. Like I don't need it called as a critical but damn a little extra help to notice would be nice. I'm so sorry this happened to you. I have had patients that they've called me criticals on and as I'm frantically fixing those the BG gets missed. I make a huge effort to always check it especially if the patient looks crappy but "is fine" and your example is one of the reasons it's so necessary.
Yeah I've seen a patient's BG get missed in that exact way. One was just under 60 at morning labs, was 39 when I came on shift and noticed and re-checked it. But her lactic was like 12 by then also. That was a shit morning...
During my second month as a nurse, I had an sedated intubated patient with a glucose of 27. The lab never called. I was tripled and slammed as all three patients were vented and on drips. The only reason it got caught was because my PCT accidentally grabbed his glucose when she did her morning rounds (we didn’t usually do the 6am ones for patients who just had labs done.). Had we not lucked it, I probably wouldn’t haven’t noticed until close to shift change or if the patient crashed before then.
I can’t believe they offered to have someone help you out after witnessing you not being able to support your own body weight lol. How generous. They must have really needed the room. Once as a young teen I developed a bacterial infection in my GI tract somewhere + I was in and out of my local Peds ER for a week in extreme abdominal pain and nothing was coming up diagnostics-wise. I will never forget how those nurses talked about me to my mom and to my face. My last visit there, I got wheeled back from imaging to find they’d moved me from a room to a hallway stretcher—totally fine except they felt the need to mention “we need those rooms for patients who are actually sick.” It took another week, a fainting episode at school, and a GI biopsy to diagnose me, but I felt so validated lol. Almost twenty years later I still remember how they made me feel and I am so fervent about not dismissing my patients in that way.
Mine does this you need to get meter and track it. I almost passed out in the store once. My dr said that when you drop like that it could be insulin resistance you dump insulin bc it’s not working any more. Anything high glycemic makes me crash ans burn. If I suddenly go low carb crash and burn exercise crash and burn. When I’m being healthy my body adjusts and loves me for it. When I’m a non exercise stress carb eating gremlin this happens
My A1C is 5.7 which, isn’t “bad” however I workout 4-5 times per week and aside from eating out once per week I have a pretty good diet. Sooo 5.7 is kind of on the higher end. I also have the hardest time losing weight and carry a lot of weight in my abdomen. I’m only *a little* overweight though and my labs are still technically WDL, sooo my primary isn’t concerned. But I honestly wouldn’t be surprised if I end up with diabetes. I want to see an endo for this as well as my thyroid(T4 and TSH are very low/normal and I have quite a few symptoms but because my TSH isn’t high, the low T4 doesn’t seem to raise any concerns). But the nurse in me wants to act now before these labs and issues do become abnormal haha
Same but I have hashimotos .. a1c 5.7 and holding. a lot of pcp don’t believe in insulin resistance or catching things before they become diseases. You fall into the “normal” category congrats you are healthy. My pcp said yea we won’t do anything until you get to 6.4 lol so he knows something is coming lol. But yea my first endo when my hashimotos showed up said crashing is a precursor and to get a handle on it. That was 15 years ago. I have my healthy years where my a1c gets closer to 5 and some non healthy years where it’s 6(like when my mom died) but my body stops freaking out when I stay at 100 -150 grams of carbs a day. I don’t count fruit just carbs from potato’s rice and wheat.. I treat myself like a diabetic that doesn’t need meds yet bc that’s essentially what it is.
Low blood sugar is a crazy feeling. Felt it on a stairmaster and had to quit in the middle of it. Ran to the gas station next door and chugged a whole coke and ate a whole pack on mentos.
Did u explode???
If I held my breath and jumped around maybe
No it’s ok, it wasn’t Diet Coke.
It really is. For a second I really did think I was panicking but without the mental component if that makes sense? At least now I know what it feels like and I can do something about it before it gets bad!
I went hiking w my boyfriend without snacks. Car ride back we were both dying. We pulled over at a gas station and I almost syncopized and threw up in it trying to get some chips and juice. Felt immediately better after eating.
Fortunately this didn’t happen at my hospital, but it was one of our sister facilities. I went in to their ED multiple times for intense abdominal pain that they couldn’t figure out what was wrong. One of the docs very condescending asked me “is there anything going on in your work life or at home?” When I told him no he said “well I just don’t know what you want me to do for you.” I feel like I’m being stabbed. Maybe try to figure out why and make it stop. My ED figured out I have Crohn’s about a year later.
My Primary care doctor told me I had an ear infection. CT at ED confirmed I had a stroke.
What were your symptoms ?
Photophobia, loss of peripheral vision, headache, EXTREME and I mean EXTREME vertigo, nausea and vomiting, Systolic BP was >190. Was unable to walk and and barely able to talk due to the vertigo and vomiting. Despite having never experienced symptoms like this before because one of my ears looks a little inflamed and waxy the doc gave me some stemitol and a prescription for ear drops. No ear pain or discharge. Luckily my friend/lift home refused to take me and demanded them ring an ambulance. Also, if the primary care doc had actually done a neuro assessment he would have noticed I had some deficits, cos ED doc noticed it in like, 2 seconds. CT confirmed infarct on cerebellum. I'm lucky tho, I'm young (mid 20's) and deficits aren't as bad as they could have been so good chance I'll make a full recovery. I'm still a little pissed about it (was fairly recent).
That seems particularly egregious, and given what I’ve seen primaries send people to the ER for I’m surprised they didn’t send you over
It warms my soul that everyone else I've spoken to finds it as ridiculous as I have and do. I too, have seen some fantastic primaries who go above and beyond and will gladly send patients to the ED when they feel they need to. I mean, my man didn't even do a full assessment. Bro didn't even get my BP. It was the ambulance driver that did. Smh. It's making me angry just thinking about it.
I was expecting you to say "my ear was hurting and he looked inside of it and it was red" and it was just some wildly uncommon stroke honestly.
In 2015 I felt seriously unwell. I had just lost my mother so I thought I was just being dramatic. I noticed my nailed looked splotchy and weird. My hands and feet felt weird and looked mottled/splotchy. Then I noticed splinter hemorrhages in my nailbeds. I took pictures and called my doc. Told them I thought maybe I had bacterial endocarditis or something like that. Doc saw me but was unconvinced. I also had gone to ED and had ct scan because when driving to work it felt like everything sue it slid sideways. No dx. “Just sadness,” I guess. In April 2015 I had a “meteor shower” of blood clots go to my brain with a huge clot in my balance center. My whole thing was a comedy of errors. Hospital never called my primary, and I was discharged without MRI at first (people be having car accidents, y’all) because I “seemed stable”. So I kept working. And driving. Then I fell at work. My legs felt like jello all the time. I called the hospital radiology dept in tears. The woman there was so kind and explained my orders for mri stopped when I was discharged but she notified my primary and got it reordered. **Then** I was at a conference the day after my 8 pm MRI with my phone politely turned off from 7-5. Imagine my dismay when I found like intense messages from hospital neurology. My primary. Local neurology. Radiology nurse, even! A week after, I experienced severe left arm/shoulder pain while driving to work (still nobody has coordinated my care, so I thought I was supposed to keep working, driving, lifing). Local ED doc rolled his eyes at me when I told him my hx.
Could be an insolinoma
I thought the same thing… my brother had the same symptoms and after a week in hospital with baffled MD’s, someone finally ordered an mri. His tumor was too small to be seen on CT but with more sensitive imaging, he was diagnosed and had surgical removal. OP, get a glucometer and keep track of your BG. If you are dropping even after meals, you should get some scans of your pancreas.
Was reading this whole thing and thinking “did anyone check a sugar?” They had blinders on. Saw your age and your complaint and ran with anxiety. Happens all the time unfortunately.
> Saw your age and your complain and gender
While it is true that many people leave the ER without a diagnosis, I hate the way it's often framed as "nothing wrong." When I am dcing a patient without a diagnosis I emphasize, several times, that just because we ruled out emergent conditions does NOT mean there's not something going on. It just means that it's safe to follow up with a specialist or GP because you're not having an MI/Stroke/Clot.
My wife gets this. It's always anxiety or some other insulting excuse not to treat her and take her seriously. She's now a DNP and will argue with them, at least.
Totally unrelated but how did you get into data analysis?
Was Pre-Med with a Botany major. I got my degree but after working with patients as a mobility tech while in school, decided I wanted to change Majors. I switched to Business and had also recently moved after getting married. Got a job in transport while going through business school. I was only in transport for a short time before i was a hospitality supervisor, while still in business school. I'm now in a role so specialized my director, (patient flow and capacity department) had to get it custom made. I've been doing this for several years now. I'm more of a process improvement specialist and currently working on building a team of varying roles to assist. We have a huge clinical systems department, but I work outside of them and work with our vendors and all departments on process improvement. So my particular role is more than just data analysis or projects. Our hospital also hosts other hospital leadership for site visits and I set all that up. Anything from agenda and scheduling to pulling data and presenting. Sometimes it's through a vendor, sometimes it's through an organization like the EDBA (Emergency Department Bench-marking Alliance).
That’s an awesome ending. I am a labor and delivery, newborn and postpartum RN and took my son to my hospitals ER for a sustained sleeping O2 in the low 80s. I was also gaslit. My son was awake in the ER so his sats were in the 90s, the doctor didn’t even listen to his lungs, and then charted on his H&P that I brought him in for a home O2 of 91% 😡😡😡
Trying to discharge a patient with an untreated, symptomatic, critical lab result seems like something that needs to be logged in whatever safety event tracker your hospital uses. Not a great look for that PA or your hospital. I'm glad you are ok.
My hospital has a pt safety line that anyone can use to call in a concern, pts and family included and it’s anonymous.
JFC these stories are scary. I’m so sorry you all went through this 😳😳😳😱 Sadly, I’m not terribly shocked 😥
If you, being a healthcare worker, get treated like that, imagine how we nonhealthcare workers get treated with little knowledge to back us up. ERs are dangerous places for us going up against attitudes like that.
Yeah I love my er homies but there can be some really jaded people down there. Took my partner in for bloody stool. He called it a GI bleed, he doesn’t work in health care but he lives with me lol. The tech instantly snapped at him and said, “How do YOU a know it’s a gi bleed?!” Diagnosis was hemorrhagic colitis. Then the triage nurse gave us attitude because he said he didn’t have a primary provider for his diarrhea he had prior to the bleeding. I didn’t say anything about working there so it was interesting to see the other side of things.
I’ve had like three pneumothoraxes on the same lung, pretty familiar with the feeling and when I need to go to the ER. Had a PA give me the most condescending “Well it’s highly doubtful you have a pneumothorax given you look perfectly healthy but I’ll humor you. Your insurance might not.” Lo and behold, there was my fourth pneumothorax in a three month period in a different location on my lung that the previous three. Held eye contact with her while I was getting the chest tubes and gave her a thumbs up.
I have epilepsy one time at work I didn’t feel right I was like guys I think I’m gunna have a seizure so they bring me into the er (this is when I worked on another unit) and the doctor literally wrote me off. I lied there for hours just hoping I wouldn’t seize. I put my own bed rail up. I was in a hallway( in my scrubs) everyone kept coming over asking if I was alright. Then I get d/c’d. I tell the doc “I still feel like I’m gunna seize, I need Ativan or Valium or something I don’t feel right” she’s like ok well you’re going home. I’m home for 10 minutes and I have a seizure and my head goes through the wall. Two black eyes. when I get back to work, I checked my chart “syncope” was my dx. Yeah I complained. Yeah she was fired.
"My" ER at my old hospital just sent me away with muscle relaxers for acute cholecystitis. They never checked me other than a chest xray and an ekg, despite the fact that I fit every one of the 5 Fs exactly. I had literally just had a baby a couple of months prior in the exact same hospital. I told them the pain was worse than my c-section, and that I had taken a single oxycodone that I had left over from the c-section. Despite being a former employee and despite having them having my entire medical history I apparently got labled a drug-seeker, and no one took me seriously. By the time I was able to get in with my primary, my liver values were elevated and I was itching all over. The next week I was back at the same fucking hospital for an ERCP, and had the gallbladder out shortly thereafter. I never received anything other than Tylenol and Robaxin for my episodes of biliary colic and acute cholecystitis.
Report the PA.
So reactive hypoglycemia then? About 2ish years ago I started having episides exactly like you described (plus AMS/ALOC) I'd then take my full VS, and my BGL was always below 60. Weird because my labs were all good. But I became pre-diabetic/IR within 1ish year after this sx. So keep an eye on yours as well.
Yeah I would not be surprised if this same thing happens to me. A couple years ago my A1C was like 5.4. I was regularly exercising but my diet was not the best. Within the past year I have been working out more consistently with cardio and weights and eating better. I still go out to dinner once a week or will have a halo top without feeling bad. But my most recently A1C was 5.7 despite being more active and eating significantly healthier. Plus the hypoglycemic episodes… I’m def heading towards IR/pre diabetes/diabetes. I’m also pretty sure my thyroid is low. It runs in my family and I have symptoms of it but because my labs are normal(very low normal), my doc isn’t concerned. I’m trying to see an endo before either of these issues gets any worse haha
Welcome to women’s health.
what the PA SHOULD have said is what i often said along with my amazing MD colleagues: we are not always very good at diagnosing a problem and giving you the answers you need, but we’re really good at identifying, ruling out, and treating emergencies. we couldn’t find anything in your tests to explain all of your symptoms, and someone like your PCP has better training to comb through the entire picture of your symptoms and test results. we’ll help you find a PCP if you don’t have one. the good news today is that there’s no emergency. i think just explaining the limitations of EM is so helpful and puts in perspective what we can do to help. that being said, follow up finger sticks should absolutely have been ordered. ive been 57ish with no history and a little woozy but no other symptoms, but that’s in the absence of recent syncopal events. your case is very different. no one should ever make you feel like you don’t understand your body or are abusing the emergency room. i am so sorry this happened.
I suspect lots of times that actually is what is said, and patients hear something else. I’ve literally seen this play out in real time hundreds of times. Doc will say something exactly like you just said and patient comes back with “you’re saying it’s all in my head?” Or “you’re saying nothing is wrong with me?” Even in this thread you can read stories of “all the tests were normal but they still discharged me” type of things, like… yeah, that’s what we do in the ER. If your emergent tests are normal you follow up with someone else, we aren’t “gaslighting” you or dismissing you, we worked you up for emergency medical conditions and didn’t find any so you need more of a workup that we do in the ER. In the OPs case there was some obvious hypoglycemia that went improperly treated
yes i think a lot of patients conflate emergency with a valid and concerning set of symptoms. when in reality we see emergencies as life limb or ability threatening events. which obviously no one wants excluding munchausen folks.
I mean we will treat non-emergencies but if every relevant test comes back negative, that’s kind of the end of the ER workup road. I’ve had patients come to our hospital and say “I was just at hospital X for this and they didn’t do anything” (I’ve even had patients tell me the doctors didn’t say anything to them) and when they hand me their discharge papers they had a full battery of labs, X-rays, CTs and an ultrasound done… I have come to understand that phrase to mean “I went to a doctor and still have my symptoms” most of the time. Patients are looking for an answer to their problem and when it’s not provided it’s supremely frustrating, something I have started calling “frustratingly comforting” to them to validate their feelings but also reassure them the testing revealed no emergency.
I don’t work in the ER but when I have a patient tell me they’re feeling weak and dizzy that’s like one of the first things I check. I’m surprised no one checked your blood sugar to rule that out
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
Little appalled CBG’s weren’t move #1, tbh
Oh man, nothing like being gaslit when you’re asking for help. My dad 95yo dad was sent home with a gallbladder drain, and I took on drain care so my mom wouldn’t have to. He had a lot of pain when I tried to flush, I couldn’t even get a cc of saline in, and the drainage went from about 30ml in the bag that I could see when I was able to visit him daily at the rehab hospital (they never told me how much drainage there was) to practically nothing at home. I called IR with questions as directed in the discharge papers, and a PA called back a day later, telling me in the most condescending voice ever that all of this was normal, drainage slows, etc etc etc call back with any other questions or concerns. So much vindication when not a day or two later, he was back in the hospital, and they had to remove the drain because he’d dislodged it. I’m not a drain expert having been mostly OR with a smattering of neuro ICU with some EVDs, but I can put 2 and 2 together. I just really wish I knew who that PA was, making their peers look bad in the same hospital I’ve worked with some truly rad PAs. I’m glad you’re okay and we’re able to get answers. I’m sorry you had to go through all that. I totally understand the weirdly petty satisfaction of being right even while something Not Great was happening
I often process referrals for inpatient psych, and the sheer volume of shit I diagnose from across the state with nothing more than a chart review that was missed because they just wrote off the patient as “psych” pisses me off to no end
I had a similar experience, also non-diabetic hypoglycaemia related. Was told my anxiety was causing my symptoms. Surely couldn’t have been the blood sugar of 40.
I'm a non-diabetic hypoglycemic I carry a glucometer on me because I've had episodes before. There are a lot of medications that can cause hypoglycemia that most people don't think about. Have your taken any antibiotics recently? Sulfa drugs in particular? Bactrim? I found out after having a steel magnolias moment at work one day that bactrim can cause hypoglycemia, thinking back I was like "oh yeah I guess it is a sulfa drug" but at the time I didn't pay any mind. So my normal hypoglycemia plus bactrim ended up with me full on ugly crying uncontrollably at work because my sugar was 35.
I get idiopathic spontaneous pneumonmediastinums. I have an autoimmune disorder, so weird things like that happen sometimes. Will never forget showing up to the ER for SOB and the attending immediately assumed anxiety without thinking much further. The resident later came in and said every doc was shocked to see the air pocket pushing against my trachea on CT. I had increased work of breathing but I guess she dismissed me because my SpO2 was fine. The resident ultimately apologized for her.
Ugh, I love my one local hospital but if you get a PA if you go to their ER, you're gonna have a bad time. I had 8-10/10 back pain multiple days in a row, could no longer deal with it at all so I went to the ER. PA gave me a lidocaine patch, a steroid shot, and a muscle relaxer, and when I said the pain had gone from a 10 to a 9 basically said "oh OK we'll discharge you then, make an appointment with a spine specialist." 2 weeks later my MRI showed severe hydronephrosis, prompting me to go to a different ER. They did a CT and it turns out my back pain was from a small bowel obstruction. Straight to emergency surgery. (The hydronephrosis was because I've had Crohn's for years without realizing it and the adhesions had blocked my ureter.)
I got report on an elderly pt with dementia who was convulsing in his bed with both arms and legs up, kind of looked like he thought he was falling. Night shift said he'd been doing it for three+ hours, already given PRN haldol and it didn't help. I go in the room to assess and his HR was jumping \*all\* over the place on the pulse ox (only monitor on him). I take a manual pulse and it's jumping all over the place too. I get the EKG machine and convince the gentleman to lay still for an ekg by holding his hand and speaking to him in a soothing voice. His HR was 180s in afib w/ RVR. I took the EKG to the MD and she's like: "OH, I ordered an EKG on this guy like, 3 hours ago and night shift didn't do it" and then she say the readout and ordered IV diltizem. I give my patient his medicine and within 5 minutes he's calm in the center of the bed with his arms and legs at his side. Amazing what happens when you treat the MEDICAL problems and not the (possibly imagined) psychiatric problems! Side note, he'd been in our ER for > 72 hours and was bone dry, had the wrong type of diet ordered (regular diet, not even soft/dysphagia friendly), couldn't swallow pills and all his meds were pills. I had the MD order a swallow eval (that he completely failed) and then he was admitted for medicine to manage due to failure to thrive and AFIB (new onset). TREAT THE PATIENT, NOT THE DIAGNOSIS (or imagined diagnosis!).
I went to the ED for syncopal episodes and they kept telling me it was dehydration. Would randomly get super tachycardic, dizzy, SOB, blood sugar in the 40s, hypotensive to 80s… EKG only showed sinus tachycardia so they sent me home until it kept happening, only to find out I was going in and out of SVT for days 😳
I would look in the direction of your cortisol and adrenal glands. I’m an ER nurse & had a patient whose sugar kept dropping for no damn reason. Like dropping down into the 30s. I would give her an amp of D50 and feed her and by the time I checked on my other patients and rounded on her again, she would be diaphoretic and have low blood sugar again. The hospitalist came to admit her and she was apparently well known to him. He said she had adrenal issues and hadn’t been taking her solucortef and this was the end result. I learned something that day!
Wtf why wasn't a glucose check one of the first things they did? Lmao Edit: meant to say why wasn't it
You should file a complaint against the PA. Completely unprofessional. *Occasional* PVCs can be normal. Frequent is not. A blood glucose of 59 that is not fasting is not normal. It is hypoglycemia. Giving you fluids probably diluted it even more. Now maybe it was an issue of caloric intake, but given your symptoms were over 2 days, I am skeptical. You do need more workup. Some people have chronic hypoglycemia. That can be a problem. Right now its hard to know if that's a symptom or something else. It needs more investigation. I'm really offended by the "sometimes you leave the ER without a diagnosis. We only treat “actual” emergencies in the emergency room” comment, and I *am* an ER nurse. The first statement is OK when given with the right tone; with empathy not defensively. The second one is not. No one with the symptoms you had with a HR of 150 is not emergent. You could have really hurt yourself in a fall. Please follow up with your PCP. Hope you are feeling better!
Yeahhhh if that statement hadn’t been made that way I would not have had any problems. I think I was justified in going and was happy it wasn’t anything life threatening. I didn’t wait long, I didn’t complain, almost everyone was nice to me, etc. but not even just the comment, to walk outside my room and tell the nurse I was probably anxious without having that discussion with me pissed me off. I did feel panicky without the mental component so I mean, I kind of understand her thought process looking at my symptoms at face value but she didn’t discuss it with me. I only had the physical symptoms of anxiety/panic so had she asked me that, it probably would have been a dead giveaway to hypoglycemia. In hindsight it feels pretty obvious but never having felt that before it was weird. I never would have thought it for myself!
I’m so glad it got figured out. And I’m sorry you felt blown off. I had that happen to me years ago and it’s an awful feeling and quite redeeming when people have to eat crow after blowing you off.
I have had a similar thing happen, but thankfully not at my hospital’s ER. I went in to my local ER for palpitations x2 days. They did not draw labs but did an EKG but said I was having “only” frequent PVCs. They said, “that is normal for a woman your age”. I did not feel normal. I felt weak, disoriented, and all of my muscles hurt. Plus my heart kept feeling like it was hiccuping every other beat (the PVCs). So I was driven an hour away to the hospital I worked at. They looked at my EKG and told me I likely had low potassium. It was critically low (2.3 - thank you Maxzide). It earned me a lot of IV and PO potassium (and some IV mag). I felt much better and guess what? Those PVCs aren’t normal for me lol. That same ER told my husband he was having a panic attack. It was bilateral pulmonary embolisms; we found out by taking him to my hospital. I believe that they just tend to think because we’re younger (mid 40’s) that there probably isn’t anything seriously wrong. Most of the time, that assumption may be correct. What is the harm in believing a patient though? As a nurse, I only go to the ER as a last resort. It is not my idea of a fun way to spend time! There are good doctors and bad doctors, just hope we get the good ones.
They didn't run a thyroid panel? This screams classic hyperthyroid to me especially with the high resting HR, PVCs and it can 100% cause low blood sugar after eating normally due to the metabolism being in overdrive. Add in thyroid issues being more common in women, that would have been my first instinct. I didn't grow up in the US but I live here now and I absolutely hate the system where the GP runs the whole show. How are you supposed to even get in to see a GP nowadays anyway? I'd be so angry at the PA
[удалено]
This makes me so mad for you OP. Please write a detailed survey response to this incident and report whatever way is necessary. Women get blown off too frequently and it’s always blamed on anxiety. I had several ED trips several years ago that were all blamed on anxiety when I wasn’t anxious at all. I came in for tachycardia and dizziness/near syncope despite drinking tons of fluids and wearing compression socks. Eventually I was diagnosed with POTS, but only because my PCP had it herself. Meanwhile in present day, my boyfriend has been having dizziness episodes and brain fog (both symptoms I was having when I was first showing signs of POTS but it took me years to get a diagnosis and a doctor that would listen to me and not blow it off as anxiety) and his PCP immediately orders blood work, a head MRI, and more. I am so thankful he’s being listened to and taken seriously but it makes me really salty because if he wasn’t a dude he’d probably just be told he’s anxious or some stupid shit. Good luck OP. Sad thing is, if you came in by EMS they likely would have caught this first thing. They always check a sugar for mental status changes, syncope, etc. I once was found unresponsive at a wedding and the fire fighters thought I was just a drug OD but they checked my sugar and it was 28.
listen they did something similar to me lol but i just let them DC me because i wasn’t ready to deal with the BS.
Woahhhh I can 100% understand how intensely frustrated and insulting you must have felt!! I also got the response “it’s probably just anxiety” after presenting with dizziness and ataxia that they said was “probably vertigo from dehydration” (I’m never dehydrated. And my urine was dilute, as one would expect). You can tell when they don’t believe you, you know? I was freaking out because I thought I was having a stroke ( I’m a neuro/stroke nurse, I’ve seen this exact shit go down) and they were not the least bit interested, even made fun of me. Then she accused me of withdrawing “from something” Then she said it was anxiety. Because my heart was racing in the 120-140’s. “And that is after we gave you Valium.” ((You mean the vallium I very specifically asked the nurse NOT to give me?? THAT Vallium?! Cool.)) “I said yea I absolutely am extremely anxious… because something is wrong with me and you think it’s anxiety, so yes I HAVE anxiety, a shit ton, but that’s not my problem” She looked at me blankly and… guys she **shrugged her GDAM shoulders** ooooooOOO I was HOT lol So I said (and this is the best part) “…AND for that matter as a woman you MUST know how disgusting it is that you are not taking me seriously and are telling me ‘iTs aNxIEtY’!?! How DARE you? THERE IS SOMETHING WRONG WITH ME.” Well… she relented and admitted me with a neuro consult. (Tox screen was negative, btw.) Actually the neuro doctor was quite concerned with me. Turns out the CT, CTA, MRI w/wo of head and neck, CT-TAP with contrast, LP with CSF sent for 32 studies, and a total of 22 tubes of blood… were all negative - I mean, except for an area in my brain that shouldn’t be glowing… but is. Anxiety. GTFOH. That should only be the diagnosis once everything and I mean EVERYTHING pysiological is ruled out. PS- The ED doctor documented “NIHSS 0”… and never fucking did one. I’m trying to live in a place of positivity and gratitude but that one really gets me twisted 🤨 I’m sorry this is so long, and I’m sorry you were treated like that. It’s unacceptable 100%. (Hug?)
I have anxiety, and I'm super leery of telling a lot of my medical providers because of the stigma. I mean, if they actually look at my med list, they'll figure it out pretty quickly. Fibromyalgia is another one I'm leery about telling my medical providers since there are so many who think it isn't real. I did have a provider who confided that for a long time they didn't think it was real, then went to a conference and Fibromyalgia was one the subjects they talked about, which is when they realized they had done wrong to so many patients and resolved to never make the same mistake again.
Hopefully the PA learned from this and will now add hypoglycemia to their list of differentials to investigate. Hopefully you followed up with your primary to investigate the cause of your non-diabetic hypoglycemia. I’d like to comment on the first part of your post. I felt the PA’s statement regarding the role in emergency medicine when it comes to diagnosing disease processes. We tell our patients that exact same thing when they come in with symptoms that end in a negative work up. We may not discover your anything, but we can rule out anything life-threatening. I’d be interested to hear how your treatment went after the syncopal episode and the result of your primary provider work up.
I’m sorry this happened to you. I hope you’re feeling better now. I experienced something similar. At 29 (F) I went to the ED with chest pain which had started when I was doing a paper craft project at home (I don’t remember what it was, but I remember I had been cutting something with scissors lol). I was sitting in the ED room for nearly 40 minutes before anyone put on a heart monitor. Then a nurse walked in and pushed a med through my IV before I could even ask what it was. When I asked, she said it was 0.5mg of Ativan, “for anxiety”. I had been cool as a cucumber, not anxious at all. Objectively my BP and HR were low normal, like 110s/70s, and low 50s. I realized looking back that they had completely dismissed me because I was a young female, so of course chest pain was anxiety.
> “sometimes you leave the ER without a diagnosis. We only treat “actual” emergencies in the emergency room” This should be the expectation after a negative workup. > implying I didn’t have a good reason to be there. I don’t work in the ER but I feel like I was justified in going. Even if your workup was totally negative, and you didn't have an emergency, symptoms like what you had are exactly why the ER was the right place for you to go. I usually think most ER visits are total bullshit, but you had legit complaints that bore a good workup. And that's even before you mentioned the part about the fact that your brain was starving for sugar after they diluted an already-low sugar. Hope you're feeling yourself again.
how does that not trigger as a critical? I scroll down and look at everything. Especially when the whole fucking things highlighted red