The reason I hate hospitals and don't trust doctors, part 4 of 3 (!??!)

[MaggieTheCat]

I thought I was done posting about horrible doctor/ER experiences for the time being, but apparently no! This happened to my best friend last night.

She had been having abdominal pain for about a week; it started out minor and inconsistent but got worse as the days went on. She had an appointment with her primary doctor yesterday and based on the type/location of the pain, her prior medical history (she had Guillain–Barré syndrome (GBS) a few years ago and is still quite sickly as a result) and the medications she's on, he sent her to the ER.

I'm not sure exactly when she was admitted -- I got a text from her around 3:30pm or so saying that she was in the ER waiting for test results (so she'd already been there for a little while) and she wasn't released until after 11:30pm. They had to stick her 11 times to try and get blood; apparently they were trying to get an IV started in case they had to do surgery (they were thinking either appendix or gallbladder issues based on her description of the pain) but she 1) has bad veins to begin with and 2) was pretty dehydrated from not eating/drinking much in the last couple of days due to pain and nausea, and they wouldn't give her any water in case she had to have surgery. In the end, they never did get an IV started.

They eventually did a CT scan, which revealed nothing. I'm not sure if they ever actually did bloodwork, since they kept telling her she needed to get the IV in order for them to draw blood to do bloodwork. They also never did an ultrasound, which they originally were going to do, because they told her since she didn't get an IV, they couldn't give her tracer fluids needed to do the ultrasound.

All of this sounds bogus to me. I am not a medical professional, but I did end up in the ER about 4 years ago with gall stones. They were able to get an IV started in me, but the final diagnoses came from an ultrasound which revealed my enlarged gallbladder and the dozen or so stones inside it -- no tracer or bloodwork required.

In the end, they basically told her, "Whelp, we dunno what's wrong, here's some pain medication, go back to your primary doctor on Monday."

She is so pissed (and frankly her story has done nothing to renew my faith in doctors/ERs.) She is just hoping she can hold out until Monday (she is still in quite a bit of pain, and is nauseous), when she is going to talk to her doctor about getting an ultrasound without the need for an IV/tracers/bloodwork.

[jedimaster91]

I'm an imaging tech, so maybe one of the nurses can answer my burning question: why the heck did they not put a PICC line in? I know a PICC is pretty invasive, but it would seem to me that since IV access isn't viable and this person might have needed surgery, they would put a line in.

[trailerparkmedic]

At my (big Level 1) hospital, there are no PICC lines on the weekend. Standard procedure at my hospital is that if the nurses can't get an IV, the residents can try ultrasound on the arms or they can go for neck veins for an IV. Not everyone has good neck veins and not every hospital has ultrasounds.

PICCs are central lines, which are considered very invasive (the end of the PICC is like right next to your heart) and only used on people who are being admitted. Abdominal pain is not always an indication for surgery; it's often benign and even when we do lots of blood work and great scans we can't always tell why people are in pain.

You can usually get a little blood on a patient without an IV by using a butterfly needle on veins that are too small/short for IVs, like the veins on your knuckles, but even that's not a guarantee.

Are you sure they did a CT and no ultrasound and not the other way around? Abdominal CT scans are not nearly as helpful without IV contrast. Ultrasounds for gallstones don't require tracers/contrast/whatever.

If your friend isn't happy with what happened, she can always try a different hospital.

[Sapphire Silk]

What trailerparkmedic said.

Tracers for an ultrasound doesn't make any sense. We don't need them for that; the ultrasound makes a wonderful image via sound waves, no dye required.

However, a CT of the abdomen with contrast is a standard part of the work up. But the contrast is usually PO. IV dye is used when they want to see blood flow, usually if they're looking for a kidney stone.

Very often the diagnosis is "We don't know." Abdominal pain is very hard to diagnose even when all the testing is done, often it comes back normal.

She may have gastroenteritis, which is usually a viral infection of the GI Tract and causes pain, nausea, vomiting, and diarrhea. The treatment is supportive care: fluids, meds for pain/nausea, and wait it out. Or she could have something that needs further workup to diagnose, such as an endoscopy to see an ulcer or a colonoscopy to see an inflamed diverticulum that the oral contrast missed. Or something else entirely.

Dehydration will definitely make it hard to get a line, and no hospital I've ever worked at puts in any type of central line unless it's a sure admission or a life or death situation where fluid resuscitation is THE treatment the patient needs, or the patient needs an antibiotic/TPN and MUST have a central line for that. A PICC line has its own risks and complications; we don't put them in just because we can't get a line if we can get supportive care going by other means. Though not done too often these days, you could always get fluids subcutaneously (SUb Q), which is very common in veterinary medicine.

A little phenergan or compazine, and PO fluids 1 tablespoon every 15 minutes is enough to maintain fluid balance on most patients like your friend.

Your friend should follow up with her regular doctor if her symptoms don't improve. She may need additional workup that can be done outpatient. If she worsens, she should go back to the ER (though she can try another one if there is one reasonably close--say 20 minutes as opposed to an hour away)

[trailerparkmedic]

However, a CT of the abdomen with contrast is a standard part of the work up. But the contrast is usually PO. IV dye is used when they want to see blood flow, usually if they're looking for a kidney stone.

That's good to know. My hospital LURVES radiation so almost everyone with abdominal pain gets CT scans with PO and IV contrast and I wasn't quite sure of the difference between the contrasts.

Also, if you friend can keep any liquids down, sports drinks like Gatorade or Powerade have a lot of electrolytes that are lost through vomiting/diarrhea. I can totally sympathize with the suckiness of vomiting/diarrhea/pain. I'm currently stuck at home with a nasty case of gastroenteritis; it seems to be going around right now.

[Sapphire Silk]

That's good to know. My hospital LURVES radiation so almost everyone with abdominal pain gets CT scans with PO and IV contrast and I wasn't quite sure of the difference between the contrasts.

CT scans are greatly over used. If the doc really thinks its the gall bladder or kidneys, an ultrasound will usually get a diagnosis, with no radiation involved.