LymeNet Flash: What would you say to an ER doc?

This is topic What would you say to an ER doc? in forum Medical Questions at LymeNet Flash.

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Posted by Aniek (Member # 5374) on :

I'm stealing Timaca's idea (hope it's ok)

A friend is coming in to town, and he just starting his residency in the ER. I figure if Timaca can pass on some Lyme advice to her friends who are docs, so can I.

I know many of us have had horrendous experiences in the ER. There are probably way too many stories to pass on. But what are the real basic common things you wish all ER docs know when it came to Lyme?

Personally, I was brought to the ER when I was 12 with a bug bite, a circular red rash, chills and a headache and sent home with some benadryl. I'll make sure he never does that to somebody.

Posted by Foggy (Member # 1584) on :

Did you take Bedside Manner 101 in med school?

Posted by timaca (Member # 6911) on :

Of course it is fine if you apply my topic to a different doctor Aniek!

I asked my father in law this very question last week, for he was an ER doc for 30+ years. I asked him..."do you think the ER docs would have figured out that I was having a herx reaction when I was in so much pain a year ago?"

He said "that is unlikely". Most ER docs are trying to save (1) a life or (2) a limb. If it looks like you're not going to die, or not going to lose a limb, then they will make sure you're stabilized and wait until the specialty docs (neuros, etc) are available to exam you.

In my case, with all the pain I was in with my herx reaction (and not knowing at the time what it was)...it would have taken a very special doc to have figured it out.

The docs probably would have made sure my vitals were stabilized...maybe admitted me for observation, but that would be about it.

My father in law did say that our local ER had one good doc that could spot the "zebra among the horses"....He MIGHT have figured it out, had he been on duty. But, there is so much going on in the ER, that their main business is usually saving the life or the limb.

If someone presents with an obvious rash, take in photos and articles, and ask to be started on antibiotics...at least enough until the PCP can come on the scene to follow up.

Tina

Posted by DR. Wiseass (Member # 6777) on :

Tell your doc friend:

1) If a patient comes in & says:

"I have Lyme disease & I can NOT have STEROIDS".......

THEN DON'T SEND A PATIENT HOME WITH AN RX FOR A STEROID (ESPECIALLY without telling them it's a @#$% steroid!!!!)

2) LISTEN & don't be condescending - as the patient may actually have a general idea as to what might be wrong...

3) NEVER ASSUME the patient is just having an anxiety attack if SHE happens to break into tears (because she is completely frustrated with the medical system & her symptoms!)

I could make up some doctor 'rules' all night long....but I'll not waste my time & just leave you with my top 3.

Thanks for the opportunity!

------------------
DR. Wiseass - not a real doc - just a real wise ass.
www.twistoflyme.blogspot.com

Posted by Lymetoo (Member # 743) on :

quote:
Originally posted by imanurse:

My advice to physicians is, "Listen to the patient long enough and they will tell you the diagnosis."

DITTO!!!

and ditto to this too!

"Any time a patient is describing fatigue, neuro related symptoms, pain, or using the word "weird or bizarre", THINK Lyme!! In my experience, nurses and doctors are not doing thorough enough neuro examinations and are missing a lot."

------------------
oops!
Lymetutu

Posted by Aniek (Member # 5374) on :

Thanks guys! This is an absolutely wonderful person, and one of the smartest people I know. If there's somebody who can find the zebra, it's him.

Posted by Caryn (Member # 366) on :

well, dr verysmartbutt,-your posts are funny!- they actually will dx you steriords for "bursitis"...

nurses thought my halucin...opening my eyes and seeing a hosrses hove (sp?) - and yes it is sort of downright funny.

but i told him steroids were deathly to lyme patients. and still, what my reccommendation for treatment was. this isn't funny. mercer county. and i was not keeping liquids down, let alone foods, and this was not a problem for them

Posted by trevor (Member # 4353) on :

Make sure that if a Lyme patient is herxing and if they look like they're presenting with sepsis, and even if blood cultures for sepsis, which are very often contaminated and inaccurate, no IV antibiotics. This will make the herx much worse and can easily cause long, long lasting damage.
Also of course I agree with everyone else about the no steroids. Also, if a patient is herxing, no morphine, fentanyl, demerol, etc., unless absolutely necessary, the constipating effect will recycle the toxins when really what's more appropriate is an enema or colonic irrigation, but good luck finding these at the ER.
-Trev

Posted by trevor (Member # 4353) on :

Plus, Tagamet (cimetidine), IV can be used instead of steroids for anaphalaxis.

Posted by dulcamara (Member # 5691) on :

quote:
Originally posted by timaca:
My father in law did say that our local ER had one good doc that could spot the "zebra among the horses"

This makes me realize what I want say to ER docs, and all other docs and medical personnel: Lyme disease is not a zebra! It's a horse! And not just in the northeastern US, either.

Posted by dulcamara (Member # 5691) on :

oops. Double post. sorry.

[This message has been edited by dulcamara (edited 20 April 2005).]

Posted by timaca (Member # 6911) on :

I agree.... it's not just in the northeastern US....I live in Arizona!!

Posted by Aniek (Member # 5374) on :

Want to know why you get such bad treatment as a Lymie in the ER? It's because they don't teach ER doctors anything about Lyme, beyond what to do if somebody comes in with an obvious tick bite.

There is now at least 1 ER doctor who knows that

(1) if a person comes in with a red circular rash then that person very likely has Lyme and needs antibiotics immediately, and

(2) if a patient says they have Lyme under no circumstances should that patient be given steroids.

I'll keep adding to his knowledge base each time I see him

Posted by AZURE WISH (Member # 804) on :

If a lyme patient says they have been on long term antibotics.... Do not tell them well if you have had more than6 weeks of antibotics and are not cured then you don't have lyme anymore....You are not going to get better.... You have fibromyalgia now...

Grrr.... WHat's really scary is that some people might believe these drs. who say this..... If I would have believed them I will be disabled for the rest of my life.....

Instead ... I'm disabled right now but I know one day I will get my life back.

That's great if a er dr is willing to listen to try not to make mistakes regarding lyme disease.

Best wishes