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About this head injury?

(39 Posts)
FrancisCrawford Sat 03-Sep-16 09:38:37

Spent last night in A & E with my friend and her 16 year old son, who had come off his bike.

He had head and shoulder injuries.

We told reception that he had been unconscious for two or three minutes and that he had no memory of the ten or so minutes before the accident.

He was pale, shaky and bleeding where his face had scraped along the ground.

It was 90 minutes before he was triaged. Luckily, he got away with "only" a broken collarbone and concussion. He is very sore and bruised all over.

But surely with a head injury he should have been triaged sooner than that? If he did have a brain bleed then they would have wasted so much time. He's a big lad, plays rugby and is very fit and didnt want to cry in front of his mum and her friend. But he is still very young and was in a lot of pain and very worried.

Or are we being ridiculous?

HandmaidsTail Sat 03-Sep-16 09:45:54

Well I suppose my assumption is that the staff were busy with urgent/critical cases, not having a cuppa.

I could be wrong obviously! But with things in the NHS being as they are that might be as good as the care gets now in some overstretched areas.

JudyCoolibar Sat 03-Sep-16 09:50:23

Triage staff presumably wouldn't have been dealing with urgent and critical cases. Yes, I would certainly expect a patient in your friend's son's situation to be prioritised.

Silvercatowner Sat 03-Sep-16 09:52:14

in a lot of pain and very worried.

The staff will have been dealing with patients with potentially more urgent injuries/conditions than your friend's son. There simply are not the resources to prioritise what are defined as 'minor' injuries. IME triage at A&E is good at identifying what is major and what isn't - although it wasn't obvious, staff would have been keeping an eye on him.

FrancisCrawford Sat 03-Sep-16 09:56:20

It was 90 minutes before he was triaged/seen by anybody.

Nobody saw him at all. They definitely were not keeping an eye on him because he hadn't been assessed or seen by anybody. We were sitting at the far end of the waiting room and there were no medical staff around.

I thought a head injury from a fall, with a period of unconsciousness and memory loss would be treated as serious until proved otherwise? Obviously I got that one wrong.

Sirzy Sat 03-Sep-16 09:59:50

Presumably by that point he was fully conscious and showing no obvious signs for concern? Presumably if he had been one of the adults with him could have gone to report things getting worse and ask for him to be seen?

It's not ideal, but sometimes these things can't be avoided. Especially in a busy a and e on a Friday night.

biscuitz72 Sat 03-Sep-16 10:00:46

A possible head injury surely shouldn't be classed as minor; especially where the patient in question has lost consciousness.

I know from personal experience that what appears to be nothing can suddenly turn into something major (coma, etc).

People with head injuries can appear okay, but as the internal situation worsens they can suddenly deteriorate; and in head injuries they talk about the golden hour, where the 1st hour can really determine a patient's outcome.

biscuitz72 Sat 03-Sep-16 10:04:06

I'm sure you've already been told by the A&E staff, but I would keep an eye on him for the next 48hrs (from the time of injury) and make sure he avoids alcohol too.

BittyWanter Sat 03-Sep-16 10:09:15

Did you sit and wait for 90 mins without asking any staff/receptionist when he would be seen? I can't understand why you would question that the day after when it's no longer an emergency.

I would assume that there were more life threatening situations going on 'behind the scenes'.

I've always found a and e completely remarkable and think the staff do an amazing job. I doubt they neglected your friends son in any way

FrancisCrawford Sat 03-Sep-16 10:10:17

We got to A&E at 5pm.

He was pale, bleeding, cold and shaking.

We asked after 50 minutes and again after 80 minutes and each time we mentioned the head injury.

He is very lucky not have a serious injury, and his mum kept an eye on him all night. He's up this morning, but not feeling great and is sore all over.

It could have been so very much worse.

FrancisCrawford Sat 03-Sep-16 10:12:59

I am asking today because I didn't get home until after 10pm and was quite tired.

And I genuinely am not sure if a head injury like that should have been assessed more quickly. I thought it should have been, but I am not a doctor. I thought you assumed the worst until you could rule it out?

Happy to accept I was wrong.

TooStressyForMyOwnGood Sat 03-Sep-16 10:15:05

By nobody seeing him, did you see people behind the desk? Surely he was checked in? At my local A and E there are experienced nurses behind the desk. So if a patient is booking in with the receptionist they are also being eyeballed by an extremely experienced nurse who is ready to whisk them in to be seem straight away if necessary. They are looking at each and every patient when they come in even if they do not see them each individually or take them into the cubicle. They get complaints as patients think they are doing nothing but in reality it is the first part of triage. Perhaps that wasn't the case for you, apologies if so, but it would never happen here. Patients often think they haven't been seen but they have.

lljkk Sat 03-Sep-16 10:17:24

Partly depends who else was being treated & for what. In theory, may have been much more urgent cases being dealt with.

Plus the hospital has a 4 hour target: they have a very strong incentive to take much more minor issues/illness people sooner, if the minor-issue people have been waiting almost 4 hours, and your friend's son seemed to be coping ok in meantime.

I hate the 4 hour target. It's a very perverse incentive. Glad your friend's son was ok after all.

Whatthefreakinwhatnow Sat 03-Sep-16 10:17:25

I had a blow to the head earlier this year, went to A&E and was sent straight to majors, so think 90 mins to even be triaged was awful!

JudyCoolibar Sat 03-Sep-16 10:20:39

You weren't wrong, for the reasons given by biscuitz.

I went to A&E recently for something I thought was relatively minor - I wouldn't have bothered them, but I had been to the minor injuries unit first and they sent me on to A&E. They had an arrangement where there was a triage nurse sitting next to the A&E receptionist who did an immediate basic history and check and ultimately seemed to do a swop with someone else and call people in for further checks. I noticed that she called in before me some people who had arrived after me, including babies, and that was absolutely fine: my issue wasn't urgent and I accepted she had to prioritise. And I really would have expected her to prioritise someone with the history your friend's son had.

Silvercatowner Sat 03-Sep-16 10:21:22

A&E staff are brilliant. It is vanishingly unlikely that no-one would have been keeping an occasional eye on him. Our NHS is stretched to hell - tough decisions HAVE to be made.

JudyCoolibar Sat 03-Sep-16 10:23:10

The most experienced nurse in the world is not going to be able to tell whether someone has bleeding in the brain by eyeballing them through the glass. As an absolute minimum you'd need a blood pressure and pulse check.

JudyCoolibar Sat 03-Sep-16 10:24:47

A&E staff are brilliant. It is vanishingly unlikely that no-one would have been keeping an occasional eye on him.

Yes, mostly they are brilliant. But statistics show that they definitely are not infallible, and that "vanishingly unlikely" is a massive exaggeration.

MrsRyanGosling15 Sat 03-Sep-16 10:27:42

As someone who has worked in a &e as a nurse, he absolutely should have been seen and triageD as soon as he came in. Head injury, loss of consciousness etc are red flags. There is a specific box on the flimsy for head injuries and protocols on the treatment and response times to these. We have absolutely had patient deteriorate, even arrest with signs such as the ones you describe. We also need to know if anyone with a head injury is on any medication that may increase theit chances of bleeding. That most certainly needs to be known before 90min. My best guess would be that it wasn't coded correctly but the receptionist who may just have put laceration.

lljkk Sat 03-Sep-16 10:30:13

I went to minor injuries unit & told them I had a broken arm.
I already took strong painkillers. I broke arms before, so I knew.
Quiet skepticism radiated off them but I didn't care.
It's a quiet MIU so I got X-rayed quickly.
"Oh, look at that! You really have totally broken it, both bones across too."

I don't blame them... they get burley blokes moaning about an impossibly painful break when they only have a mild sprain. I can't help but wonder if the nurses at OP's A&E assessed "That's a Walking coherently Talking patient, if he really was unconscious, it was no more than 3 minutes" and prioritised accordingly.

AnxiousCarer Sat 03-Sep-16 10:30:54

From my understanding the only true way to tell if he had bleeding on his brain would be a head scan, which wouldn't have been indicated if he was fully concious when he arrived, even with a short period of unconciousness. If he had deteriorated whilst waiting then it would have become more urgent. I waited a similar time for a head injury when I fell off my bike, similar sounding presentstion, then had xray to rilr out fracture. My DH was seen more quickly and had a head scan because he was very confused when we arived following a fall and head injury, even though he was drunk as they needed to identify the cause of the confusion . Even the receptionist has a minor triage role based on set questions.

funnysmells Sat 03-Sep-16 10:31:40

When my husband experienced a head injury similar to this, he was triaged immediately and actually taken into proper treatment immediately too - when generally you'd wait 4 or 5 hours. I think head injuries etc. talk you to the top of the pile.

Glad your friend's son is okay, however, please ask her to do to Headsmart's website and properly read all the information on there, as my husband was given the all clear and almost a year later started to experience symptoms of brain injury, which no one told us could happen.

MrsRyanGosling15 Sat 03-Sep-16 10:32:18

Lljkk medical staff at a&e most certainly do not take the minor patients 1st just to meet the 4hr target. I have never heard anything so ridiculous. The doctors and nurses in a&e treat their patients as their health dictates. It's usually just the bed managers running around freaking out about the 4hr targets. Are you seriously suggesting staff purposely put patients lives at risk just to take the easy patients? You have proof of this?

FutureMrsTempah Sat 03-Sep-16 10:37:03

I once had to wait about 3 hours with temp of over 40deg, coughing up blood and generally feeling quite shocking. I had been directed to A&E by NHS Direct (wish they'd bring that service back). Turned out the dragon on a receptionist had written "sore throat" on my notes! She was horrendous, wouldn't let my partner answer any questions eg. My name, age etc.
Needless to say as soon as triage nurses heard what was actually wrong and took my temp things picked up pace considerably, and I was on a ward win minutes having had bloods and chest X-rays done and then moved to a private room within hours

FlumptyDumpty Sat 03-Sep-16 10:37:37

Agree he should have been seen much quicker. A head injury like that can become very serious, very quickly, all while the patient is conscious, chatting and seemingly ok. Remember Natasha Richardson?

A&E cocked up. It may be they were just too inundated by even more urgent cases at the time, and knew they were running a massive gamble with his life, but that means they should have been way better staffed than they were. Many A&Es are massively underfunded at the moment, though.

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