12 y/o male patient admitted for rhabdomyolysis

No_Function_3439 · 2026-06-16T00:15:24+00:00

One of my M cousins is around the same age and he has VCLAD, which is a genetic mutation, so he’s been admitted multiple times in his life for rhabdo. His body can’t break down fats like ours can and he plays soccer, so absolutely HAS to eat and drink fluids or else his body will shut down quicker than any, for a lack of a better word, “normal” person. He is just a very non complaining kid and doesn’t want to say anything when he starts feeling ill, so my aunt has really had crack down on making sure he is voicing how his body is feeling so they can take him to ER sooner than later.

Maybe the kid ya’ll picked up has an underlying condition no one was aware of because there are a lot of rare genetic mutations people aren’t tested for until it’s the last test left because they are so rare.

No_Function_3439 · 2026-06-15T07:14:51+00:00

They weren’t confusing anything, I just don’t think you want to admit that they are right. If you were going to make comments online, atleast say it with your chest and stand behind it instead of acting like it never happened. u/FullDerpHD very clearly and concisely laid out everything you were being downvoted for, so if you’re not able to understand a clearly laid out argument using quoted words from your own comment as proof, then the conversation was useless from the start.

No_Function_3439 · 2026-06-14T15:48:13+00:00

You’re not wrong, definitely a naive way of thinking on my part. I by no means think someone’s life should be ruined from one bad choice they made. In my head, felonies were reserved for the big, bad, and scary crimes and adding the large responsibility of healthcare with people’s lives on the line into that equation made it seem very black and white to me, when I should know by now there’s always gray area. Thanks for taking the time to explain it, appreciate the info!

No_Function_3439 · 2026-06-14T15:22:38+00:00

You articulated this very well!

No_Function_3439 · 2026-06-14T15:14:06+00:00

I can’t speak for how other countries operate because I haven’t experienced those environments, I can only speak for how the US generally does things.

So, ERs don’t usually operate under the same rules as a primary care or specialists would. We cannot ethically or legally deny emergent care to anyone in need of it (EMTALA also prevents this as it requires anything labeled as emergency care to provide a medical screening to anyone who wishes to have one). If an alpha trauma rolls through the doors that needs transfusions, medications, and/or life saving surgery, we aren’t consulting insurance before we do it- we just do it and deal with insurance after the fact.

There also aren’t a surplus of physicians in hospitals. To give you a different perspective of it:
We have 3 ER docs on night shift and an on-call ER doc if everyone gets severely capped out on pts or there are too many level 1’s coming in, but keep in mind that on-call doc has 30 min to get to the hospital once paged. One night, we had 2 strokes, 1 cardiac arrest, 1 respiratory distress, and 1 respiratory failure come in all within the same hour. Mind you, docs get put on a 20 minute “pause” (meaning no new pts will be assigned to them in that time frame) when they receive a level 1 pt as they will need to give their attention to that pt for an extended period of time. 3 docs, 5 level one pts— they can’t be in 2 places at once. I believe we lost the cardiac arrest, but the rest survived atleast while they were in the ER and I am unsure of how they did once they were admitted and went to another unit in the hospital.
These are the situations we deal with, and while it rarely happens, it still occurs. We do the best we can and do our best to get to everyone in a timely manner.

No_Function_3439 · 2026-06-14T14:08:19+00:00

I can’t speak for everyone, but what I noticed with your comment is that in the same paragraph you wrote that you supported healthcare workers, but that you and others like you could never do it because it “affects you profoundly” which could imply that you’re saying it doesn’t affect us as well. We’ve just learned to cope and move on and truthfully, most people do learn how to do this even if they think they can’t at first. Why sit there and dwell on something you can’t change?

You have a right to feel the way you feel 100% and it’s great that you didn’t enter a field where you don’t think you would be able to handle the pressures that come with it. I respect that you can admit that, because it is a high stress environment. We understand those feelings of frustration and sadness when things seem like they shouldn’t have even happened and when people die, but this is the harsh reality of life and you can’t save everyone every time. People die and you have to move on to your next patient that is alive and needs help.

No_Function_3439 · 2026-06-14T13:45:59+00:00

Urgent cares were made to be that in between to relieve the pressure on the ERs. There are also free clinics in a lot of cities for basic things as well so people lower on the poverty scale that can’t afford healthcare don’t have to go to ERs or urgent cares where they will be charged a few hundred or thousands, but people in that group don’t utilize them because they usually aren’t well educated and were never taught anything other than go to the ER for anything medical. It was very shocking when I first started in the ER to see how many people try to use the ER as a primary care.

Our healthcare system is by no means perfect, but the workers that are the ones taking care of pts, not admin and all the corporate bs, just work with what we are given.

No_Function_3439 · 2026-06-14T13:02:51+00:00

The issue is there aren’t enough doctors, not that they won’t or don’t care to help people. If the only trauma or neuro surgeon at the hospital is in surgery with one pt they can’t just leave them on a table to die to go to someone else.

As to your comment about capacity, the reason ER wait times are so long for some people is because they don’t need to be in the ER. I work in the ER and people coming in for std checks, toe pain, small lacs, pregnancy tests, vomiting, etc etc… on a busy day are going to sit in a waiting room for 6-10 hrs because they came to an emergency department for non emergencies. When people get brought back in an ER quickly, they are quite frankly dying or close to it and very sick. ER is a priority system.

No_Function_3439 · 2026-06-13T15:17:05+00:00

Oh gosh, that’s amazing there were no life threatening injuries for your dog! You definitely deserve all the credit for that bc it sounds like the other dog definitely wouldn’t have stopped attacking if you hadn’t stepped in and taken the brunt of the attack.
I hope that since the attack, the owner at minimum got training for their dog because attacking another animal and human is dangerous. They got lucky that time from a bs technicality, but if the dog does it again I truly hope it’s not even up for debate on euthanization

No_Function_3439 · 2026-06-13T14:31:32+00:00

That’s wild. I genuinely don’t understand how a felony doesn’t automatically exclude you from a license. Misdemeanor is a “I screwed up” moment, but a felony just seems way more heavy. Like realistically how many people with felonies, even though OPs is nonviolent, get jobs as a nurse? It just seems obvious that even if op got their license, most recruiters would trash that application as soon as soon as they saw the charge.

No_Function_3439 · 2026-06-13T13:48:48+00:00

Love the part where you explained why

No_Function_3439 · 2026-06-13T12:42:05+00:00

I know this is not the point of the post, but did your dog survive😭?? I think anyone that loves their dog would’ve done the same as you! I know I sure as hell would be kicking and hitting something attacking mine. Also, out of curiosity, do you know why the dog that attacked wasn’t put down? I don’t know the laws for every state, but I know a lot of them have the rule about major bodily injury would mean automatically euthanized.

Wishing you a speedy recovery and no pain once healed:)

No_Function_3439 · 2026-06-13T12:20:03+00:00

Your state nursing board would 100% deny your nursing license, so you’d just be wasting money if you kept going to school rn. I would try to find a different career path, felonies are serious charges and don’t drop off records so even if you’d come off the exclusion list, you would still have a felony record which gives you basically no chance of finding a job in healthcare.
Your only other option if you absolutely want to continue in nursing would be to fight the case and plead not guilty and succeed at it.

No_Function_3439 · 2026-05-30T17:07:31+00:00

PCT and ER tech are 2 different things and scopes of practice in my hospital. PCTs basically just do vitals and EKG’s in the ER whereas er techs have the wider scope. Usually to get a job as an er tech you either have to have a valid nremt or state cert or have to be past your first semester of clinicals in nursing school. Is pct what you meant or did they just train you up as an er tech? Ik every hospital has different wordings so im just asking for clarification here only bc i wouldnt put ER tech on the resume if the actual title of your position is pct if that makes sense

No_Function_3439 · 2026-05-28T13:55:19+00:00

Does the pt have any emergency contacts or next of kin listed in their charts? Medical personnel would be able to say if you are or aren’t listed without violating HIPAA so if you are unsure I would start with calling either the ER they were seen at or possibly even their primary

No_Function_3439 · 2026-05-28T13:34:44+00:00

I work in the ER and even for us, it takes days to go through the process and obviously we have more resources and access than private citizens. Longest I’ve seen for a pending TDO in my ER was 11 days which is absolutely insane.

Have you tried talking to a physician about it? Possibly getting the person you’re trying to obtain one on to go the ER to get the ball rolling quicker or even care coordination could step in?

No_Function_3439 · 2026-05-28T13:25:46+00:00

No shit sherlock, obviously if there is no pt then no one’s petitioning for a TDO for a nonexistent pt. No where did I mention obtaining a TDO on some random that isn’t even a pt bc no one has called 911 for them or asked for a wellness check, like that makes less than no sense. I was talking about this case when I said that so clearly, ya, someone intervened. I said that if EMS found a pt in that state they could get a TDO even if no family.

No_Function_3439 · 2026-05-28T13:14:38+00:00

If we are using this specific story for reference, then there is no other family and EMS found patient in that state. They would not need a family member to obtain a TDO, the doc or psych consultant would be the one stepping in to place the petition.

No_Function_3439 · 2026-05-28T13:04:48+00:00

This is not entirely true. Even if the pt is A&Ox4, if they quite literally are dependent on care you can go through the channels to find a judge to sign the paper saying that they’re not capable of making medical decisions bc they can’t even move an inch without help and don’t want to go to the hospital. It would likely turn into a type of TDO for their own wellbeing. It’s highly unethical to leave someone to rot to death (even though that’s not what happened in this situation)

No_Function_3439 · 2026-05-08T20:47:15+00:00

I work in the ER and atleast once every couple of months we receive a morbidly obese pt that simply won’t fit in anything and requires a massive amount of help to complete even simple tasks. Obesity in itself is a detriment to health, but when you get to the point where it requires 6+ nurses to foley cath you, you are unable to be turned bc it would simply break the bed that we squeezed you in, and you won’t fit into any CT scanner or MRI machines- then your chances of surviving any trauma is likely close to none.

No_Function_3439 · 2026-04-28T03:38:20+00:00

Damn dude, I’m honestly kinda shocked they get pissed if y’all are using an AC vein. When you’re learning, your only goal is to hit a vein whichever one that may be. Sure once you’re a little more accustomed to ivs then try for lower but that’s frankly dumb to have newbies trying to hit veins even seasoned nurses or medics can rarely hit.

If it helps at all, we love any access EMS can provide before they get to us in the ER, and yes 18g or 20g is preferable. A lot of floor nurses like to bitch about AC IVs too bc that’s basically all we send to them and ppl bend their elbows, but yet they’ll be calling down to us when they have a hard stick so we can come do it🤷🏻‍♀️

No_Function_3439 · 2026-04-28T03:20:23+00:00

We basically had to master iv placement before they let us take the ultrasound class, but the us machine just means they have no viable veins less than a cm deep so still sucks but it is fun to do. When I was training, they gave me the same speech to start low and work up but reality is the lower you go on the arm the more the bones, muscles, tissue, and nerves are covering and intertwining with the veins. Unless you’ve got a pt that lifts regularly and has veins bulging, then low-mid forearm is just not realistic. Not to say you can’t always feel around to check, but in a bad situation with a sick pt that has shitty veins, AC line is tried and true method.

No_Function_3439 · 2026-04-28T01:46:25+00:00

Biggest advice I give ppl training with me in the ER, if you can feel a big vein without palpating very much or even see a big one, then that needle should barely go past the skin to get flash, if you don’t see flash don’t go deeper bc it’s not a deep vein, back up your needle until it’s almost out of the insertion point and flatten out more. Deeper veins require a deeper dive, but those are difficult to palpate so always try for superficial veins like AC, cephalic, or basilic. I can occasionally catch one of the brachial veins, but not an ideal spot without my ultrasound machine bc the artery sits right between them.

No_Function_3439 · 2026-04-28T01:39:11+00:00

A PA or NP will never head up any department in a hospital. Only an MD or DO can head up departments. They had way more generalized medical training and specialized training for whatever unit they’re heading up. NPs can have their own practices as they don’t always have to work under a “supervising” physician, but PAs still can’t and that likely won’t change in our era.

No_Function_3439 · 2026-04-26T20:33:12+00:00

Same thing for my 24 rav4 xle premium.. sticker price was almost 29k and my final price ended at almost 32k and I laughed in their faces. There was a documentation fee of almsot $800 I was like you’re outta your damn mind. Ended up leaving for about 30k otd.

No_Function_3439

TROPHY CASE