On the night shift in the ER, there are two types of patients: predators and prey. (There are many more types but this combo is a common theme.)

For example, last night I had a female who was the victim of domestic violence. Her husband had choked, punched, and kicked her. She ended up with a fracture of her cheekbone, a ruptured eardrum, and lacerations on her fingers from bite marks. She is prey. She doesn’t leave the ER in the middle of the night unless she is safe. This includes offers for domestic assault nurse evaluation, making a police report, and social work if available to arrange a safe disposition (DV/womens shelter, etc). She has the option to pick and choose what resources are offered, but we do our best to make sure she is offered those things more than once, by myself and nursing. I can’t actually make her choose/do anything.

Looking at vaginas in the ER is not something that appeals to me, especially when they are 73 years old. I had a woman last night who had some sort of drainage and bleeding from her perineal area. She could not tell exactly where it was coming from. An external exam showed what appeared to be vaginal bleeding. The only problem was that she was decades past her last period, and postmenopausal bleeding is often related to some sort of gynecologic cancer.

I see kids in the ER with fevers virtually every shift. Often, parents have done nothing to try to improve the fever. They seem to have a fear that somehow the fever will kill their child. They don’t understand that the fever is helping fight the infection.

Additionally, something that is not intuitive is that the body would not try to harm itself. So, most fevers will cap out < 105°F. That’s about the max temperature that the body will push for to try to fight the infection because temperatures higher than that can cause tissue damage, specifically denaturing of proteins. But somehow, with all the internet searching that’s done, it does not seem like parents find that information.