Things are starting to settle down, no one in the waiting room, several admitted patients in the ED all waiting for beds and admission orders, and the usual suspects in the Psych corner, either sleeping off their alcohol/drug binge, or waiting to be evaluated by the psych staff.

Suddenly two patients show up in the waiting room. Wanting to be helpful, I go out to do the triage thing. Even though I'm still a newbie and technically not yet qualified to run triage and decide who gets to be seen first, it really can't hurt in this case because I plan to bring them both back anyway. We have more than enough empty beds.

I look at the chief complaint as entered by the registrar so that I can decide who to call into triage first. One says "Private" and the other says "High Blood Pressure". I take a peek out and the "private" patient is a young lady in no apparent distress, and I suspect she probably has a GYN problem which is what "private" problems tend to be. The high blood pressure patient is a 56 year old woman, so I bring her into the triage room.

Here is how the interview went:

Me: So what's brought you into the ED today?
Her: High blood pressure
Me: How high?
Her: 158/105
Me: OK, what symptoms are you having? Any headache, changes in vision, chest pain?
Her: No
Me: Do you have a history of high blood pressure?
Her: Yes, since 5 years ago
Me: So what happened this morning that you decided to come to the ED?
Her: Well, I woke up at 3:30am to go to the bathroom and just decided to check my pressure and it was 158/105. My cardiologist told me if the bottom number was above 100 I should go to the emergency room, so I came.
Me: Did you take your blood pressure medications last night?
Her: No
Me: When are you due to take them again?
Her: I take them at 5am in the morning.
NOTE: BP at triage 145/89

I took her back to a room, the doc saw her and told to me recheck her pressure in 30 minutes, it was 144/87, the doc discharged with printed instructions to not miss her BP meds. And to follow up with her primary physician ASAP.

Is it just me or could this have gone a whole lot differently, e.g. maybe recheck BP at home in the bathroom, take morning BP meds, and then recheck BP. Come to ED if BP is not dropping after morning meds or is symptoms present.

Just a thought.

As for the "private problem" patient, she wanted a pregnancy test. At 4am in the morning.
Just because.
Really.