Sunday, September 13, 2009

BLOCKED!!!!

My hospital has blocked me from accessing blogspot at work!
I can understand facebook but blocking my ability to vent about how ridiculous the new policies and administrations decisions are in just going too far! I am sure this is a violation of some right I have. I'm sure I have a legitimate grievance here I can file with the union.... hmmm now if only I could remember which union I work for....

Saturday, September 12, 2009

I'M BACK!!!!

After almost 6 months of turmoil in our ER and 75+ hour work weeks , I am finally back to writing!


In the last 6 months my ER has gone thru major changes both physically and personnel wise that has not always been for the benefit of the employees or the patients, but great for the hospital's bottom line. A few of those changes including firing the ER MD group and hiring a mega group from out of state, expanding our ER physically without hiring more staff and cracking down on the PC of the ER staff and environment. Our morale in the ER could not get any worse...


After 20+ years of service our ER group was fired and replaced by a corporation from out of state that is determined to make us over into a carbon copy of their other take overs. Our patients are losing continuity of care from MDs that has taken care of the community for 20+ years and they are losing the relationship our ER Drs have had with community and hospital based specialists.


Our ER has expanded physically by opening up an overflow area 24 hours a day but not having the appropriate amount of staff hired to do it.. on average the nurse in that pod works alone with 5+ patients without a tech or secretary and not properly stocked or set up to run as a full time unit. Our Express Care area (walk in clinic) has expanded it's hours--but oh yeah not hired the nurses to operate it....... Brilliant.


And the last major change amongst a million other small changes is the cracking down on inappropriate behavior AKA "NOT PC" comments, attitudes AND attire of the staff. Yes yours truly has been recently compared to (along with her other com padres) TRUCKERS! ( I wonder if I should tell my boss I take that as a compliment as I have always secretly wanted to drive one of those big rigs?!) Apparently it is not appropriate to swear or make judgemental comments in our nurse's station that is a 90% glass soundproof enclosure.. Seriously?


Sorry administration but I am a cranky bitchy nurse that isn't going to change who I am because your white shirt high polished shoe wearing candied asses are offended by what I have to say. If you don't like it, stay in your comfy offices pushing pencils and keep out of my ER where we aren't afraid to get a little dirty and real with our patients.

Tuesday, February 10, 2009

Front Row

We all know that the economy has gone to sh**, sadly those of us in healthcare have gotten a front row seat in the impact this has had on our communities.

In the last couple months our SI\SA (suicide ideation,suicide attempts) have drastically increased. Before we would get people "attempting" suicide more for attention getting behavior than from depression. Now on average I deal with 2-3 true attempts a shift. These are patients that by shear luck someone has found them and called 911.

The despair these patients and their families find themselves in I cant even imagine. The sad story is that time and time again there are children involved, so not only have they been helplessly watching their parents struggling to make ends meet but now have to deal with fact that their parent choose the easier answer of death than the harder fight of staying with them and protecting them albeit with a less flashy lifestyle.

While I fight to keep these families together, I cross the hall and walk into another patient's room and advocate for the destruction of another.. The DV (domestic violence) rates are shooting up. Patients ,in particular women are showing up in droves with injuries that only a closed fist or boot could make. They come in with their bogus stories and babies that look at me with timid faces telling me about their Mommy's "ouchie". My heart breaks for these children stuck in almost a lose lose situation.. Stay in the current situation and watch the abuse and become a victim of it as well, or have mommy leave and end up on the street or living in the car because so many shelters are full right now.

I wish I had a solution... I pray the President does as I see only things getting worse as my community looks down the barrel at the upcoming layoff planned for the end of this month at our local major employer.

Sunday, January 11, 2009

Influenza update

Back in October I was wondering aloud about how effective this years Influenza Vaccination was going to be and B*tching about the CDC pushing for all healthcare workers and children under 18 to be vaccinated. I held the opinion that until they perfected the makeup of the vaccine and not making it an educational guess I would not get the vaccine for me or my children.

Well according to their website today 146 million vaccines were made.. of those they have projected 85.8 million adults and children have been vaccinated. As of today the CDC reports that 52,199 influenza tests have been given to patients with 1,173 testing positive and resulting in one death a pediatric. The CDC also admits that this years vaccine does not cover the Influenza B strain out there meaning that the vaccine is only 50% effective...

With this information I am still OK with my decision, but look forward to science perfecting this vaccine as I know the benefit of it for those at high risk..

MIss me?

YEAH I am back... After being sentenced to practically the last 2 months non-stop in the ER I finally have been paroled.

As those in the medical field the holidays are a bad time for us..we are swamped. For some reason people forget about taking their meds or not consistent with them..people start hitting the bottle pretty hard or over doing it with the high fat and salty foods, decide that maybe they don't need their psych meds, and my favorite deciding family get togethers is the place for knock out drag out melees... all of this leads to increased sick patients in the ER and admissions. We have had our hospital at capacity since Thanksgiving resulting in us boarding ICU patients for days on end needing 1:1 nurse care, causing an ER staffing shortage.

Now don't get me wrong we ER nurses are very good, thorough, highly technical, advanced trained nurses...but we are NOT ICU nurses. Both types of nurses will agree with that. This is not a bad thing... just a difference. So when ER nurses are asked to work as ICU nurses it throws us for a loop causing us to change gears and thinking patterns causing our shifts to drag on for what seems like days..

So my 2 month sentence has felt like years... I am glad to see daylight again and be back here as I have missed you all and my place to vent...

Thursday, November 27, 2008

Monday, November 24, 2008

No,Nope,Nada, Not going to happen

Dear ER Patients,

I know that for many of you our ER feels like home as you spend more time here than in your own home I am sure -but there are still rules you must follow. So here is a quick list of absolute "NOs" while you are here in case you have forgotten them in the last 2 days since your last visit.

1. No you may NOT eat Cheetos and drink Pepsi when you are here for Abdominal pain and waiting for your CT scan.. remember you are also nauseated!

2. No you CANNOT bring every person you ever met in your life back to your room. One visitor only, I might allow 2 if I think that paper cut you have warrants a trauma activation!

3. No you may NOT go outside to smoke... if you are well enough to participate in that disgusting habit then I am going to discharge you... and parents please don't make the mistake of asking me to either watch your child who is the pt so you can go smoke or ask if both you and your teen can go smoke... My lecture on your parenting skills will not be sugarcoated, will take time from my very busy caseload, and time away from your smoking as you call my boss with complaints to which she will repeat the NO SMOKING policy.

4. NO I will not watch your child who is my patient while you run an errand, go get something to eat or try and track down your BF who was last seen flirting with the cute chic in the waiting area. You brought your child here because you thought they were sick enough to warrant a 2am ER visit so place your butt on the gurney next to your baby and don't move.

5. I am an ER nurse. I am NOT your secretary..I will NOT take messages for you when someone calls the ER looking for you. I only answer phone calls from other health care workers dealing with my patients. So tell your buddies to save their quarters and use your cellphone. You can check your messages when you are discharged!

6. NO I will not arrange your transportation home. You got yourself here without my help so I am sure you can figure it out in reverse on your own.

7. NO I will not go looking for your missing friend, relative, spouse, SO, partner or whatever you choose to call them this visit... If they wandered off out of boredom and now can't find your room it isn't my problem you should have chosen a smarter more sympathetic person.

8. NO I will not call your medications into the pharmacy so you don't have to wait to get them. And NO I will not fill your narcotic prescription with our Charity Fund.

9. NO I will not get feeble grandma or grandpa out of your car for you.. you got them in you get them out or call 911 they always love that call.

10. And finally I will NOT jump every minute you push your call light. I will get to you in order of priority... please realize that some people actually come here only for TRUE life threatening emergencies and I might be a tad busy with them so that warm blanket you want is going to have to wait, Deal with it!

Tuesday, November 11, 2008

Thank You for Protecting My Freedom

Veteran's Day 2008

Emotionally Tapped

I am once again working too many shifts... I am tired, cranky and in desperate need of a vacation.. or even a couple days off....

The last 2 weeks we have seen some heartbreaking cases...

A 14 month old brought in by mom after drinking lamp oil.. inital oxygen sat 30% heartrate 280.. not responding to pain stimuli.... Ped trauma activated, attempts at IV placement successfull then quickly blow.. IO placed in her leg.. oil suctioned out of her lungs and stomach.. HCT dropped from 31-23, she was going into DIC.. transferred to Ped trauma hospital in big city.. placed on lung bypass machine.... and mom upon hearing that social workers needed to talk to her.... has disappeared...

A 26 yo male codes after a history of Percocet and Oxycontin addiction has put him into critical condition with pancreatitis and hepatitis..coded 4 time in 3 hours... 4th time we lost the battle.

A 16yo football player is head butted by opposing player after play ended.. CT scan + for C4 fx, spinal cord trauma.. shipped to trauma center for paralysis...

Foreign exchange student gets into argument with host family son... Goes to his bedroom and returns with knife and stabs himself multiple times in front of family in the stomach..

31yo male in with shortness of breath, cold symptoms for last 2 weeks... XR recommends CT for definitive diagnosis... Results Stage 4 lung cancer..

Actually I think I could use a hug more right now....

Friday, October 31, 2008

HAPPY HALLOWEEN!!

I work tonight... Let the fun begin!!

Thursday, October 30, 2008

Stethoscope...Danskos..Taser.. ready for work!

Once again ER Nurse is working way too many shifts.. we have been crazy busy and flu season hasn't even begun yet...Here is a snippet of some events that has ER Nurse proposing routine tasing just to make me feel better.

23yo M in for asthma crying on his gurney because his O2 probe was "Too Tight".

19yo M with Fx ankle from skateboarding who reports not wearing a helmet because the "Type" of skateboarding he does doesn't require a helmet...

24yo M Jehovah Witness in for abd pain who refuses blood draws because of his religion...

26yo M who only drinks "a couple" quad shot lattes a day in with SVT- Heart rate- 268

The Fs on state assistance who come in 2 weeks late on their periods with "Abd Pain" for their "free" pregnancy test, then come back at 16 weeks for "Abd Pain" for their "Free" ultrasound to find out the sex of their baby. ---Since me the tax payer has to pay for all this "Free" care I think I should have a say in the tests ordered...right?!

The parents who bring in their feverish infant daughters but refuse my In/Out cath for urine... because then their dtrs won't be Virgins anymore.

78yo F brought in by concerned dtr who was afraid her mom "Might" get pneumonia this year.

21yo M brought in by mom after smoking marijuana for the 1st time and not acting himself.

Monday, October 20, 2008

Boarding..

We are overflowing with patients both in the ER and on the floors. This weekend we have lived on DIVERT.. average patients time in the waiting room 6+ hours. We had patients in the ER for 15+ hours. And now because of this we are Boarding patients that need to go to PCU.

I hate boarding patients and this shift I have 3. I medicate based on a MAR and if I want to give more medication than the DR ordered on the MAR I can't just wander down the hall and ask.. I have to page the admitting Dr. If my patient has hypotension and I want to bolus him I have to call for an order.. this kills an ER nurse.

We work so independently.. we take care of our patients and then let the ER physician know what we have done...This paging, waiting for a return call. summarizing who my patients is and problems and what I think should be done and then the Dr asking tons of questions and then okaying my suggestion is going to be the death of me....

ER nurse needs a vacation.......

Sunday, October 19, 2008

Carribean?Hawaii? My Bed?

ER nurse has worked 131.25 hours in the last 2 weeks....
ER nurse needs a vacation.

Sunday, October 12, 2008

Our Week

HAPPY EMERGENCY NURSE WEEK

Tuesday, October 7, 2008

Whoppers anyone?

SHE IS BAAAAAAAAACK!!

The drunk chic from the last 2 nights is back again for the 5 time, after getting drunk and passing out at----- Hold your horses..Yep Mc D's bathroom again !

OMG... again BAL 0.387, this time enough is enough we are sending her to involuntary secure detox. If not for her own good then for my sanity... though I am half tempted to get her a Burger King gift card and a one way ticket to the next county!

Monday, October 6, 2008

Who wants to party?

Two recent LOL (Little ole lady) stories...

Medics bring in 74yo after being found down at home by granddaughter with a blood sugar 38.
Granddaughter guilt ridden that she went out with friends and was not there for Granny...
ER nurse explained to distraught granddaughter that it was not her fault... It was Grandma mixing Glyburide and her 1 1/2 pint to a 1/5 of whiskey a day habit.

Mother and daughter bring in 68yo old grandmother for altered behavior, thinking Granny as having a stroke... Head CT neg and all lab tests neg except one. When asked if the patient minded that her family was in the room during discussion of test results and diagnosis the patient was adamant that family stay... OK Granny everything looks great no stroke, head bleed or brain tumor but you might want to reconsider your use of cocaine! I thought the family was going to fall out of their chairs..

Have I met you before?

ER Nurse rarely refuses to care for a patient.. but tonight I have had enough it is someone else's turn to care for the 33yo alcoholic that keeps getting drunk and finding her way to the local McD and passing out in their bathroom.

Normally this would be an easy pt to care for .. but this would have been the 4th time in 36 hours I personally have taken care of her for a BAL >0.377 after sobering her to 0.06 hours earlier and sending her home.

Nope it is my turn to throw the temper tantrum today.... I won't do it and you can't make me--- so there!! :-p

Sunday, October 5, 2008

NH stunt

Dear Nursing Home Nurses,

It is NEVER EVER acceptable to send your patients to the ER via ambulance for the sole purpose of peripheral IV placement!

Love,
Your Very PO'd ER Nurse

Cold Shoulder...

Husband calls 911 after waking in the night and finding that wife is not her usually cuddly self and a little on the cold side.. Medics find her asystole..
On a side note...Medics bring her back and we admit to CCU...

Saturday, October 4, 2008

Come in IV form?

Attention ER nurses : New cure found for abdominal pain!!!

Peanut M&Ms!!
It is amazing that my patient who was crying in triage and rocking back and forth with pain was found munching on M&Ms on her gurney under a blanket and when reminded she was NPO and in the "worst pain" of her life she explained "but these really help I have to finish them or the pain will come back."

That is why I love this job.. I learn something new every day. And to think the cure was there all this time... in the vending machine down the hall.. I wonder what other diseases I could cure with $1.25 in quarters.

You can't make this stuff up...

Man shoots himself in arm after being denied sex

Story Updated: Oct 2, 2008 at 12:50 PM PDT
By Associated Press
FORT MYERS, Fla. (AP) - Authorities say a Fort Myers man shot himself in the arm after his girlfriend refused to have sex with him. The Lee County Sheriff's Office reported that a 29-year-old man and his girlfriend returned home from a bar early Wednesday morning.The girlfriend told deputies that her boyfriend wanted to get intimate, but she just wanted to go to sleep. When she refused, he became irate.Authorities said the girlfriend went to a spare bedroom, and several minutes later she heard two gunshots. She told deputies her boyfriend came into her room and threatened her. He then stumbled into the kitchen before falling into the oven, knocking himself unconscious.The man was treated for two gunshot wounds to the arm and was taken to jail.The man was charged with threatening violence and firing a weapon in an occupied dwelling. He was being held on $100,000 bail.

Thursday, October 2, 2008

Are you?

Yeah got my re-cert this week... Now I can officially save your life!

40-50-60%?

It's that time of year again..

Time to start making bets on what percentage of Influenza Viruses will be covered by this year's scientifically guessed vaccine. Last year it covered about 40% and it made the CDC look real bad so I think they learned their lesson and went to Vegas and let some professional guessers decide the concoction.

My guess is 53%---- anyone else care to guess?

PS My idea of a flu shot!

Wednesday, October 1, 2008

Accident?

Very few cases split the staff at the ER. Usually there is a very clear right and wrong to what our patients have done that has caused their need to be there.

Police bring in a 20's female after an accident car VS pedestrian. Female was the driver and during triage she admitted to having been drinking earlier along with smoking chronic and being non complaint with her IDDM so her blood sugars were in the 400's.

Triaging her was extremely difficult as she was crying hysterically about the situation, I initially thought she was distraught over having hit someone... but I was unfortunately very wrong..

She was yelling and screaming and crying threatening to hurt herself because one of the paramedics had been mean to her.. Mean to her? One of our paramedics had packaged up her victim and prepared her for airlift to the major trauma center in the big city in critical condition..after completing this the paramedic was responsible for checking the driver... Seeing that the driver was under the influence was the last straw and let the driver have it.. Telling how she was going to go to jail for the rest of her life because her victim was not going to make it.

She had no sympathy from me. I hoped the book was thrown at her as well and I fully supported the paramedic. Other staff felt sorry for her and felt her " accident" could be contributed to her high blood sugar and thought the paramedic was wrong. I felt otherwise. There is no excuse for driving impaired whether drunk, high, or having uncontrolled DM, and in her case she was all three...

The driver during her stay got more and more worked up finally demanding to talk to the fire chief about his paramedic violating her rights to good care... Understanding the paramedics frustration I told her the only right she should be concerned about is the one for an attorney as she had killed someone..her victim had died.

I hope she writes a complaint-I will gladly except it.

Monday, September 29, 2008

POLST

Seen recently on an ornery little old man's POLST form
DNR- ( Can zap me once if that doesn't work stop)
Artificial Feeding-Yes (don't want to starve to death)
Antibiotics- Yes (but not the ones that give me diarrhea)

This form is a check off list- so to see this shaky handwriting on it made my night.. That LOM was a hoot!


**Physician Orders for Life Sustaining Treatment (POLST) form is a “portable” physician order form that describes the patient’s code directions.
· It is intended to go with the patient from one health care setting to another.
· It represents a way of summarizing wishes of an individual regarding life-sustaining treatment identified in an advanced directive such as a Healthcare Directive or Durable Power of Attorney for Health care and includes the following:
1. Patient wishes for resuscitation
2. Medical interventions
3. Antibiotics
4. Artificial feedings


Who would have guessed?

I never know who is going to walk thru our ER doors and sometimes I am very surprised by which of my patients I enjoyed and wished could have stuck around longer to chat.


I have taken care of all levels of celebrities from local stars to national sport players to world famous singers.. and I treat them the same as everyone else. I never bring up who they are or ohh and ahh asking for autographs.


So tonight when a local celebrity brought his wife in for a migraine I gave her the standard care I give all, but for this family member that wasn't good enough.. he complained that everything took too long, that we didn't start with strong enough meds, they weren't getting enough attention, that our ER was too noisy, that the techs answered the call lights and not the nurse yada yada...

3 beds away was this attractive 40yo woman in with chest pressure with hx of MI that once ruled out for critical cardiac issues and was waiting for the repeat 4 hour cardiac enzyme check was pleasant and understanding, realized how busy we were and that I wasn't ignoring her and asked for things when I checked on her and didn't live on her call light.

I couldn't wait to get the "star" out of my ER and could have sat and chatted for hours with my chest pain patient and learned how this charming, demur woman became a high class call girl.

So tired..


Sorry have not posted any good stories in awhile..in the middle of working 18 12 hour shifts in a row and at the tail end and barely functioning... why do we nurses do this to ourselves?? Hope to post something later....

Damn......

Man claims penis amputated without consent

By BRETT BARROUQUERE, Associated Press Writer
LOUISVILLE, Ky. (AP) - A Kentucky man who claims his penis was removed without his consent during what was supposed to be a circumcision has sued the doctor who performed the surgery.Phillip Seaton, 61, and his wife are seeking unspecified compensation from Dr. John M. Patterson and the medical practice that performed the circumcision for "loss of service, love and affection." The Seatons also are seeking unspecified punitive damages from Patterson and the medical practice, Commonwealth Urology.A woman who answered the phone at Commonwealth Urology would not take a message for the doctor Thursday. But the Seaton's attorney said the doctor's post-surgical notes show the doctor thought he detected cancer and removed the penis. Attorney Kevin George said a later test did detect cancer."It was not an emergency," George told The Associated Press on Thursday. "It didn't have to happen that way."Seaton was having the procedure on Oct. 19, 2007, to better treat inflammation.The lawsuit filed earlier this month in state court claims Patterson removed Seaton's penis without consulting either Phillip or Deborah Seaton, or giving them an opportunity to seek a second opinion.The couple also sued the anesthesiologist, Dr. Oliver James of Shelbyville, claiming he used a general anesthesia even though Seaton asked that it not be administered

Wednesday, September 24, 2008

They love me!!!!


Not bad--- been working in the new ER about 2 months and they voted me Employee of the Month.. I guess that means they accepted me as part of the team... I even get a pretty cool star for my badge.. Ok so I am a little proud of my star!!

Saturday, September 20, 2008

Mr Lucky ain't a prize

Mr Jones who goes by "Lucky" was at the casino tonight when he blew thru his mortgage payment..called 911 from the casino for chest pain and shortness of breath and brought in by medics...

While I was getting his EKG and IV started he asked if I would call his wife and tell her he was there and we were concerned he was having a heart attack. No I told him but he sure could when I got done with all my initial orders... he was rather disappointed in my answer and when I asked why he said that after I called her and she got all upset and ran to the ER to see him he could then tell her about the blown mortgage and she wouldn't be mad...

ARE YOU KIDDING ME?! This guy called 911 as a scam because he didn't have the jewels to face his wife... Unbelievable... What a loser!

Dr Feel-Good Strikes again---

Dammit he struck again---

http://prpnurse.blogspot.com/2008/05/say-what.html

Admission order "Warm Milk or Tea and back massage at bedtime for insomnia" I swear one of these days I am going to choke him...maybe I need to send him a nurse's job description from the State Nurse Commission since he seems to be getting medical floor and massage parlor confused!

Wednesday, September 17, 2008

Hero


My hero tonight is my co-worker who came to work while passing a kidney stone, refusing Toradol or checking in to be seen, dipped his own urine 3+ Blood and when pain got worse checked in as outpatient for quick CT KUB... 7mm with hydro but continued seeing his patients with just an occasional moment bracing himself against the counter.


Meanwhile 34yo male GOMER in room 12 writhing in pain and crying in the fetal position begging for more and more Dilaudid had a 1x3 stone...PANSY. I wanted to take Hero and parade him around the ER and tell the other renal calculi patients to buck up and get a pair.


Dx What?

Patient came in tonight with complaints of a foreign body in her ear. Walks out with DX of psychosis... would love to have heard the dictation on that chart.

Ped Temps

One of the most frustrating things we ER nurses deal with, are parents who bring their children to the ER for temps slightly above normal for fear they MIGHT have a seizure... and I wonder who put that idea in their head..

Now I know... as I was at my pediatrician's office I could overhear the triage nurse on the phone with a child's parent telling them that if the child's fever does not come down with Tylenol/Motrin over night or continues to be above 100F to go to the ER for further eval and treatment as there is potential for seizure with high fevers. I almost gave myself whiplash looking in her direction to glare... 100F!!!! Time I had a chat with the pediatrician...

Friday, September 12, 2008

Fair?

Police bring in a schizophrenic for mental eval... guy is obviously off his meds and violent..
Before we can clear him for a mental eval we need a Utox and a BAL (blood alcohol level) . The techs typically do the blood draw as most are big guys and are protective over us nurses.. as one of the techs is drawing his blood the patient has his head bent down and is cooperating with all commands when out of nowhere he punches the tech in the face knocking him off his feet. We immediately call a code strong and security and police arrive and assist with restraining the guy.

In our state it is a felony to assault or even threaten to assault a health care worker... so after the police finished restraining the patient and come to fill out the paperwork to file charges it is unbelievable to have the police tell us that because the patient assaulted a tech the charges weren't going to be as severe as if he had assaulted a nurse!!

Are you kidding me?! These techs bust their butts doing all the grunt work with no recognition from patients, families, and some bitchy nurses so we nurses can do the jobs that get praise.. and for this they are fair game for our patients wrath with little to no consequences...

Well if that is the case then i think all our techs should start carrying tasers sounds fair to me.
Unfrigging believable---

Wednesday, September 10, 2008

Jackpot

When nights get really stressful the ER staff finds ways to break the tension and laugh a little some times it is playing pranks on each other from clipping hemostats to the back of each others scrubs to putting KY on the grip of water bottles..
My favorite is BAB..otherwise known as Blood Alcohol Betting ---

A patient comes in usually by medics after consuming some large quantity of alcohol and attempting some mundane feat like leaning out a truck door to vomit and falling on their face..
Before the patient arrives everyone gets the story and for $ 0.25 you can place a bet.. once the patient arrives the betting stops. Everyone gets involved in this from admitting, to hospitalists, to housekeeping, but this week I am on a roll.... I have my next week worth of lattes covered!!

Tuesday, September 9, 2008

Joke?

This weekend we got slammed night after night... and just when I thought we had gotten thru it a code is brought in 90 minutes before the end of shift of a 6 night string.. and who should decide to show up at the same time... Dept of Health.. are you kidding me-- nothing like diverting staff to go room to room looking for open medication bottles or undated juice in the fridge. Thanks guys!! They should have to wait in triage like everyone else!!

Worth It?

54 year old female seen in our ER 2 weeks ago for small stroke that left her with residual word finding problems but physically fine, discharged home the end of last week with prescription for Nicotine patch for long history of smoking.. after a day patient quits wearing because it made her "Nauseated" and smoking helped her feel better...

Tonight after having a headache all day and her cigarettes not "helping" -her husband hears a thud in the bedroom and finds that she is unable to talk, move her entire right side nor able to manage her swallow or secretions... She has had a MASSIVE stroke..

Because of her stroke 2 weeks ago we can't give her TPA a clot busting drug... her prognosis is very dismal.. and all i want to ask is were those cigarettes worth it?

Tick Tick Tick

Dear Patients...
We are not a drive thru ER. Showing up in my ER and the first thing that you say to me is " Can we make this quick..I am kinda in a hurry" I guarantee you will tack on at least 2 hours to your visit due to "lost" lab and Xray reports..

So next time if your problem is not a life threatening/ending situation go back to bed and see your Dr/Clinic in the morning , but if you HAVE to come we will see you and treated as fast as we can and not any faster or slower..cause trust me I don't want you here either any longer than you have to be.

Monday, September 8, 2008

Just like old days...

Homicidal and suicidal patient with special alert for potential for staff assault is in a locked room having her vital signs taken by the tech who leaves the door ajar..
Tech is 5ft maybe 105lbs..Pt is 5-7 180lbs, pushes past the tech and takes off running, I hear the yelling from another room and see her bolting for the doors in her paper scrubs.. while tech yells for security... I take off running after her along with the former Army ranger now tech... The patient makes it to the parking lot before being "detained" OK more like body slammed...
Damn that was fun.. Afterward the patient's nurse asked me what I was thinking "You should have let security handle it" .. hmm what was I thinking... just about the take-down hon, and damn was it good.

Sunday, September 7, 2008

Dare

This story is courtesy of my favorite and the best EMT in our county...

Man comes into the ER after a drinking party with the guys 3 days earlier... What it is about guys/alcohol/and testosterone mixing I don't know but it always seems to lead to dares and proving manhood... his dare... placing a carrot up his rectum.. problem-after 3 days was still unable to pass it, and the ER Dr while able to feel it could not get a hold of it.. pt got to go to surgery for removal... wonder how he explained that to his family and work...

Tight Squeeze

Obese woman comes in with complaints of shortness of breath, lab test shows elevated DDimer..( test for blood clots). She needs a CT scan of her chest to find out if she has any in her lungs... Small problem our CT scanner can only fit someone LESS than 350#. By looking at her I figured she was pushing that limit but just to be sure I pulled out the scale and asked her to step on it... Quite irritated I would not take a "Stated Weight" she got on and her weight was 337#. I knew I was close!! She of course said the machine was wrong and I should have it recalibrated.
So to make her feel better and to prove it was right I stepped on the scale... you are right I told her the machine is off... it is under weighing us!!!

I swore I heard her mutter "Skinny Bitch"

Tuesday, September 2, 2008

Ho Hum weekend

Hard to believe that with a holiday weekend how slow we have been..no great trauma but a few interesting cases...
#1 --5 yr old boy sitting on the counter watching mom cook when he slipped off the counter landing on the back of his head... come walking into the ER for complaints of headache unrelieved by Tylenol and Motrin.. CT Head report--- C1 unstable fracture.. Off to major trauma center for him for halo-ing.
#2-- Man calls up wanting to know exactly how close can get to the campfire with his nasal cannula oxygen going... Hmmm as close as you want as long as you have nothing to do but spend time in the ICU burn unit. Idiot!
3#-- Man comes in with neck pain and tingling/numbness in right arm.. neck pain d/t stenosis.. MRI says right arm problems are MS. Why is it always the nice people we have to give bad news to.
#4--Teen wanted to work on his car but couldn't find the jack so he used a rock and some 4x4s.. He was surprised when it gave way while he was under it...
#5--Guy walks up to triage and asked to be admitted to Psych unit because he feels like an episode of "Sex Fever" coming on. We gave him to the male ex-army ranger now nurse.
#6--Man comes in for abdominal pain..CT scan reads gallstones. Dr tells pt who promptly lifts his gown showing a scar and says "nope I had that taken out years ago when I got stones and it was infected". We re-scanned and sure enough his gallbladder was there. His Right Kidney...now that wasn't. Gallbladder/Kidney same thing right?

Wednesday, August 27, 2008

Very Classy

Just when I thought I had seen it all... Woman comes to the ER after her husband is brought in by medics for suicide. He is being kept alive (he arrived brain dead due to trauma) for possible organ donation and until she can be located. She comes running into the ER hysterical.... with boyfriend in tow!!

Oops!

Quickest way to bring an ER to a standstill and tons of firefighters come running with bunker gear on at 1:32 am.... Burnt Toast. Poor nurse she was so embarrassed.... and the firefighters.. weren't too amused either....

Sunday, August 24, 2008

Look Mom I am Famous!!

W hen I started this blog I meant it as a way to vent and meet other healthcare workers feeling the same frustrations... never did I imagine that people from around the world would find this let alone read this... amazing and humbling..here are where some of my readers are from out of the last 100 visitors...
Australia, Iceland , Russia , United Kingdom
German, Indonesia, Pakistan, Malaysia
Poland, Canada, Netherlands, Singapore,
Egypt, Israel, Beligum, New Zealand, Austria,
Brazil

GCMs

In our ER using the term "Frequent Flyer" to describe patients that practically live here is a big no no and grounds for a write up for being judgmental and derogatory... so I use the term "Gold Card Member". Typically GCMs are drug seekers with a list of allergies to all non narcotic and OTC pain relievers.

One such patient came in this week while I was working Fast Track (the area of the ER that is open from noon to midnight that is designed to see quick cases, typical walk in clinic patients..we get most the GCMs during operation hours) and this is how he started our interaction...

"Hey lets not waste anymore of my time, the stuff you been giving me is garbage... I need something better and a lot of it cause I can't keep spending all my daylight hours here..it is summer man and I got things to do!"

Nope no reason to be judgemental here...

Thursday, August 21, 2008

Entitlement

Illegal Mexican family brings their daughter to the ER for hives with unknown cause. Dr orders chewable benadryl.. we don't carry tablets only IM shots,IV dosing, capsules and benadryl elixir with 14% alcohol. These are all unacceptable dosing as this is a very minor minor allergic reaction. Here is my discharge conversation with the parents..

Er Nurse- Hi Mr &Mrs "Lopez"...Do either of you speak English or should I call for a translator?
Mr Lopez- Yo hablo un poquito english.
ERN- Great ......."Maria" is having an allergic reaction, she needs to take benadryl as prescribed on this prescription. You can fill it at 24 hour pharmacy.
MRL- You aren't going to give her something now.
ERN- We don't have chewable, and she doesn't need an injection.
MRL-How am I suppose to get to the pharmacy at this hour.
ERN- You drive.
MRL- I can't drive there I don't have a drivers license. So you need to fill it for us.
ERN-How did you get to this ER ?
MRL- I drove.
ERN- Great now you can drive past the pharmacy on the way home. Have a nice night.

It really amazes me you patients that think I owe it to you to make your life easier. I didn't force you to come to the ER if you had an ounce of common sense, and weren't so frigging lazy your life would be easier and I wouldn't have to work so hard to support the medicaid system.

Wednesday, August 20, 2008

Bad day...

In order for people to see me at work they generally have to be having a bad day... and then there are some who's day has turned into a full nightmare...here are 3 recent

Middle age woman at a friend's summer party has a bit to drink and falls thru their 2nd story windows.. Fracturing her left hip and femur


2nd Middle age woman falls 5 ft from a ladder, landing her chest on a fence post, piercing her left chest and tearing away a chunk of breast tissue and popping her 30yr old breast implant. It seriously looked like a shark bite it was so extensive.

22yo male gets fired from his job comes home and argues with his girlfriend, decides he is going to find a permanent solution to his problems. He unfortunately does not check how much weight the cord that he chooses can hold. Because he truly is having a bad day the cord breaks and he lands face first onto a dresser.. We end up sending him to bigger city trauma center with numerous facial and jaw fractures.. not quite the permanent solution he was hoping for but definitely he will have permanent reminders of this day.

Monday, August 11, 2008

Thank You



CheckList

Dear Drug Seeker,

Thank You for complimenting me on my youthful appearance, despite the fact that I look in my mid 20's I am not. While I may appear to look like a new grad I have been doing this for 10 years so that compliment you gave me to distract me from your seeking behavior did not work and instead just irritated me.

For future reference when coming to the ER looking for drugs there are a few things that clue me into your game.. here is a list for you to print off memorize and use as a check list before trying this sham again.

1. Get out of your car with your act already started. You never know who will see you in the parking lot jumping out of your vehicle or running. More believable is family member running into ER grabbing w/c or walking in bent over with family supporting you on either arm.

2. Dress appropriately for the weather. When you come dressed for a blizzard in 90 degree weather I wonder what you are hiding under those sleeves.

3. When I ask you questions appear to search for answers. No one remember everything about how their injury/illness occured. Answering all my questions in one breath before I ask them tells me you aren't new at this.

4. When I pull up your sleeves dont blame the old IV marks on a blood draw this week. especially the ones on your wrist and back of arm.

5.Don't have allergies to Tylenol, Codeine, Motrin, Toradol, Morphine, Ultram, Darvocet.

6. Never rate your pain a 10/10 while munching on Doritos or laughing with your buddies

7.Don't lay on the floor and moan and cry while looking to see if we are paying attention. Instead I recommend pacing the floors stoically while periodically leaning over for a couple deep breaths. This is more effective.

8. Don't TELL me what your treatment plan should be including medication and dosages.

9. Remember who your Dr is and never state you are just passing thru on vacation.

10.And finally remember to remove your arm band that you receive at the other ER today.

I guarantee using this list will make your next try more successful and we can just skip the superficial compliments and me incurring additional L&I claims from all my eye rolling.

Sincerely~ ER nurse

Headshaker..

Another head shaking weekend in the ER. Here are some stories of our DNA donors...

**Teenage couple 15 & 16 come in for STD testing, after he has burning and "gross stuff" dripping out. She admits to not being a virgin when she slept with him, he was shocked, Me? Not so much.

** A guy threatens suicide when he is arrested for drugs thinking he is going to come to the ER and we will protect him from going to jail with a mental eval hold... Wrong, our SW eval'd him and sent him on his way..side trip 1.5 hours not quite the 72 he was hoping.

**Female brought in by medics for eval at police request after she is found asleep/passed out in the aisle of local grocery store...seems she took a bunch of oxycodone then decided to go shoplifting in order to buy more.

**16 yr old girl out partying with her friends when they notice she is not responsive and shallow breathing.. being teens they did the "smart" thing and decide to drive her home. Once there they can't get her out of the car and are forced to get her parents. Dad calls 911 who intubate on arrival and bring her in to us. Blood Alcohol- 356.== 4.5 times the legal limit. While I was caring for her, mother asks who is going to give her daughter "The Talk", about responsible drinking.. Hmmm HELLO PARENTS, that is YOUR responsibility, my job is to save her ass, not raise it!

**There was a local house party with a large family gathering when friends arrived and get into a confrontation and shotguns are fired with people scattering on foot and in cars. One car loaded with 3 guys crashes into a telephone pole a block away and they take off on foot. Guy#1 has facial lacs from glass and calls a friend to come get him. She calls 911 asking for directions to the nearest ER. We are it. During triage they change their story numerous times...
Guy #2 was tracked down by K9 officer and decided to resist the cute puppy.. Bad idea-- we counted more than 38 bite marks over his right arm,flank and thigh.
Guy#3 decided to give up and also brought in by police for facial laceration.
During all of this #1 denied being involved nor knowing 2&3 despite when he thought we were not looking he would go talk to them-- during which our ER was crawling with cops from 5 different jurisdictions...Dumb Ass. He left like the other 2 in handcuffs and us laughing at his stupidity.

After this weekend I need to get my neck eval'd for repetitive motion injury..I wonder if I can claim L&I?

Friday, August 8, 2008

MIA

New nurse shows up for first day orientation, is shown around the unit and then disappears. No joke. We have not seen her since, and that was 3 days ago. Now I know that nursing can be hard but come on.. only lasting 20 minutes on a unit? That has got to be a record!!!

Thursday, August 7, 2008

I Accept


What a difference these EDs are from the little magoo ER I use to work at. Here was ONE of my 12 hour nights this last week....

*Arrived to a packed house... parking lots jammed, people sitting/ laying all over waiting room with average wait time for "GOMERS" 4+hours.

*Broke hospital record with most ambulance arrivals =15 in 40 minutes. And all really sick and crazy.

*3 walk -in MIs (heart attacks)

*8 months pregnant here on vacation, out boating when her water broke...arrived via EMS and delivered 7 minutes later! Its was a boy!

*Teenager brought in by mother out of control assaults mom in ER...Amazing show of force by staff, including security and police. She spent the next few hours in a locked room by herself, crying for her mom to get her out.

*24 yo female walked in with asthma attack that needed intubation.

*Some idiot threw his/her lit cigarette into the bushes in the parking lot resulting in a small fire... guess who's truck was parked next to this bush...yours truly! Bastards!

*Drunk woman brought in by medics and police after drinking 3 bottle of wine and fighting with husband... shortly thereafter began throwing up said wine all over the gurney, herself, floor and wall... and then i hear "Nurse i think my tooth came out" And guess who you think got to search thru her dinner and wine looking for this tooth? Yep me again!! Woohoo I am on a roll!

*Found out the triage RNs here carry pepperspray. I like that about these nurses. They have no problem defending themselves!! You go girls!!

And that was just a snippet of some of my patients that night!

At the end of my shift the ER director arrived and spoke with the charge nurse and then asked if I liked working for them even after a night like that.... if so she wanted to offer me a full time position based on all stuff she heard about me. Hmmm let me think about that a--- never mind Hell yeah I'll take the job. This is damn fun.

Monday, August 4, 2008

Not fresh meat..


Dear EMS & Law Enforcement,

Yes I know that I am new to these ERs, but I am not new to your games... please show me some friggin respect and quit with the over used come on lines and leaning on the counter under the guise of introducing yourself, just to get a look down my scrub top. Grow up guys.. you give your badges a bad name.

And Dr "Rico Sauve", your reputation precedes you. I heard about you when I was at Rural ER. Your blatant comments are offensive make my skin crawl, and only scream short man compensation. Sorry not interested in becoming Ex Wife #4, especially after I heard how 1-3 cleaned you out. So quit hitting on me before I foley cath your little buddy with a chest tube...ky lube always optional. Love Er Nurse

Crazy, I am so Crazy....

Been crazy busy bouncing back and forth between the two ERs. I don't know what the hell I was thinking... I can barely see straight I am so friggin busy and tired..

I will write more later about the recent cases I have seen on my shifts..here is a sample.

  • a young female comes in with rectal pain after "experimenting" with young stud boyfriend.
  • Motorcycle crash at 120mph
  • C1-2 fracture after fall.
  • HIV test request in young guy
  • 35yo Diabetic pt with a Do Not Resuscitate order

This ER nurse is off to take a nap....

Tuesday, July 29, 2008

Buttkicking Certified

I spent 9 hours today in class at Big ER learning how to verbally de-escalate an aggressive patient and how to physically fight off an attacking one..

Rural ED could have cared less about my physical safety.. despite being attacked there several times by patients including one time warranting police to come and arrest my patient and charges filed, rural hospital never thought I or my co-workers were worth protecting so that we could go home to our families safely. (Administration never even called to check on me after that incident,despite the fact I was injured)

But Big ERs 1&2 are paying for me to have this training AND they also have 24/7/365 security with local police also making indoor/outdoor patrols. It makes me wonder why I stayed for 4 years at rural ER.

Class was fun today but tomorrow's 9 hours will be better.. I get to learn choke holds, subduing and how to drop a patient twice my size.... This is my kind of nursing class!!

Monday, July 28, 2008

TB/Demons/Gomers oh my

I went today to have my TB test placed and I swear the Employee Health nurse stuck me with a 14g needle! With all the bleeding I did I was wondering if maybe I should have my H&H checked!!

Next I went and did my pee test* ...Such a sad statement that it is required, but in actuality as I have talked about before there is a disturbing percentage of healthcare workers who "self medicate"---On a sad side note, this week a nurse I have worked with for years was fired for being high.. she is currently in the HPS program *** Health Professional Services (HPS) is a confidential program for chemically impaired health professionals. HPS ensures early entry into recovery for the impaired practitioner while providing maximal protection of the public safety *** But the challenge of sobriety was too much and she relapsed. I wish her the best and am THANKFUL I have never had to battle that demon.

*My test was of course (-)

Last night I went to #1 ER to bring a latte to a nurse friend working a late shift, since I do not have my badge yet I sat in the waiting room till she could let me thru to the back...if I had any concerns that I was going to miss out on the murky gene pool that rural ER served they were completely eliminated... This job is going to be fun

Sunday, July 27, 2008

Love Me?

Where am I ?


ER nurse has finally left rural ER and now is working at the 2 biggest ERs in the county. I was going to just work at the biggest one, but as those in medicine know we are a small world and #2 in the county found out I was looking for a change and offered me a job as well. And as any good ER nurse I am a glutton for punishment and now scheduling myself for both jobs orientations, new hire education classes and precepting.. Thank God I am an experienced ER nurse so my precepting will be short as in a matter of days and not months as some new ER nurses need.

Hopefully working in these 2 ERs will bring more excitement, trauma and occasionally a good Tasing! Stay tuned ....

Tuesday, July 22, 2008

Nice try...

Rural ER has finally decided to listen to their staffs' concerns over safety and hired a security firm at night... that is great progress BUT they won't be armed, can't put a patient in restraints but hey at least they are trained in verbal de-escalation.
Great in other words it is up to the nurses still to physically deal with meth'd out, drunk, violent, psychotic patients... They just don't get it do they.

Stress Reducer

I saw this link on another blog and laughed so hard I was crying...

http://failblog.org/

Friday, July 18, 2008

W.A.G. System

Patient comes in tonight with an insulin pump infusing thru the skin on his abdomen. A new nurse had never seen this before and this patient was more than willing to explain it to the nurse.

Patient very seriously explains how the machine works, how it transfuses into the skin and that he changes the site every 3 days. He then explains how he decides how much extra insulin to give himself based on what he ate for his meal using the carb exchange. And then he talks about the basal (how much insulin infuses continuously every hour)setting and how he changes it based on the WAG system.

This new nurse looked at the patient and then at me in confusion.. I could tell that his mind was going back to pharmacology class trying to remember the WAG system. After a minute or so I decided to let the nurse off the hook and asked my patient to explain WAG.

WAG- Wild Ass Guessing! I love new grads--- they make my nights so much more fun.

Saturday, July 12, 2008

Altered LOL

Grandma brought by family after having Mental Status change... Grandma has been falling, slurred speech, confusion and lethargy for 2-3 days.

Grandma has chronic pain issues and recent fall which exacerbated chronic pain.. Good intentioned PCP prescribed Fentanyl patches (25mcg dosage) to get her off oral narcotics and try and give continuous pain control.

Grandma did not understand directions of use (change patch every 3 days). Grandma arrived covered in patches.. Applied every time and everywhere pain was bad..

Grandma was STONED.

*Dilaudid is 8x stronger than Morphine. Fentanyl is 80x stronger than Morphine.

New ICD 9 Diagnosis


A trucker from the southern US passing thru our town was brought in after drinking too much and passing out at a bar while on stage...(medics informed me of his musical preference) His BAL was 0.456 almost 6x the legal limit so he was less than alert and orientated.. Every time he would arouse to stimuli and see me he would say " You sure are purty" and then promptly pass out again. This line must work for him as he had numerous different women's names tattooed on him.

Occasionally he would ask why he was in the ER and each time I would tell him "Because you were singing bad karaoke" to which he would nod and smile and pass out again.

After numerous hours in the ER Mr Trucker was coming around and asked again why he was there.. I told him his BAL "That's not illegal I wasn't driving" No I replied just a drunk trucker, with a big cowboy belt buckle belting out Barry Manilow karaoke. Now that should be illegal!

Tastes like chicken


Eyebrow bit off during fight.

We have WINNERs!!

4th of a July this year was horrible in the ER... We were way understaffed for such a major holiday that fell on a Friday night and there was great weather for.. the combination was perfect for all those that murk up the gene pool.
We saw so many burns and firework injuries that we actually ended up turning the back half of the ER into a burn unit and called in an additional MD to run it (but not additional nurses..that would make sense!).

It amazes me year after year the things people do in order to celebrate the 4th with the biggest boom...

This year the winners of the 4th of July Darwin awards are my patients who thought

“ Hey let’s fill up an extremely thin piece of rubber with a highly explosive, volatile gas that could explode at any moment and put a flame to it! " .... aka filling balloons with Acetylene (gas used in welding torches) and igniting it. Several of these guys unfortunately also learned about static electricity mixing with these balloons resulting in severe burns to legs, chest, arms, hands, stomach and face.

A close runner up are the ones that light off mortars in their hands and aren't quick enough in throwing...

And of course my favorite irresponsible parents that let their young children play-light fireworks. One child came to the ER after sibling stuck a lite punk into his eye.. parents decided to wait a few hours before coming in to see if vision would improve on its own...Morons.

So what do these lucky winners get... For those that really "out did" themselves a trip to our Trauma Burn Unit in another county aboard a $800 "taxi" red lights and siren free of charge.
For the rest they get to learn all about pain, wound care, infection, and scarring.

For an application for next year contact ER nurse.. Only entry requirement--Stupidity

Sunday, July 6, 2008

The Gamut...

This weekend has been crazy.. the firework injuries, drinking, stupidity, MVAs, short staffed , I think my last weekend here has been just about my worst ever... gotta run to another shift will blog all about the last 48 soon...

Friday, July 4, 2008

Happy 4th of July


PS I work tonight... I am praying for rain.

Thursday, July 3, 2008

Come one come all....

The ER gives out the TB tests to the night shift workers so they don't have to come during the day..it is a convenience thing. It only takes a minute so we don't mind this mundane task, but the other night was a first...

A new housekeeper comes in and asks me if I can give him his new employee shots (Hep B series) No I explain but I can give him his TB test. And this is how the rest of the conversation went...

HK-- "How often do I need that"
Me --"Once a year unless you are + then you need XR upon hire and when you become symptomatic"
HK-- "Oh I just had one a few months ago"
Me-- "Ok go get a copy of the paperwork from your previous employer and that should suffice"
HK-- "No the jail gave it to me"
Me--"Excuse me"
HK--"When I was doing time, they said I was fine, is that enough"
Me--"Let's figure this out outside the med room"

Amazing, it took me 3+ years to get badge access to the EXTERNAL doors of our hospital.. yeah it is time to leave.

Tuesday, July 1, 2008

Nice hospital corners..


A nurse is a nurse is a nurse.....hmmm not quite

We have had several nurses out for various reasons and been struggling to find coverage for them... This is not a problem isolated to us, this is a national problem and will only get worse as more nurses reach retirement..

Because we are small rural ER it seems harder to get agency nurses for coverage than the bigger hospitals so the nurse supervisor gets creative and tries to utilize what staff we have.. this we all appreciate...

But on a weekend night shift sending a nurse from med/surg with less than 2 years experience, unable to place IVs, triage, order tests, nor has pyxis access and never been in a code.. or even seen a dead body for that matter.

Kinda makes you ask "What can you do?"

Monday, June 23, 2008

Make mine a double

I had a nightmare night...

Airlifted a teen out with a c-1 fracture after a high speed MVA, told a 42 yo man that came in with chief complaint of feeling tired and lack of appetite that he had metastatic lung cancer and had a mother come running into the ER throwing her baby into my arms that was blue and limp...

I went and had a few drinks after work-- so it was 6:30 am.. I earned them
Side Note..Fracture of the Dens(Odontoid Process)
Most dens fractures are caused by motor vehicle accidents and falls
About 1/3 of C-spine injuries occur at C2 and about ½ at C6-C7
As expected, most fatal cervical spine injuries occur at C1 or C2

Treatment
Type I fractures are usually treated with a hard collar for 6-8 weeks
Type II fractures can be treated with
*Halo immobilization for 12-16 weeks
*Operative fixation (odontoid screw)
*Arthrodesis of C1 to C2
Type III fractures can be treated with a halo or surgically.

Sunday, June 22, 2008

Not a superhero...

Dear ER Dr,

I am an ER nurse. I am NOT a social worker aka "Miracle Worker". Our patients did not become homeless, unemployed, alcoholic, drug addicts or the result of a murky gene pool in the time they spent in our ER. If I cannot fix their problem by placing some pill, tube, fluid, needle, or any other of my fun tools into one of their orifices or creating one of my own I am not going to fix it..so QUIT friggin expecting me too.

~Er Nurse

I think not..

So a lady calls the ER tonight in a panic crying telling me that she is in horrible pain and I need to call her primary Dr at home to get an order for her medicine.."the only one that works!"

I inform her of course that I will do no such thing.. We would be more than happy (Ok so I lied) to see her in the ER eval her and our Dr will decide what med to give, but I am not calling a PCP especially when she wasn't even here and he wasn't taking call.

This brought on another sobbing episode about how only he knew how to treat her pain yada yada... Ok I give. What is the only thing that works for you?

"Dilaudid 12mg IM!!!"
Oh yeah I am right on that...

Friday, June 20, 2008

Moving Day.....

Smooth seas do not make skillful sailors. - African proverb

Sorry have not posted in awhile... ER nurse is in the middle of switching Er jobs. ER nurse has decided to move on to the BIG county Er in the area. It is the ER where all the area trauma goes.

Why move on? Well for starters I am always looking to expand my knowledge base. We are a small Er so we don't get to see real trauma unless it walks in. I find myself repeating the same night over and over. Treating the same patients over and over. Big Er sees 5x the amount of patients we see.... guaranteed more interesting cases more things to learn.

Second small ER is moving in a direction I don't think is safe for my license or my patients. Like I have said before I protect my license with everything I have. And it means moving on in order to do that this time.
Third I feel that this administration does not value their staff nor feel the need to protect us physically from deranged patients. We always hear what we do wrong, but never get praise for all the OT we put in or the nights we get our asses kicked. We are also constantly reminded how expensive it would be to make the ER a safe working environment and it currently is not something they feel they can budget for.. Hmm what a nice message.
So as much as I will miss the camaraderie of my co-workers and the FF/PM and police, it is time to move on, time to expand my knowledge base, time to feel appreciated, and above all time to feel safe at work.

My stories will continue... but hopefully will be more bizarre and maybe even Trauma>Drama!

Sunday, June 15, 2008

Happy Father's Day

To Mr. Er Nurse...
Thank you for my babies... the greatest gifts you ever gave me.

My name is......


This weekend could not be anymore opposite from last weekend..We have been slammed.. It has truly been ugly..

And my patients general consensus is that I am "inhumane" and a "bitch"... aka the nurse who won't hand out the Dilaudid like Tic Tacs....

Oh you poor poor patients... you better hurry and report me to the state for substandard care cause I won't gork you out of your minds! Just remember and spell my name right.. Thanks ~ Er Nurse

Wednesday, June 11, 2008

Trade?


We don't have an IV team at our hospital. When a nurse on the floor can't get their IV in, they call the ER for one of us to do it.

Most of the time I don't mind, but lately it is becoming more and more often . I have actually turned it into a game to see if I can get the IV in, flushed, dressed, clean up my mess and charted in less time then it took them to walk to the ER to ask for help (they never call for this request, they always come an ask in person, not sure why).

This little game amuses me, keeps my skills up and makes the floor nurse feel kinda bad for not getting the IV in.. I probably wouldn't find such joy in this if they occasionally thanked us with pizza, chocolate or offered to do our next digital disimpaction. Its fair right?!

Yawn.....

This last weekend was ho-hum.. nothing exciting.. just the routine:
Failed ODs/ Successful ODs/ Drunks in Fights/ Falling Grandmas/Short of Breath Grandpas/Babies with Fevers/Babies Without/Kids with Colds/Kidney Stones/Burning PeePees/Dripping Privates/Chest Pains

I actually missed my Meth friend from last weekend...

Saturday, June 7, 2008

Now paging...


A patient is brought in by family after having a seizure non responsive. Patient has a long history of seizures ...

As I am trying to assess the patient and call her name to look for a response the family informs me I would have better luck using her nickname.. Sure no problem what is her nickname....
Shaky!
Come on that is mean! But damn funny!!

Tuesday, June 3, 2008

FIVE


THE FIVE RIGHTS

1. Right Patient
2. Right Time
3. Right Medication
4. Right Dose
5. Right Route


THE FIVE WRONGS

1. Falling asleep before taking bedtime Insulin dose
2. Waking up and panicking
3. Deciding to take insulin while not fully awake.
4. Not reading label of Insulin vial before drawing up medication
5.Injecting self with 80 units of Humalog thinking it was 80 Lantus! (Oh Sh*t!)

(Humalog is short acting insulin peaks in 2 hrs, lasts 4 hrs- Lantus long acting, lasts 24hrs!!)

This little ole man(LOM) was so embarrassed about what he did and of not being able to keep his sugars up at home when he realized what he had done. As a 20+ year insulin dependent diabetic he knew better. He stayed with me for hours on a sugar drip (D5,45%NS) and me bolusing him with even more sugar (D50) every hour. I also stuffed him full of every protein ladden food I could get my hands on.

LOM apologized every time I came into his room for bothering us and messing up so bad. I gave a little nursing education about the "5 Rights" we as nurses live by. And he promised never to make this mistake again...

But if it did, I want him embarrassed in the ER with me rather than at home trying to save face..

Because this is a LETHAL mistake, I can easily fix with just a little chiding added on.

Monday, June 2, 2008

That Other "C" Word....

Last nights nightmare was a 40 yo female hyped up on Cocaine/Meth/Narcs and Amphetamines running around a nearby town buck naked. The police came across her in the middle of the road having sex with some guy she had just met, when they turned their lights and sirens on she still continued riding her new cowboy.

Upon pulling her off she became belligerent/yelling/fighting with the police and dropping to the ground spreading her legs and yelling at the LEOs to go ahead and take their turns..

She arrived at my ER still fighting ..It took everyone working in the ER at the time to wrestle her onto our bed and putting her in locked restraints. She continued to thrash and yell and I got the joy of putting her IV and Foley in. The IV was a little difficult as I was aiming for a moving target but I got it on the first try. The Foley was a whole other matter.

In my opinion there is nothing worse than cathing a habitually unclean female after she has had sex.. That aroma sticks with you the rest of the shift .

During all of this rodeo girl was screaming-thrashing-cursing-threatening-grabbing anyone, anything in reach, throwing her legs open and inviting passengers in her most lady like manner.

As a given she and I were not destined to be buddies. She hated me and made sure I knew it. I was not impressed with her behavior and made sure she knew it, to which she informed me she was going to behave anyway she wanted and I couldn't do a damn thing... That sounded like a Challenge... I accept!

30 minutes later I had calm returned to the department. And princess? She had Ativan/Haldol intravenous and adult diapers on.

Show over...I won.

Sunday, June 1, 2008

The Good Stuff....

I deal with a lot of patients that we call
"Frequent-Flyers". We see them almost weekly for every little thing, real or imagined wrong or so they can try and scam narcotics. They remember me from all their visits and even know my name without me saying it..It gets really old, fast!

But then there are patients that I take care of once but because of something crazy -they stick in my mind forever and make great contributions to storytime and I usually never see them again. But this weekend one of my favorite ER patient stories came back and he remembered me after all these years...

Guy comes in to the ER in police custody after running from the police..tased.. for a medical "Okey Dokey for the Pokey". As I am taking care of him he says to me "You don't remember me, but I remember you.. you took care of me couple years ago" This didn't cause much interest in me..I take care of a lot of people so I continued with what I was doing. Him seeing this continued on.. "I walked in here after being stabbed.". OK now he had my interest.. We are a small hospital in a rural area we don't get many stabbings let alone walk ins. So I asked where he was stabbed.. "My chest". Bingo we have a match..I tell his story all the time.

This guy walks into the ER clutching his left chest stating matter a factly "I have been stabbed". He was covered in blood so we rush him to our code room, undress him and see the wound. We jump into action with Ivs, monitors, fluids, scans and blood to transfuse , we start calling for a life flight helicopter to take him to the trauma center in the big city. While we try and stabilize him and wait for the helicopter I ask why was he stabbed. He tells me he went to his buddy's apt they got into an argument and he got stabbed. "What were you arguing over" I ask. "I lent him some porn and he would not return it" Say what? "You got stabbed over porn?!" I asked in total disbelief . "Yeah but it was the GOOD stuff!" he said defensively.

Now when I tell this story people always ask me what he meant by the "Good stuff" and you know I was afraid to ask a couple years ago.. and the other night I still didn't want to know.

Somethings are better left unknown!

Saturday, May 31, 2008

Not Paid Enough...


My night sucked....

Way too many drunks, way too many people getting their butt kicked, and too many who couldn't hold their own...

ER nurse got thrown up on TWICE last night..well almost three but the OD lady missed me.

The 1st was a good looking Marine...(If only I was 20 again!!) I forgave him... he lost it after I unwrapped his lacerated finger and he saw all the blood.. oh and he also fainted! He was so embarrassed and did I mention good looking?!

The 2nd..NOT so cute, a drunk (Schnapps and Flops) brought in by medics after being found down outside non responsive, with blood running out of his ears. Schnapps and Flops had a brain bleed and vomited everywhere including into ER nurse's hair during his stay..

Now why do I keep showing up for work?

Friday, May 30, 2008

How many can you take on??

23

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Say What??

I kid you not this is what a Dr wrote as an admission order---

"Treatment for Insomnia-warm herbal tea or milk, white noise at low level (tv or radio) and BACK RUB at HS (hour of sleep)" .


I am not sure what the Dr was smoking or the patient either for that matter, but that order is not going to happen... there aren't enough nurses as it is to take care of all the patients' "APPROPRIATE" orders...


Plus last I checked I work in the hospital not "Mona's Magical Hands Massage Parlor"!!!!


Got insomnia? Take a pill like the rest of us!