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

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!!

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!

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...

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---

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!!

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.

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.

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"

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?