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.

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...

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!

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

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...

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!!

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.

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.

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!