The Nights of My ER.....: January 2009

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...

Oh yeah I almost forgot....

This blog is here for yours and my entertainment..
All identifible characterizations have been changed to protect the not so innocent or smart so they may show their faces in our town.
If you think any of this might be about you or your family you are wrong and should have that paranoia problem addressed..
All HIPPA regs have been noted. Though not always appreciated.
All opinions expressed here are mine and mine alone.. and not shared by any facility,administration, or co-workers I come in contact with., and they are all thankful for that.
All medical information written here is for fun, and in no means should be used to treat,diagnose or otherwise used in an intelligent conversation.
Now that should CMA... On with the show!!

Math Quiz for ED Staff

1. You are assisting a primary nurse with charcoal administration down an orogastric tube. The room measures eight feet by twelve feet. The patient starts to retch before the tube is pulled. Knowing that charcoal can spew out of a tube in a five foot radius (even with a thumb over the opening) and the stretcher is two feet wide, how many feet per second do you have to back up to get less charcoal on you than the primary nurse?
2. Doctor A picks up a chart out of the rack. S/he finds that it is a repeat patient with abdominal pain. Doctor A puts the chart back. Doctor B picks up the chart five minutes later and also returns it to the rack. Doctor A leaves the nurses' station heading south at three miles per hour. Doctor B leaves the nurses station for the doctors' lounge at five miles per hour. How long before the patient is at equal distance from Doctor A and Doctor B?
3. You were assigned two large treatment rooms and the gynecologic room. By the end of the day you have cared for ten patients. Four patients were female over the age of 80, all complaining of weakness. Two patients were male, ages 72 and 50. The last four were female, between the ages of 24 and 40, all complaining of abdominal pain. It is 3:00 p.m. and time to restock the rooms. How many bedpans will you need?
4. You are the primary nurse for an elderly patient with congestive heart failure. The IV stick was exceptionally difficult, but you are able to start an 18 gauge catheter on the second attempt. You leave the room to check on another patient. A relative thinks that the IV has stopped dripping and opens the clamp. How much IV fluid will infuse before you return?
5. You are sent for your morning coffee break. You need to use the restroom but can't find one unoccupied and have to walk down to the lobby. The coffee pot is dry and you have to make more. When you get to the cafeteria, the line extends ten feet into the hallway. You can't remember exactly when your break began. How much time do you have left?
6. You are the primary nurse taking care of a particularly shy female in the gynecology room. Her private physician arrives to see her, but you can see that he is not in a particularly good mood. After much coaxing, the patient agrees to a pelvic exam. How many people will open the door during the exam?
7. An elderly man arrives in the Emergency Department by rescue squad. Twenty minutes later his wife arrives and registers him. She is shown the entrance to the department and slowly shuffles in. How many rooms will she walk into before she finds him?
8. You are assigned to the EENT room. You have a patient to be checked for a peritonsillar abscess. The ENT physician has been paged and expects to arrive in 45 minutes. Three hours later, he arrives and is at the patient's side, asking for a flashlight. Lightly jogging at 22 miles per hour, how many rooms will you have to search before you find one?
9. You have been asked to cover a coworker's rooms during her break. One of her patients is an elderly, confused male with an enlarged prostate. A catheter has been inserted and his physician is coming to see him. Somehow he manages to get off the stretcher. The drainage bag is firmly hooked to the side rail. Knowing that the catheter is 16 inches long and the drainage tubing is three feet long, will he be able to reach the door before pulling out the catheter?
10. A college student named Muffy is brought to the Emergency Department with a sore throat. She has no relatives in the area. Will there be enough chairs in the waiting room for deeply concerned significant others?

Written By Myka Clark

RULES for the EMERGENCY ROOM

Here are some tips to those who may end up in an ER, be it yourself or a family member.

-If it requires the ambulance team and entire truck crew of firefighters to transport you and safely place you on a hospital stretcher, it is time to go on a diet.
-Never start out by saying, "I was searching the Internet . . . "
-When asked how much you weigh, please do not give the "Deer-In-The-Headlights Look", and tell us you "really don't know". It's a simple question with a simple answer.
-Just because you have a phone and know how to call 911, we are not impressed by your arrival on an ambulance stretcher. You had better be sick.
-If you came escorted via EMS for multiple complaints that started more than one week ago and your entire family followed the ambulance to the hospital, you will be labeled a ninnie and treated like one, enjoy the waiting area with your family.
-One complaint/ailment per visit.
-Just because you came in on a ambulance, doesn't mean you're going home on one. You better start making arrangements, now. I am not driving you home, or figuring out how to get you home. Cab vouchers are not an option.
-If you have one of these four, go to your own doctor in the morning: a Migraine; the Flu; a stomach virus; or a stuffy nose.
-Do not ask us how long it will be. We don't know. I don't know what is coming through my door 30 seconds from now,so I sure as hell don't know when you're getting a room.
-We have priorities. We understand that you have been waiting for two hours in the waiting room. If you don't want to wait, make an appointment with a doctor. The little old lady that just walked in looking OK to you is probably having a massive heart attack. That is why she goes first.
-If your mother is a patient and we ask her a question, let her answer it.
-If your child has a fever, you had damn well better give him Tylenol® before coming in. DO NOT let the fever remain high just so I will believe the child has a fever. Do you want your child to have a seizure?
-If you are well enough to complain about the wait, you are well enough to go home.
-Do not utter the words "it is in my chart", I don't have your chart, and I don't have the time to call and get it. Just tell me. It is faster.
-We know how many times you've been to an ER. We can usually tell if you are faking it during the first 5 seconds of talking to you. Do not lie to us. If you lie about one thing, we will have to assume you are lying about everything.
-If you are a female between 16 and 42 and your last period was between 28-35 days ago, please don't waste our time if you are here for Abdominal Pain & Vaginal bleeding. Guess what!!?? You got your period, again.
-Do not bring your entire posse with you. One person at the bedside is all you need.
-Every time I ask you a question, I learn more about what is wrong with you. I don't care if I asked you what day it is four different times. Each time I ask, it is for a reason. Just answer the questions, regardless whether you have answered them before.
-If you want something, be nice. I will go out of my way to piss off rude people.
-Our definition of sick is not your definition of sick. If a member of the ER staff says that someone is sick, it means that they are in the process of DYING. They have had a massive stroke, are bleeding out, having a heart attack, or have been shot. We don't consider a kidney stone, sick. Painful, yes. Sick, no.
-There is a law (similar to Murphy's) in the ER. If you have four patients: one of them will be sick (see above for definition); one of them will be whining constantly; one of them will be homeless; and one of them will a delightful patient. (don't be the whiner).
-If you see someone pushing a big cart down the hall at full speed and you hear bells going off, do not ask for a cup of coffee. Someone is dying, you inconsiderate a*****e. In the ER, bells don't ring for nothing. Sit down, shut up, and let us work.
-If you can bi**h about the blood pressure cuff being too tight, or the IV hurting, you are not in that much pain.
-Physicians and nurses are not waiters. We are not customer service representatives. This is not McDonald's®, and you may NOT have it your way. Our job is to save your life, or at least make you feel better. If you want a pillow, two blankets, and the lights dimmed, go to the Ramada®.
-If you have any sort of stomach pain and you ask for something to eat, you are not sick.
-Do not talk s**t about the other members of staff I work with. The doctor that you hate? I work with him every day, and I know that he knows what he is doing. I trust him a lot more that I trust you. I am not here to be your friend, and neither is he. I will tell him what you said, and we will laugh about it. If you want a buddy, go somewhere else.
-If you are homeless, don't ask for a bus token or cab voucher to get home. It just confuses the staff.
-Please don't tell us how to do our job. Do we go to your place of business and tell you how to do your job?
-Please don't bring in a "show and tell". If you have to fish it out of the toilet, it's really not necessary to bring it in, we will take your word. If you did fish something out of the toilet, you may not use my pen.
-author unfortunately not me.

The Nights of My ER.....

Sunday, January 11, 2009

Influenza update

MIss me?

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Math Quiz for ED Staff

RULES for the EMERGENCY ROOM