ERnursey

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Get a Job
2007-11-18 17:41:00
This post at Monkey Girl got me going.I think there are too many people who don't have anything to do every day but sit and think about their problems. When you have nothing to take your mind off your real or imagined ills they start to grow in your mind until they are so huge that they obscure everything else. It's like when you wake up at 2 am and start worrying about something. Awake alone in the dare, the problem becomes monumental when in reality, and in the light of day, it is not nearly as bad.In our society there are too many people who do not work. There is a huge group of people on welfare as well as a surprisingly large contingent of young, able bodied adults who are on disability for such things as 'back pain' and 'fibromyalgia' among others. First of all don't get me going on how they get their disability approved when there are people with real disabilities and serious medical issues get denied.When you don't work you really don't have anything to do all...
More About: Get a Job

That thing is a BUG?
2007-11-17 04:09:00
I found this in my garage today, it was 3" long and clearly in its death throes. I have NEVER seen anything so incredibly disgusting in my life. I screamed so loud that I scared the dog. He spent the rest of the day following me around to ensure that I was OK. His idea of following is to walk three inches behind me so that whenever I change direction I either a)step on him or b)trip over him. Now I am afraid to go out into the garage. As a matter of fact, I'm kind of afraid to go outside either. I'm calling my bug guy first thing in the morning.
More About: Thing

Change of Shift
2007-11-15 19:05:00
Kim at Emergiblog is hosting Change of Shift this week so head on over there and check out the best posts of the week.

I'm not as dumb as you think I am
2007-11-15 05:06:00
I was reading my comments lately and someone cautioned me to watch my apostrophes. I got a good long laugh out of that one. It has been a looooonnnnnggggg time since English and punctuation was never what I would call my strong suit anyway. So let me apologize about not knowing for sure where to put that dang apostrophe, not knowing when to use a semi-colon or a colon and for my tendency to engage in run on sentences. I must drive cranky professor insane!But seriously. Everyday at work I encounter people who tell me stories that are so patently ridiculous that I can only assume that a) They are complete idiots or b)they think I am a complete idiot.For instance, I recently triaged a man who came in with a complaint of flank pain, possible kidney stones. During the triage he let it slip that he had been seen at hospital X across town. I asked him why he had not returned there and he told me he had called them and they told him that they wait was very long and told him to go to ...
More About: Dumb

I Hate This
2007-11-14 05:23:00
Do managers take special, secret classes in how to best aggravate and stress out their their staff members? I'm home on my day off, which happens to be a Friday, I've been out running errands and get home after five. I check the answering machine and I have a message from work. It is my manager: "We need to meet on Monday to discuss and issue, please come to my office before I start my shift." Arrrgh! Did you mean to leave that late Friday afternoon so there is no way I can get in touch with you and have to stew and worry all weekend? Of course you did.So I stew all weekend. What have I done? I thought I was being especially good, I haven't pissed off any of the floor nurses, my patients have all thanked me, I haven't dispositioned too many people to jail so what have I done? Did I make a med error and not realize it? I am fanatical about quadruple checking everything but it is always possible, oh my God, is the patient OK. Now I am freaking out. I don't sleep well e...
More About: Hate

Being a rebel
2007-11-13 04:13:00
I never get up with the idea that I'm going to cause trouble, I swear I don't, but sometimes I just can't help it.....it's like the devil just moves on in and takes control.Take today for example. I got up and went to work like any other day. The ER nurses have been a little up in arms lately since we found out that the administration have decided to give the critical care nurses a 5% premium. We were told we are not critical care. Despite the fact that we routinely care for incredibly sick and unstable patients that we STABILIZE before they go to the ICU. Despite the fact that we routinely hold ICU patients because of lack of beds. Some nights it looks like ICU south. But apparently we are not qualified to do so. Fine. We are fighting that one with the union.So an hour into my shift we get in a trauma patient who is well and truly FUBAR'd. He is so messed up that he can't even go to the OR. The ER is slammed, the waiting room is full and we are on diversion. Anoth...
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On a non-nursing note
2007-11-11 04:09:00
What is the problem with people that they all feel free to treat the world as their garbage can? I was driving down the freeway today and all along the side of the road is garbage. Cups, paper, boxes, buckets, bottles etc. etc. etc. It looks awful. And cigarette debris. I think it is a fairly well known fact that California is an inferno waiting to happen in the summer, the grass is so dry that you could set a fire by looking at it wrong and yet that doesn't stop people from tossing lit cigarette butts out the window and setting fires by the thousands. Every so often you'll come across a blackened patch, sometimes small, sometimes many acres. Hello you morons, just because you are too lazy to use an ashtray you are putting peoples homes and lives at risk.So in ERnursey's world the penalties would be:Tossing anything out the window that could start a fire: Pulled out of your car and shot on the side of the road and left there to rot. A couple of those and everyone else wo...
More About: Note , Nursing

The Draft
2007-11-10 03:21:00
After a night of drug seekers and malingerers we got to talking about what will happen if they reinstate the draft. After the question was posed we looked around the ER, which was filled with 18 - 30 somethings, most of whom had never known a day of work and all of whom listed Vicodin, Oxycontin, Klonopin, Ativan and Soma in various combinations on their med lists, and decided our country was screwed.I think our perceptions get skewed by what we see on a daily basis and I truly hope these people are not an actual representation of that age group. Surely there must be some gainfully employed, non drug addled adults out there somewhere.
More About: Draft

This isn't my definition of ecstasy
2007-11-09 16:20:00
Late one evening we got a call from EMS that they were bringing in a 20 year old female having seizures. When they arrived the patient was still seizing, the report was that it had been going on off and on for over 20 minutes. (At that time I lived in a community with no paramedics and mostly volunteer rescue squads)We swung into action, one nurse put oxygen on the patient and another started looking for an IV site, a third placed her on the monitor while I went and grabbed some IV Ativan, a medication like Valium that we give to people having seizures.When I got back to the room, the monitor was on, the patients HR was 180 and her BP was 224/130! As if that wasn't bad enough, a rectal temp was taken and it was 107! What the hell? We figured some sort of Amphetamines were involved, was she seizing from the high temp? We gave several doses of Ativan with no effect, the seizure continued unabated.Prolonged seizure can lead to massive muscle breakdown known as rhabdomyolysis. W...
More About: Definition , Ecstasy

Hey!
2007-11-07 04:57:00
I just found out that...........IMPACTED NURSE IS BACK!!!!!!!

A new approach to ER overcrowding
2007-11-07 04:43:00
Actually this is a very good idea but I imagine there are hospital administrators that are getting out the tar and feathers.h/t Scalpel

Trauma Center
2007-11-07 04:40:00
The first edition of the new blog carnival, Trauma Center , is up at Straight Talk from the Stanford ER. This is an ER themed carnival and the next edition will be in two weeks. You can use the blog carnival thingie on my sidebar to submit.

Watching Mama die
2007-11-06 04:38:00
The ETT is left in place but the ventilator is gone, along with the noise. The room is silent, the nurses motions are slow, gentle and hushed. Morphine has been given to allay any pain or air hunger.The lights are dim.In the distance the noise of the ER has receded like the dull roar of the surf, heard only faintly in the subconscious. All that matters is here, Grandmother to twelve, mother to four, beloved wife. Collapsed suddenly at lunch, CT shows brain full of blood, no hope of recovery or any sort of meaningful life the family has chosen to let her go.The children and elderly husband have gathered at the bedside, silent tears rolling down their cheeks.on the monitor, which is turned away from the families view the spikes grow further and further and further apart until they stop.The doctor pronounces time of death and expresses her condolences. The family wants to know if she knew what happened and did she suffer. We tell her that we don't think so, the injury to her brai...
More About: Mama , Watching

Are you on the phone or just nuts?
2007-11-05 05:31:00
Ok, the freaking bluetooth earpieces are ridiculous. What is so important that people have to be yakking on the cellphone every minute of the day. But it has enabled me to come up with a new game to entertain myself when I am waiting in lines and whatnot.....when I see someone yakking away, apparently to themselves, I try to guess if they are wearing an ear piece or if they are psychotic. It can be endlessly amusing.
More About: Phone , Nuts

Burnout and Death with no dignity whatsoever
2007-11-05 04:37:00
Came across a new blog today and read this. Reminded me of why I left the ICU setting, I am a firm believer in death with dignity. When I first started in the ICU, we went all out on those that could benefit and did comfort care on those that couldn't ie the patients with no hope of recovery. Over time I noticed that we were doing more and more on people that were going to die anyway and it began to feel like an endless torture of sick, elderly people. I saw doctors overturn patients DNR's when the family asked (when the patient was not able to speak for themselves) because they were afraid to get sued. I've participated in the intubation, insertion of multiple invasive lines and tubes in people with severe heart disease, diabetes, multiple amputations and strokes confined to a nursing home in their 90's for god sakes because the family 'wanted everything done.' At what point did medicine become 'have it your way' instead of what is medically indicated. Anyway, I could...
More About: Death , Burnout , Burn , Dignity

California says HAH!
2007-11-04 02:28:00
It was sunny and eighty degrees out today. I was wearing shorts and got a sunburn. For those of you that live in places where it didn't get above fifty today........HAH! Bet you aren't laughing at us now.
More About: California , Calif

Politics Explained
2007-11-04 02:27:00
FEUDALISM: You have two cows. Your lord takes some of the milk. PURE SOCIALISM: You have two cows. The government takes them and puts them in a barn with everyone else's cows. You have to take care of all of the cows. The government gives you as much milk as you need. BUREAUCRATIC SOCIALISM: You have two cows. The government takes them and put them in a barn with everyone else's cows. They are cared for by ex-chicken farmers. You have to take care of the chickens the government took from the chicken farmers. The government gives you as much milk and eggs as the regulations say you need. FASCISM: You have two cows. The government takes both, hires you to take care of them and sells you the milk. PURE COMMUNISM: You have two cows. Your neighbors help you take care of them, and you all share the milk. RUSSIAN COMMUNISM: You have two cows. You have to take care of them, but the government takes all the milk. CAMBODIAN COMMUNISM: You have two cows. The government takes both...
More About: Politics , Politic

Etiquette
2007-11-04 01:08:00
Whitecoat Rants has a funny rant about cell phones. I hate it when a patient or their family member is talking on the cell phone when I am in the room but you know what I hate more? Nurses that carry a cell phone and have an audible ringer and answer the damn thing when the are supposed to be working. What in the heck is the matter with people? I obviously was raised in a different age, or by different parents anyway. I was taught that when you are at work you are working. And when your own work is done there is always someone that needs help or something that can be cleaned or sorted or tidied. You don't sit on your duff at work, you don't make or receive personal phone calls except in dire circumstances. You don't call in sick unless you really are sick because it causes a burden on your co-workers and employer.Most of the time that isn't the case. I see people everywhere on the phone when they should be doing something else. For instance, one day I was at Wally world...
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How to go wrong with an Epi pen
2007-11-04 01:03:00
Wow, here's a new one on me, courtesy of Straight Talk From the Stanford ER.
More About: Wrong

Change of Shift
2007-11-03 04:09:00
This week's Chan g e of Shift is hosted by Mother Jones at Nurse Ratched's. I love the pictures and I bet you will too. Check it out!

Keep Quiet or Else
2007-11-02 04:31:00
The more things change the more they stay the same. Head on over to see what Girlvet has to say about it.
More About: Quiet

Do they think they are the first?
2007-11-02 04:12:00
Mental health patients are going to be dumped on ER's in Austin. Hmmmm. That certainly sounds familiar. A few months ago our county legislature, in their infinite wisdom (not), decided that it would help balance the budget if they closed the psychiatric hospital. So now, all the patients in psychiatric crisis come to one of the local ER's while we try to locate a bed for them elsewhere in the state, often fruitlessly. It is nothing for a patient to spend their whole 72-hour hold in the ER. When the 72-hours is up we have to let them go. In the meantime they have received no treatment and are in no better condition than when they arrived. Sickening.Some of these patients are a danger to staff and other patients. They are disruptive and upsetting to the sick and dying patients who are also in the ER. Staff have been hurt, several have quit in disgust. While the psychiatric patients are being held that is a room that can't be used to treat the ever growing backlog of ER pa...

What Really Happpens in the ER at Night
2007-10-31 17:21:00
Thanks to Kim for this pictoral essay of a night shift in the ER.
More About: Night

Alcoholim
2007-10-31 17:01:00
In a comment on my previous post about drunks Maria has a link to article about an apartment building in Seattle that the city built to house some of their chronic homeless inebriates. Of course there was the expected furor from the public because the residents are allowed to continue drinking. The public thinks "they should have to stop." Get a clue people, they aren't going to stop, they can't stop. On the street they drive up crime rates, drive down property values and cost you billions of dollars in taxes every year, sure I think they should just stop drinking too but obviously that isn't going to happen so how about an alternative to multiple ER visits and increased jail costs dragging them to the drunk tank.Two things about the article though, first it said that their had been 120 ambulance visits there and this was in 2006 so obviously they aren't doing enough to cut down on needless ER visits, how about hiring and training some care attendants of some sort to monito...

Drunks
2007-10-30 03:18:00
Today I had a drunk who was brought in by ambulance for the second time in 14 hours with a complaint of altered level of consciousness, duh....a BAC over .3 will do that to ya', you don't need a doctor to tell you that one. On the second visit he was found walking around with his broken IV tubing trailing along behind him dripping blood all over the ER. When asked why he bit his IV tubing in half he looked at it and said "Did I do that?" Steve Urkel lives.Seriously though, these people take up a huge amount of medical resources being paid for by your tax dollars. Since they can not appropriately take care of themselves they should be institutionalized which would be much cheaper for the taxpayers. And don't give me any crap about how we would be infringing upon their precious rights to drink themselves into a stupor every day and pass out in puddles of puke, shit and piss in public places so that someone has to call 911 to get them the heck out of there. That takes an ambul...

Odd things
2007-10-28 03:40:00
"My pain is a ten, it's really, realllllyyyyy baaaaad, zzzzzzzz, snort, it's the worstzzzzzzzzzzz" COME ON PEOPLE, if it is really bad you can't nod off while talking to someone, I've been there.Seen recently on a local off ramp is a man holding a sign 'Need money for pot.' I almost gave him a buck because I was so impressed he wasn't trying to scam me. I pass the same spot every day and sometimes will see the same pan-handler two or three times a week for months - "hey dude, you've been at this for quite awhile, haven't you got enough gas money to get home yet?"At the local supermarket I spot one of our regulars asleep in the landscaping, I inwardly groan and think that he'll beat me to work. Sure enough, a concerned citizen calls 911 fearing that there is a dead body and EMS duly delivers him to the ER for the 5th time this week.Terrified parents bring their toddler in for 'vomiting blood' in triage the child vomits a remarkable amount of day-glo red vomit. "look s...
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Business as Usual?
2007-10-25 15:48:00
Don't go to these hospitals until the strike is over, I cannot over-stress the importance quality, skilled nursing care has in good outcomes. Part of quality is adequate orientation to the hospital, a one day orientation just doesn't cut it. Yes, travelers do it all the time but they also have skilled staff there as a resource. Would you want your loved one crashing and all the nursing staff have less than 2 days experience in the hospital? Hell no. Seconds can make a difference in a critical situation and if the nurses don't know how to operate the equipment or find a crucial piece of equipment that can mean life or death. These hospitals should be sanctioned by DHS and JCAHO for continuing all but emergency services under strike conditions, I hope that the people in these communities will take their business elsewhere.
More About: Business , Business As Usual , Sine

Grand Rounds
2007-10-24 05:06:00
Oh heck, I forgot to submit to Grand Rounds this week. Check out this weeks edition at Pallimed.

How to Act out in public
2007-10-24 04:54:00
OK, I shouldn't have to tell you this but here goes....if you are an employee in my hospital and you come to the ER I will do all I can to expedite things as a professional courtesy. I cannot whisk you immediately into a room if there were other sicker people waiting first but I will do my very best for you. Do not come to the ER in your place of employment and act like an asshole. Don't make unreasonable demands, if you are sitting in a packed waiting room and there is a pale, sweaty puking person in a chair across the room don't throw a fit when I bring them back to a room first. Do not call the nursing supervisor and have her call me five times to ask me why I'm not bringing you back to a room, I will bring you back to a room as soon as I can. Do not sneak back and follow me around the ER asking me when I will bring you back and for damn sure don't interrupt me when I am in a room with another patient. As an employee of the hospital I would expect you to be a grown-up p...
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The Nurse is always to blame
2007-10-22 22:26:00
I was reading this post by Kim at Emergiblog and it really got my dander up. The hospital administration comes up with a stupid ass rule, the nurse is supposed to document exactly what medication and dose the patient says they are taking even if they know it is wrong and then when the doctor orders it incorrectly without verifying that the information is correct it is the nurses fault that it got ordered wrong.Excuse me? I don't think so doctor, you are a professional and as such are responsible for your own practice. I am not your babysitter. If you read the reconciliation sheet and it says Xanax 25mg you shouldn't just check off yes and move on. Of course the hospital administration is wrong in expecting the nurses to write down information that they know is erroneous but each of us is ultimately responsible for making sure our own practice is safe and without error.I worked at a hospital years ago that had gotten into trouble on the JCAHO survey because the doctors were no...
More About: Nurse , Blame , Always