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You Know It's Gonna Be a Bad Day
2008-05-10 05:19:00
I went in to see my first patient at the beginning of the shift only to find he had been incontinent of urine - the entire bed was soaked. I rounded up all the linen and bathing supplies and got one of the other nurse to help me. She rolled him over and I washed his back and bottom and pushed the dripping wet linen underneath him, usually I would start the dry linen but his old stuff was so wet we elected to roll him completely off of it to avoid getting the clean stuff wet. I reached across him and grabbed his shoulder and hip and rolled him to face me. He was kind of a big guy and ER gurneys are notoriously narrow so I had to roll him up against me to give the other nurse enough room to get the linen under him. Suddenly I felt a warm flood going down my leg and into my shoe. He was peeing and it was running off the mattress and all over me.The sad thing was the rest of the day was so bad being peed on was the high point.

Happy Nurses Week
2008-05-09 05:16:00
It's nurses week and the blogosphere is full of tales of gifts received from employers, pens, coffee cups, fleece jackets and so on.So what did my fine institution do for their nurses this year?Not a damn thing!

"We Need Some Help Out Here!"
2008-05-08 05:27:00
We got the panicked call from the ER greeter - "There's a mom here with her baby and it's having trouble breathing - I think you better get right out here."Our greeters are a very seasoned bunch and tend to not overstate things so we went right out there. Mom was about 20 and crying holding a limp, gray, grunting infant. I just grabbed the baby right out of her arms and headed to the 'crash' room without even looking to see if she was following. As I ran by the nurses station I yelled for help.Not only was she not breathing well she was having some sort of seizure activity. Like a well oiled machine the team swung into action. One nurse started assisting respiration's with an ambu bag while another searched for an IV site, a third put on the monitor leads which showed a HR of 210 and a pulse ox of 79%. Cap refill was delayed and the abdomen was hard as a rock."What happened?" the doctor asked the mom, who was hovering in the doorway.She came home from work and found the b...

How to tell if you have a problem
2008-05-06 05:31:00
So we have this doctor in town, there is one in every town, we call him doctor feelgood. All of his patients are on some cocktail of Oxycontin, Vicodin, Soma, Klonopin and so on. But.....to give him some credit, he expects his patients to adhere to the rules, he only gives out a months supply at a time and if he finds out you are going to other doctors or ER's - you're fired from his practice.Recently we had one of his patients that gave a history of being on high dose narcotics for back pain come in with vomiting. His story was nausea, vomiting and chills for 24 hours. On exam it was fairly obvious he was in narcotic withdrawal. When the doctor confronted him the patient admitted he had been out of his med's for two days.Brother, you've got a problem. You've used up a month's worth of med's in 17 days AND when your doctor finds out you've been here he'll probably give you the boot.When the ER doctor explained all this to the patient and told him that he would not giv...
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Too Much Sun
2008-05-04 04:38:00
I. Am. Sunburned.Too much yard work even with #50 sunblock but I made a lot of progress, got my drip irrigation set up and working so it will all be automatic now. But I'm absolutely glowing right now and sleeping tonight will be hell.With my pale Scandinavian skin I try to be very careful, I never go out unless slathered in sunblock, wearing a hat etc. Thankfully I don't burn all that easily, which you'd never believe if you saw me - fish belly white comes to mind. Not to mention that I am getting to the age when you don't want to actively seek out anything that will contribute to your wrinkles - they are doing fine on their own. But my care with the sun comes from another reason, one patient I just can't forget.I had a patient a few years ago that came in for vomiting. He was in his mid-forties and had metastatic melanoma. He hadn't noticed the unusual mole on his back - it was discovered after a visit to the doctor for some shortness of breath that just wouldn't go aw...

Things you hope never happen
2008-05-03 05:49:00
A long time ago in a hospital far, far away.It was January, the temperature was approaching zero and it was snowing like hell. The ER I worked in was in a resort town that was all but deserted in the winter. There was a PA and myself and we had seen a grand total of seven patients so far that day.It was after lunch. We had two patients in the department, a lady with vomiting getting IV fluids and waiting for lab results to rule out an appy and a little old man with chest pain that was waiting for an ambulance to transfer him to bigger hospital down the road to repair his broken hip. Both were sleeping and the PA and I were finishing up charting and charges.A car pulled up to the ambulance dock and a man helped his heavily pregnant wife out of the car. I went out with a wheelchair to help them."My water broke and there is something hanging out of me, I think it might be the cord."Oh my God. My heart almost stopped. We were a half an hour away from the closest hospital that did ...
More About: Hope , Things

Mylie Cyrus Scandal. Not.
2008-05-02 05:44:00
This IS NOT naked.What is the matter with people? I'm sure she shows a lot more skin at the beach without people getting all in a flap.I don't care for the makeup that makes her look like a freshly dug up corpse but other than that, there is nothing offensive about her back showing.Give the girl a break and get yourselves a life.
More About: Scandal , Cyrus

Things are never what they seem
2008-05-02 04:37:00
My patient was a petite, thin 16 year-old. She sat on the exam table, shoulders hunched and staring at the floor while her mother told the story."I found a towel saturated with blood in her hamper." I listened but mentally wondered exactly saturated was. People tend to over-estimate the amount of blood.The girl said she had started her period and had bled more than normal. She had awakened after it started and used the towel to clean up. She said the bleeding had pretty much tapered off and showed me a half saturated pad that she said was over an hour old.I wondered if she was pregnant and miscarried and was trying to hide it from her mom. I started an IV and drew blood for chemistry, blood counts and type and screen. I explained that we would have to do a pelvic exam. She had never had one before so I spent some time explaining the procedure and getting her ready.The doctor, a woman, had a reputation for unshakable calm. We positioned the girl in the stirrups and she gently...
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Your Tax Dollars at Work
2008-04-29 05:12:00
When we came on today we inherited a patient that had come in around 10 pm. She had been brought in by the police for being 'suicidal.' Her real problem was that she was extremely drunk and kept crying nearly incoherently "I just want to die." She had been incontinent of urine and stool as well as vomited all over herself. The night shift nurse, wonderful soul that she is, had bathed her from heat to toe, sent her clothing to the incinerator and found clean stuff from our closet where we keep clothes for the homeless. Now it is 7 am and her BAC is finally under 0.2 and she has told the psych resident that she is not suicidal, never has been - she must have just said those things because she was so out of it.Since she is denying suicidal thoughts we can't hold her so we call the police and they take her away for being 'drunk in public.'At noon we get an EMS report that one of the squads are coming in with a patient who was found by a passerby, passed out on the sidewalk. ...
More About: Work , Dollars

My Last Shift
2008-04-28 06:33:00
I signed into the computer 42,784 times because every time I stop to answer a family question or answer the phone it logs me off. 10111 of those times I typed my password, which is a combination of numbers and letters - some capitalized, wrong and had to do it again.The computer I was using froze up or crashed a total of 14 times requiring a reboot which takes two or three minutes each time. That is about a half-hour of wasted time.So tell me again how much this EMR is going to streamline documentation and increase my job satisfaction.
More About: Shift

Munchausen's by Proxy
2008-04-26 03:40:00
Unfortunately I've seen a lot of child abuse working in the ER. Munchausen's by Proxy is a rare form where a parent or caregiver induces illness in their child. Here is one example.It can go on for a long, long time before someone starts to suspect. The child's caregiver seems to be very concerned and loving, not the typical picture of the abuser.I was involved in a case where an infant was repeatedly brought to the ER for vomiting and failure to thrive. The baby was repeatedly hospitalized for hydration and the symptoms would quickly improve. After awhile the nurses noticed that the child would have vomiting after the mother came and did the feeds, even that at first didn't cause any suspicion. It took almost twenty admissions before someone became suspicious enough to put the baby in a room with a camera and monitor the mother. She was found to be putting a substance in the babies bottle that turned out to be ipecac. Twenty admissions and untold ER visits with blood dra...

More public health issues
2008-04-24 06:08:00
Parents, if you suspect your child has chicken pox do not bring them to the ER or, for that matter, your pediatricians office. If you do, you will expose a lot of people who shouldn't be exposed - people with weakened immune systems for which chicken pox can be fatal, Pregnant women, the elderly and other children.treat fever if your child is uncomfortable, give them plenty of fluids, oatmeal baths or calamine lotion for itching. It is an emergency if your child can't keep down fluids, if they are lethargic, complain of a bad headache or stiff neck, seizures, have difficulty breathing or the rash involves an eye. Also seek medical attention if the pox appear infected.If you do feel you need to seek medical attention, please call ahead to the ER or pediatricians office and let them know you are coming so we can properly isolate your child, chicken pox is EXTREMELY contagious.
More About: Health , Public , Issues , Public Health

Public Health Issue
2008-04-23 05:09:00
Dear Nurse Practitioner, The next time you think you have a child with measles please do not tell the mother to go to the ER where she and said child will sit with 200 other people in the lobby for several hours to be seen for the "rash" because mom isn't very fluent in English. When it is discovered that said child does have the measles public health becomes involved to try to track down all the people who may have come in contact with the child while sitting in the lobby, a rather daunting and time consuming task.So consequently public health is not happy, the ER staff is not happy and all the people who had to have a dose of immune globulin are definitely not happy.Great job.In the future, if you suspect a communicable disease please contact public health where you will find a nurse on call, 24/7 to guide you in how to handle things without causing a public health disaster.Your friendly ER staff, some of which now have sore asses
More About: Health , Public , Public Health , Issue

Grand Rounds
2008-04-23 04:57:00
Grand Rounds is hosted (hostessed?) by Val Jones MD this week. Head on over.
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A Nation that can't say NO
2008-04-21 04:50:00
When did we become a nation that can't say no?From infancy the parents are taught the extreme importance of bolstering a child's self-esteem. Don't ever tell them they are bad because it will give them bad self-esteem. Children today have no rules, they are never made to behave and grow up to be horrible little brats who can 'do no wrong' in their parents eyes.So from early childhood the sense of entitlement has become well instilled.In my job I see it all the time. A patient calls an ambulance because they have an ear ache. The ambulance must go, they must transport the patient to the hospital. The EMS crew cannot tell the patient that they don't have an emergency and to find their own ride. They are not allowed to even educate the patient that it is inappropriate to call an ambulance for an earache. God forbid we upset the patient or make them unhappy.So off to the ER they go. Is the ER allowed to tell the patient they don't have an emergency or that it is inappropr...
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A little faux pas
2008-04-17 05:24:00
A post on nurse K's blog reminded me of a funny thing that happened one time (in sort of a dark, sick way.)It was the weekend in upstate NY and it was hazy, hot and humid. Peoples tempers rose in direct correlation to the heat index and we were experiencing a sharp upswing in shootings, stabbings and assaults.It was 8 pm and the ER was slammed to the rafters, all hallway beds full, two gunshot wounds in the trauma bays and a code going on in the critical section. There were about a thousand cops, nurses, residents, attendings and ancillary staff running around the ER in barely controlled chaos.The code was called. Before we could even get our breath we got the call that there was a five car pile up on the interstate with approximately 10 criticals and 5 minors. Since we were the trauma center we knew we'd get at least three of the most critical. The problem was that there was nowhere to put them.Out of desperation we quickly did post mortem care on the code patient. There wa...
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Dear staffing office
2008-04-16 05:55:00
If you ever call me at 4 pm on Monday afternoon and tell me you didn't 'get to' finding some staff for nights on MONDAY when they are going to be three nurses short......I will have a psychotic episode.Don't say I didn't warn you.
More About: Office , Staffing

Whooping Cough
2008-04-16 04:55:00
The baby was 9 months old, his birth weight was 8 lbs 5 ounces. At six months he weighed just shy of 20 pounds. Today he weighed 15 pounds - he was a skeleton and he was dying.Mom had brought him in after treatment by his naturopath had failed. Constant coughing had made it impossible for him to take in adequate nutrition and starvation, coupled with a raging bacterial pneumonia were conspiring to shortly end his very short life.We worked feverishly. Intubation, IV boluses, major antibiotics, vasopressors. All futile.At 9:03 pm, after 30 minutes of cardiopulmonary resuscitation we pronounced him dead.This boy had pertussis. His mother choose not to vaccinate him. I won't enter that debate. Anyone who has ever watched a child die or become permanently disabled from a preventable illness supports vaccination.From Pkids.org:Babies may bleed behind the eyes and in the brain from coughing.The most common complication is bacterial pneumonia. About 1 child in 10 with pertu...
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Red Flag
2008-04-15 05:24:00
When you have had 47 ER visits this year and they are all for back pain, migraine and dental pain...........IT'S KIND OF A RED FLAG!And in case you are wondering what causes ER overcrowding, this is one of the reasons.
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feeling sorry for myself?
2008-04-14 03:38:00
I got to feeling sorry for myself the other day.Then I was surfing the 'net and read about people in other countries that live in one room shacks, dirt floors, no running water or plumbing and having to cook over an open fire on the floor.Kind of puts things into perspective doesn't it?
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This is what nursing is
2008-04-14 03:02:00
Go read this incredibly powerful, moving story of caring for a dying man and his family. Caring for the patient is only part of the job.
More About: Nursing

Six Word Meme
2008-04-11 15:39:00
My friend, Whitecoat Rants, has tagged me for a meme.Here are the rules:1. Write your own six word memoir.2. Post it on your blog and include a visual illustration if you want.3. Link to the person that tagged you in your post and to the original post if possible so we can track it as it travels across the blogosphere.4. Tag at least five more blogs with links.5. Leave a comment on the tagged blogs with an invitation to play.I'm not tagging, feel free to play.My six words are......A day without a book.....SUCKS!
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No Death with Dignity Here
2008-04-11 04:24:00
This picture speaks a thousand words.
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More on the idiocy that is JCAHO (with a little Press-Gainey thrown in)
2008-04-11 04:12:00
A couple of great anti-JCAHO rants today.The first is found at MDOD, 911 Doc you are my hero.Then for a little bit more check out this post at Respiratory Therapy 101.As much as I hate the idiocy that is JCAHO, what really is frightening me is the talk that reimbursements are going to be tied to patient satisfaction scores. I can see how that is going to be..."I want a prescription for Vicodin." says the patient that was in two days ago for the same bullshit complaint. "OK" says the poor doctor who has been threatened with his job if he doesn't keep patient satisfaction scores up.Doctors and nurses will be leaving the profession in droves. Perfect.
More About: Press , Idiocy

Dear Doctor
2008-04-09 05:33:00
If you come out of a patients room and walk past the supply cart and come all the way out to the nurses station to write an order to give the patient a urinalI WILL BE TEMPTED TO CHOKE THE LIFE OUT OF YOU.It is not beneath you to hand the patient a urinal.
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READ THIS
2008-04-07 06:09:00
Eloquently said.
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Nursing 101
2008-04-07 05:25:00
I know I sound like a hardened old bitch but I actually work very hard to make sure that my patients are as clean, dry, wrinkle free and comfortable as possible. When I went to nursing school we were taught how to be a nurse which is a lot more that being able to read EKG's and titrate drips. The high tech stuff is important, it's what makes our patients get better but it won't mean a thing to them if they are laying in a pile of wrinkled linen with no blanket.So in case you missed nursing 101:keep the linens wrinkle free. Have you ever been sick and laying in a damp wrinkly bed, it makes you feel worse. When your patient comes back from a test is in the rest room, take 5 seconds and straighten out and tuck in the sheet. If it is damp, throw it in the linen hamper and grab a new one.Keep them warm. ER's are cold and the patients are scantily clad. Bundle them up. I am a 50ish, post-menopausal in full hot-flash city but when I had to go to the ER I was freezing! Those wa...
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Have you ever wondered........
2008-04-06 04:42:00
Have you ever wondered why a woman with a complaint of vaginal discharge comes to the ER with her three kids? I mean, what does she think we are going to do with them during the pelvic?Have you ever wondered why the men who are all pierced and tattoo'd are the ones most likely to vagal out when getting stitches?Have you ever wondered why all the mandatory meetings are scheduled at 1pm which is the equivalent of 1 am to the night shift?Have you ever wondered why your boss will call you in on your day off because you didn't complete some form but won't let you know you have a subpoena waiting until you come back from your stretch of days off and find out you missed a court date?Have you ever wondered if your patients really think you believe them when they tell you their Vicodin prescription blew out the window of their car/got stolen by their girlfriend/got eaten by the dog?Have you ever wondered what your patients home looks like when they come in with filthy hair and clothes? (...

More Idiocy from the Governator
2008-04-05 04:20:00
Oh yeah, and medi-cal reimbursements are going to be delayed, half a month in July and the whole month of August.Since over half of our income comes from Medi-cal payments imagine what that is going to do to our hospital.
More About: Idiocy

Change of Shift
2008-04-04 06:25:00
Change of Shift is hosted by the fabulous Nurse Chapel (of Star Trek fame) via Nurse Ratched. How I envy nurse Chapel, working in a time when all you have to do is run the scanner over the patient and it tells you what is wrong with them, no more 4 hour workups!
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