Friday, August 10, 2007

Do it yourself 'time release' pills

A guy signed into the ER today with complaints of abdominal pain, nausea and vomiting. During the triage he revealed that he was going on a boat trip and decided to put his pills into a plastic bag and swallow it to make his pills 'time release'. The pills he swallowed included oxycontin and methadone. He really is a darwin award candidate!

The Ibuprofen and Tylenol Miracle Cure!

Mr. D has been coming to the ER by ambulance with 10/10 chest pain for weeks. States he has had a triple-bypass (with no scar), and loves his narcotics. Every visit his EKG's and enzymes are totally normal, but he has been getting narcs galore then signs out AMA when we suggest he be admitted for evaluation by a cardiologist since his chest pain is not responsive to any treatment.

Yesterday he came in again, reeking of cigarette smoke and alcohol. EKG-normal, VS-normal, Labs-drawn. The ER doc decided that there would be no narcs this visit, and told the patient. I brought him some tylenol and ibuprofen for his 10/10 chest pain. Poor guy was in so much pain he couldn't even lift his arms to hold the cup.

Miraculously, within five minutes, he was able to get off the stretcher, pull off his leads, rip out his IV, and get dressed. I had to chase him as he was leaving to try to get him to sign his AMA form, which he refused. He was in a hurry to get to a 'Hospital that can help me'.

As far as I'm concerned we did help him! After all, before the tyleprofen he couldn't even lift his arms. :)

Monday, August 6, 2007

Holding Patients

The hospital where I work is undergoing renovations, and has been in the 13 years I have been there. We have a higher patient volume and fewer rooms. Many times over the past several months the ER has had to hold patients that have been admitted. A month ago we were holding so many patients that we only had four beds to see ER patients in one morning!

We don't get help from the floors with these patients. A nurse for holding patients would be wonderful, help to put orders in would be nice too. We will have patients with med/surg, tele or ICU admissions along with the usual ER patients. Sometimes admitted patients will have orders missed and it is really difficult to provide the support and education to the patients and their families that they need while trying to take care of ER patients too.

I got a call today to ask for help with holding patients tomorrow. It's my day off but I'm going in. Hopefully there will be some discharges on the floors and we can have our ER back!

Sunday, August 5, 2007

Rx for the RN

I have had a Rx on my fridge underneath a magnet my mother gave me of an angel-nurse. The prescription is for Bitchstop-maximum dose-repeat for infinity. This prescription was given to me on a particularly hellacious day in the ER by one of my favorite MD's.

Today I received a new Rx from another physician. We were discussing Napoleon, of all people, and I jokingly observed how much he and le petit caporal had in common. To which he replied-'Kiss my ass!' I promptly asked him if that was an order-and if so to write it as such. Now I have a prescription for 'Kiss my ass-STAT-QD-PRN' under my angel-nurse magnet too.

I'm pretty sure this is a class A substance and may be extremely addictive.

Wednesday, August 1, 2007

Head on -vs- Grampas Dementia

Not long before my shift ended yesterday I heard a tone out for one of the neighboring towns ambulance crew for a head on collision. I think their ambulance is mostly EMT's so as I expected our medics were toned shortly after.

Just before that I had a patient triaged into trauma. 90 year old guy with a history of dementia, lived with his family and had gotten up several times the night before and tried to make his bed because he thought it was morning. I worked in a nursing home as a CNA years ago and we called that 'Sundowning' then. Grampa was a little more disoriented throughout the day and at 1800 on a Tuesday night it was an emergency.

I went into the trauma room and found a very pleasant gentleman sitting and reading the evening paper with his son and daughter in law. He was A&O x3, but some labs and a CT were ordered 'just to be on the safe side'. One of the medics joked that 'the families vacation must start tomorrow and they want Grampa in the hospital for a few days'. It wouldn't be the first time. I was pretty sure the tests would be unremarkable and the patient would be sent home to follow up with his PCP.

The night shift was just arriving as the ambulances started pulling up from the head-on. Apparently a young lady in a SUV was on the cell phone and crossed the center line striking another car head on at the top of a hill, dragging the other car 60 feet back down the hill.

We had four patients with multiple fractures and one with head trauma, as well as a person not involved in the MVA who had an asthma attack come in all at once. In the middle of this Grampa's son, who is one curtain over from a girl who is boarded and collared and screaming in fright and pain despite 10mg MSO4 and 100mg Fentanyl, lets us know that Grandpa hasn't had dinner yet.

I'm sorry, excuse me? I'm no longer surprised about what some people will consider emergencies, but it never ceases to amaze me when people will be oblivious to the actual emergencies around them and expect us to interrupt what we are doing to tend to them.