I had a 255kg guy sign in yesterday with leg pain. His legs were probably protesting the 500+ lbs they were forced to carry around! Well, after pushing his w/c to a room I realized that I couldn't stand up straight or take a breath. I was in so much pain I broke out in a sweat and started crying. I am not a baby, I was in excruciating pain :( I was forced to sign in to be treated as a patient in my own ER.
I'm feeling a lot better today, but it still feels like I have a charlie horse in my side. I can't lift my arms or twist my torso without increased pain. I'm out of work now til monday. Kinda pisses me off that people can allow themselves to get so freaking big...seriously, isn't he the size of two refrigerators? Then I hurt myself trying to help them! There oughta be a law.
A friend of mine let me know what I missed today. 0730, someone had fallen from a second story window sometime in the night and was discovered come morning...skull fractures, pneumocephalus, hypothermic. Later someone was thrown from a horse...c6 fx. Then a nice cardiac arrest that they got back but ? hypoxic brain injury. Then a stellar citizen with a BAL of 495. ER waiting room bursting at the seams. Another day in paradise that I missed due to the incredible 255kg man.
Wednesday, September 12, 2007
Friday, September 7, 2007
Self injecting insulin?
There was a sick call at work the other day and I decided to work 11a-7p. I could tell from the minute I walked in that it was one of 'those days'. Security sitting in the hall 'guarding' someone, people moving with purpose, flags up on a lot of charts, charts in the 'right rack' where we put people who have been triaged back to the waiting room since all the ER rooms are full....the only things missing were the police and victims inc. Before too long they were in attendance too.
Since it wasn't my usual day to work I was put on the trauma assignment (my least favorite assignment...give me a nice clean MI (not inferior) any day) A friend of mine was on my usual assignment, cardiac. And she looked pretty busy with an admission and young diabetic who kept going hypoglycemic even with a D10 gtt and a few amps of dextrose. It wasn't really the time to hear the paramedics calling in with a guy who fell off his roof and was in respiratory arrest.
When the ambulance arrived it was obvious how severely injured this poor guy was. He was intubated and still, not the stillness of succs either. He was brought to a cardiac room briefly while CT was called, a dopamine drip was hung since he was hypotensive despite two large bore IV's w/o. During this I answered a call in the hypoglycemics room, she wanted something for pain....ummm, ok. I'll let your nurse know when she is done trying to save the guys life in exam #7.
CT revealed a C2 fracture with splaying. It just confirmed what we new....it wasn't good. We are a small, community hospital, and before the patient had even arrived we had called lifeflight to take him to a larger hospital, they were still 10-20 minutes out. As we don't even have a helipad the medics had to package the patient up to bring him to the small airport up the street that almost looks like farmer John's cows must be in the lower pasture this week.
My friend went in to check on her hypoglycemic patient and found an insulin syringe uncapped in the patients bed. The patient said that it must have fallen out of her purse, but my friend suspected that she had self injected insulin and that was why her glucose kept dropping. She lost it on the patient and they searched her things and found some oxycontin and a few other drugs, but not insulin that I know of.
This girl is known to us as someone whose baby came in with bilateral burns to her hands and who will have a 'seizure' when she doesn't get meds she asks for in the ER. So, I don't doubt that she would self inject insulin. The question is has she now crossed the line from drug seeking dirt bag to someone who should be IEA'd and lose custody of her child? She had already been reported to DCYF for the previous visit.
I know that I'm glad I wasn't in my usual assignment that day!
Since it wasn't my usual day to work I was put on the trauma assignment (my least favorite assignment...give me a nice clean MI (not inferior) any day) A friend of mine was on my usual assignment, cardiac. And she looked pretty busy with an admission and young diabetic who kept going hypoglycemic even with a D10 gtt and a few amps of dextrose. It wasn't really the time to hear the paramedics calling in with a guy who fell off his roof and was in respiratory arrest.
When the ambulance arrived it was obvious how severely injured this poor guy was. He was intubated and still, not the stillness of succs either. He was brought to a cardiac room briefly while CT was called, a dopamine drip was hung since he was hypotensive despite two large bore IV's w/o. During this I answered a call in the hypoglycemics room, she wanted something for pain....ummm, ok. I'll let your nurse know when she is done trying to save the guys life in exam #7.
CT revealed a C2 fracture with splaying. It just confirmed what we new....it wasn't good. We are a small, community hospital, and before the patient had even arrived we had called lifeflight to take him to a larger hospital, they were still 10-20 minutes out. As we don't even have a helipad the medics had to package the patient up to bring him to the small airport up the street that almost looks like farmer John's cows must be in the lower pasture this week.
My friend went in to check on her hypoglycemic patient and found an insulin syringe uncapped in the patients bed. The patient said that it must have fallen out of her purse, but my friend suspected that she had self injected insulin and that was why her glucose kept dropping. She lost it on the patient and they searched her things and found some oxycontin and a few other drugs, but not insulin that I know of.
This girl is known to us as someone whose baby came in with bilateral burns to her hands and who will have a 'seizure' when she doesn't get meds she asks for in the ER. So, I don't doubt that she would self inject insulin. The question is has she now crossed the line from drug seeking dirt bag to someone who should be IEA'd and lose custody of her child? She had already been reported to DCYF for the previous visit.
I know that I'm glad I wasn't in my usual assignment that day!
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. :)
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!
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.
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.
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.
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