typical overcrowding, understaffing.... took a patient assignment for the first time in awhile. it was kind of nice to just have my 4 rooms to worry about.
coded a lady in the parking lot, that was fun. we couldn't figure out how to get her out of the wheelchair van. Once we got her out, got her into the room, we got her back! score one for the home team!
Later on, the intensivist came to write her admission orders. He asked me what happened, so I told him the story. After congratulating me on "resurrecting her", he then asked if I thought she was in respiratory failure and I said yes. Then he asked if I thought she needed dialysis and I said yes. He said "ok" and left.
ummmm..... what????? aren't you the doctor??????
and the beat goes on.
Tuesday, January 26, 2010
Sunday, January 10, 2010
This one goes out to all the fatties.
Why do you make so much more work for me?
Example #1 - 450lb lady who called 911 for her abdominal pain. She came from some kind of shelter/halfway house I guess.... She was already there when my shift started. I took report from the other nurse who told me that all she needed was to give a urine sample and that likely she'd be discharged as soon as that came back since all the other tests were normal.
10 hours later (yes, 10) and several failed attempts later, I had the opportunity to dive into the nasty folds of obesity to do a straight catheterization to get the above-mentioned urine sample as she "just couldn't go." I will not elaborate further on this as it was traumatizing even for me. We had to go this route because I refused to hold the cup for her so she could hold up her GIGANTIC stomach. She got CT contrast and if you have ever taken oral contrast, you know why I did not want to get my bare arm anywhere near that.
Over the course of these 10 hours, I probably told her 50 times that she could not eat until we had all the tests back. She also repeatedly asked for a cab voucher so she could get home. I told her that we do not do cab vouchers but that we could give her a bus token to catch the Metro bus. She refused this every time I offered. She then accused me of not giving it to her bc she was black and bc I didn't like her. While the latter was true, I told her I couldn't give her something I didn't have to give. Then she wanted to speak with my supervisor who very quickly told her the same thing.
At this point, she was refusing to leave. I told her she had been discharged from the hospital and had to leave. She again asked me for a cab voucher. I again said no. She then got angry and decided to drop the gown and walk to the bathroom stark naked. That was a sight nobody wanted to see. Then she came back around and sat down dressed and asked some innocent bystander to get her nurse for her. She asked again for a cab voucher. I gave her 2 bus tokens and reminded her that we don't have cab vouchers. She still refused to go. I promptly called security to get her out of there. I could not deal with her anymore. Security escorted her to the waiting room where she can leave or not leave or find a ride or not, I didn't care. Then the security guard came back and found me and asked for a cab voucher or a bus token for her. I told him I ALREADY GAVE HER 2 BUS TOKENS. OH MY GOSH PEOPLE!!!!!!!!!! This was like the patient from hell. I barely managed to get her out by the end of my 12 hour shift. By the way, all the tests were normal so all of this was a waste!!!
Example #2 (for all of you have made it this far): Last night I was floating at work, which means that I just cover people for lunch, respond to the Stat team calls from the ground-2nd floors, respond to codes, strokes, STEMI's.... I had literally just finished running back-to-back codes (I hadn't even finished pulling the sheet over the one when I hear the alert go out again...) Anyway, I was finishing up my charting on both codes when one of the peds nurses came over and begged for me to come try a hard-stick in peds.
I say sure, why not? I will stick anybody and most times I can get it, even in Peds. She directs me to the room where I find the fattest baby I have EVER seen. 4 months old and 25 POUNDS. For all of you who don't know baby weights and things, a baby should be twice their birth weight at 6 months and 3 times their birth weight at a year.
This baby was 7 lbs at birth, so she shouldn't even have been 14 lbs. The extra 11 pounds were stored as pure fat. She had thighs that rivaled Tanya Harding. This child had so much fat tissue that the peds nurses stuck her 5 times and couldn't even get blood.
3 tries later and I got a working IV and blood but still, I could not believe how disgusting it was. At this rate she'll be 50 lbs at 1 year old! She won't even be able to develop because she won't have the muscle strength to support all that extra weight. Sad.....
And that is the summary of my ode of anger to the fatties.
Example #1 - 450lb lady who called 911 for her abdominal pain. She came from some kind of shelter/halfway house I guess.... She was already there when my shift started. I took report from the other nurse who told me that all she needed was to give a urine sample and that likely she'd be discharged as soon as that came back since all the other tests were normal.
10 hours later (yes, 10) and several failed attempts later, I had the opportunity to dive into the nasty folds of obesity to do a straight catheterization to get the above-mentioned urine sample as she "just couldn't go." I will not elaborate further on this as it was traumatizing even for me. We had to go this route because I refused to hold the cup for her so she could hold up her GIGANTIC stomach. She got CT contrast and if you have ever taken oral contrast, you know why I did not want to get my bare arm anywhere near that.
Over the course of these 10 hours, I probably told her 50 times that she could not eat until we had all the tests back. She also repeatedly asked for a cab voucher so she could get home. I told her that we do not do cab vouchers but that we could give her a bus token to catch the Metro bus. She refused this every time I offered. She then accused me of not giving it to her bc she was black and bc I didn't like her. While the latter was true, I told her I couldn't give her something I didn't have to give. Then she wanted to speak with my supervisor who very quickly told her the same thing.
At this point, she was refusing to leave. I told her she had been discharged from the hospital and had to leave. She again asked me for a cab voucher. I again said no. She then got angry and decided to drop the gown and walk to the bathroom stark naked. That was a sight nobody wanted to see. Then she came back around and sat down dressed and asked some innocent bystander to get her nurse for her. She asked again for a cab voucher. I gave her 2 bus tokens and reminded her that we don't have cab vouchers. She still refused to go. I promptly called security to get her out of there. I could not deal with her anymore. Security escorted her to the waiting room where she can leave or not leave or find a ride or not, I didn't care. Then the security guard came back and found me and asked for a cab voucher or a bus token for her. I told him I ALREADY GAVE HER 2 BUS TOKENS. OH MY GOSH PEOPLE!!!!!!!!!! This was like the patient from hell. I barely managed to get her out by the end of my 12 hour shift. By the way, all the tests were normal so all of this was a waste!!!
Example #2 (for all of you have made it this far): Last night I was floating at work, which means that I just cover people for lunch, respond to the Stat team calls from the ground-2nd floors, respond to codes, strokes, STEMI's.... I had literally just finished running back-to-back codes (I hadn't even finished pulling the sheet over the one when I hear the alert go out again...) Anyway, I was finishing up my charting on both codes when one of the peds nurses came over and begged for me to come try a hard-stick in peds.
I say sure, why not? I will stick anybody and most times I can get it, even in Peds. She directs me to the room where I find the fattest baby I have EVER seen. 4 months old and 25 POUNDS. For all of you who don't know baby weights and things, a baby should be twice their birth weight at 6 months and 3 times their birth weight at a year.
This baby was 7 lbs at birth, so she shouldn't even have been 14 lbs. The extra 11 pounds were stored as pure fat. She had thighs that rivaled Tanya Harding. This child had so much fat tissue that the peds nurses stuck her 5 times and couldn't even get blood.
3 tries later and I got a working IV and blood but still, I could not believe how disgusting it was. At this rate she'll be 50 lbs at 1 year old! She won't even be able to develop because she won't have the muscle strength to support all that extra weight. Sad.....
And that is the summary of my ode of anger to the fatties.
Tuesday, December 29, 2009
I should have known
that work was going to be bad yesterday. First and foremost, it was Monday in the ER. Unfailinginly this the worst day to work. I should have really known it when I get to work and the charge nurse says to me and another co-worker "Hey can you guys do me a favor?" We asked "What is the favor?" She then asks us to go bag and tag a body. Groaningly we oblige. Then we find out that this is not your typical bag/tag job. This is a 9 month old baby girl. Sadness. What an awful start to your day.
Then I got sent to Peds which I don't mind every now and again. Then I got sent to our version of fast-track. Then I came back down and went to triage. Definitely crazy. We have a 10 minute window to get an EKG on everybody who has chest pain. OUr triage area has 3 beds for EKG's. At any given point I had 5 or 6 people back there and more chest pain people waiting.
On a happier note, I am basically off for 4 days! I have to work 4 hours on Thursday but I don't care about that at all. It doesn't count. :)
Then I got sent to Peds which I don't mind every now and again. Then I got sent to our version of fast-track. Then I came back down and went to triage. Definitely crazy. We have a 10 minute window to get an EKG on everybody who has chest pain. OUr triage area has 3 beds for EKG's. At any given point I had 5 or 6 people back there and more chest pain people waiting.
On a happier note, I am basically off for 4 days! I have to work 4 hours on Thursday but I don't care about that at all. It doesn't count. :)
Thursday, December 17, 2009
Untitled
Couldn't think if a way to title this weirdness.
19 y/o M complains of general weakness for a week, no energy, poor appetite and "taste bud changes." How did he test it out? After I cleaned the IV site with Chloraprep, he decided to lick it and see if he could taste it.
What on earth.
19 y/o M complains of general weakness for a week, no energy, poor appetite and "taste bud changes." How did he test it out? After I cleaned the IV site with Chloraprep, he decided to lick it and see if he could taste it.
What on earth.
Monday, December 14, 2009
People have a lot of nerve....
and no modesty. These things are a bad combination that turned particularly unfortunate for me this week. I came out of patient's room and found a patient wearing ONLY a hospital gown (i.e. no underwear) sitting at my desk checking her email and talking on the phone. I promptly ended the web browsing and the conversation and got myself a new chair. DISGUSTING. This is the same person who asked me to send all her calls to her while she was in xray. She got a ton of calls. I answered none of them.
As if that weren't enough, somehow I got roped into doing 4 hours of peds triage. This becomes quite difficult when out of 20 kids I did in 2 hours, only 2 or 3 sets of parents spoke English. My personal favorite was "My son has a fever." When I ask how high, the parents say "97." I did not know what to type as my triage. Chief-complaint: non-fever. :) Did see 2 really sick kids. 8 weeker with room air sats of 79% who ended up going to NICU and a 2 week old baby with a *real* fever who bought himself a full sepsis work-up including a lumbar puncture after the WBC's came back @ 20k.
Off for 3 days, getting geared up for the hubby's Christmas party that we are hosting. Should be interesting to say the least!
As if that weren't enough, somehow I got roped into doing 4 hours of peds triage. This becomes quite difficult when out of 20 kids I did in 2 hours, only 2 or 3 sets of parents spoke English. My personal favorite was "My son has a fever." When I ask how high, the parents say "97." I did not know what to type as my triage. Chief-complaint: non-fever. :) Did see 2 really sick kids. 8 weeker with room air sats of 79% who ended up going to NICU and a 2 week old baby with a *real* fever who bought himself a full sepsis work-up including a lumbar puncture after the WBC's came back @ 20k.
Off for 3 days, getting geared up for the hubby's Christmas party that we are hosting. Should be interesting to say the least!
Thursday, November 19, 2009
Things not to do while you're pregnant.
1) Come to the ER and say "I was bleeding 2 days ago, but it stopped now. Now I want to get it checked out." (We can't evaluate a problem that happened 2 days ago.)
2) Come to the ER and say "I'm 35 wks pregnant and I haven't felt the baby move for a week." (Why would people wait an entire week???)
3) Come to the ER and say "I'm 8 wks pregnant and I haven't felt the baby move for a week." (You are just having gas, sweetheart).
4) Come to the ER as a visitor and fall out on the floor seizing. This should be pretty obvious. If you end up as #4 and are in fact in status seizures for an hour, you may find yourself intubated and sedated on anti-convulsant drips while the father of your baby is cheering on the Redskins in the waiting room.
2) Come to the ER and say "I'm 35 wks pregnant and I haven't felt the baby move for a week." (Why would people wait an entire week???)
3) Come to the ER and say "I'm 8 wks pregnant and I haven't felt the baby move for a week." (You are just having gas, sweetheart).
4) Come to the ER as a visitor and fall out on the floor seizing. This should be pretty obvious. If you end up as #4 and are in fact in status seizures for an hour, you may find yourself intubated and sedated on anti-convulsant drips while the father of your baby is cheering on the Redskins in the waiting room.
Monday, October 26, 2009
Where am I? What happened?
This is what my patient with Transient Global Amnesia asked me about 40 times in the course of the 30 minutes I had her in triage. I did her initial triage, EKG, IV, etc... and about every 2 minutes she would re-set and go back to asking "Why am I here?" "What happened to me?" "Why am I in a hospital?"
The crazy thing is, she knew who she was, she knew her birthday but then when I asked her how old she was she couldn't remember. She knew her SSN but not her son's name.
Apparently about 4 hours later she was still asking the primary nurse the same questions!
Weird.
The crazy thing is, she knew who she was, she knew her birthday but then when I asked her how old she was she couldn't remember. She knew her SSN but not her son's name.
Apparently about 4 hours later she was still asking the primary nurse the same questions!
Weird.
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