Uh, Seriously, Step BACK!

Check me out! Two posts in one night!

Anyway, we were packed to the rafters tonight. I was triaging all the ambulance arrivals. An elderly woman arrived who had syncopized and fell into a glass-front cabinet. She was dehydrated for having diarrhea and vomiting since that morning, and her face was pretty cut up. Also, she was running for the bathroom when she passed out, and so her clothes were pretty messy. She was very anxious, as was her daughter, and they kept telling me things like, "She REALLY needs an IV RIGHT AWAY!" and making other suggestions the whole time I was trying to triage her. She was mostly OK, vital signs normal, just nauseous and kind of stinky from having an accident in her pants.

We were really busy, and it was change of shift for the 7:30am-8pm crowd, so I knew her nurse wouldn't get to her right away. I didn't have anyone to triage at the moment, so I got the lady into a bed, changed her, washed her up, started a line, gave her some fluids and some antinausea medication, all the while reassuring her daughter (who had to sit down and put her head between her legs several times as I bandaged her mom's bloody head and face) that everything was ok. I even took the daughter outside onto the ambulance ramp to get some air and drink some apple juice, because she was looking super green around the gills. I gave report on the patient to her nurse, and then went back to my post to triage other ambulances that were coming in.

The daughter kept coming back to me: "My mother's cold" (I gave her a blanket) "She has to go to the bathroom again" (I called a tech to get her a bedpan) "She feels like she's having chills!" Finally I reminded the daughter that the person taking care of her mom was Nurse So-and-So, and that she'd have to speak to him about further care.

Then we got a notification: a woman who had had premature labor with a stillborn baby and who was hemorrhaging, and who hadn't delivered the placenta yet. The resuscitation team headed to the trauma room, and as the ambulance triage nurse, it's my job to get the patient's information and help the team out in any way I can. We're all prepared, the ambulance rolls in, and the woman looks pretty bad--bleeding heavily, pale, lethargic, with a very low blood pressure. We all swing into action, and as the paramedics roll the patient into the room, I hear them saying, "Ma'am, please step back, we need to get through here!"

I'm getting vital signs on the woman and setting up fluids in the rapid infuser, when I hear, "Excuse me!" I turn around, and the daughter of the woman who syncopized is standing in the middle of the action, tapping me on the shoulder.

"Ma'am!" I say. "You can't be in here right now! Please step out of the room!"

"But my mom has a problem!"

"Ma'am, please, step back out of the room! We'll get her nurse over there as soon as we can!"

One of the techs starts guiding her to the door. As she leaves, she turns around and yells over her shoulder to me, "My mother's IV bag is empty and she is thirsty!"

Quote of the Day

Patient: I need to see an ENT. I have an appointment Monday, but I really want this taken care of today.

Doctor: Sir, if you need to see an ENT, I can refer you to one.

Patient: Why can't I see an ENT in the emergency room?

Doctor: Because there are no ENT doctors in the emergency room. There are ER doctors in the emergency room. It's like if I went to the ENT's office and asked to see an ER doctor. They would tell me to go to the ER.

Patient: so what the heck do you guys DO here all day!?

I Got Twelve Drummers Drumming!

Check out Medblog Addict's Twelve Days of Christmas feature!

I can't help but think she left the best for last....

Happy Holidays, everyone!

xoxo

GGRN

Can I just say one thing?

Itchy vaginas do NOT belong in the Emergency Room. I don't care HOW itchy it is. Go get some Monistat. Or maybe try washing that thing once in a while, stinky.

I love my couch.

Especially after working 65 hours out of the last six days.

It was kind of slow, so not a lot to report. But there were some things!

I had a 97-year-old man reach for me and yell, "I HAVE A NEED TO MARRY YOU AND SLEEP WITH YOU!!!" I told him thanks for the offer, but I'm already married. He said, "BUT I LOVE YOU!" and then proceeded to plant whiskery kisses all the way up my arm. It was actually kind of sweet.

I got shocked by a patient's internal cardiac defibrillator. It felt like a rubber band snapping on my hand. I didn't think that could happen!

We got a woman with a ruptured ectopic pregnancy up to the OR in record time. I don't even remember how fast it was, but MAN, it was fast. As they were wheeling her away she made them stop to thank me for being so nice to her. I was actually rendered speechless.

I had a chance to remind a young guy how fortunate he was. He came in after his doctor had called to tell him about some abnormal labs that turned up after a blood draw during a routine physical. He was asymptomatic, but the lab values indicated some severe blood dyscrasia or immune system failure. Needless to say, he was a little freaked. I had time, so I drew his blood in triage, sent him outside to register, and then went inside to see the docs so they could order the appropriate labs.

An hour later, his labs were back--all within normal levels. I explained to him there must have been a mixup at the lab his first samples were sent to. He rolled his eyes and said, "Yeah, and I just spent a hundred bucks to find that out."

I said, "No, you spent a hundred bucks to find out you aren't deathly ill. Merry Christmas."

He smiled and said, "I guess that's a better way to look at it."

After midnight...

...the weirdos DO come out! I'm out in triage working a little overtime until 4 am, and MAN, are there some doozies who come in.

Like the gal with the huge lac to her thigh (with all sorts of meat and tendons hanging out--but the wound is strangely dry and is not bleeding freely) who denies any drug and alcohol use, who reeks of ETOH and whose pupils are huge. She says she got up in the middle of the night and ran into a large mirror. Does your leg hurt? Not really, she says. How long ago did this happen? Forty minutes. She called her boyfriend and waited for him to come over to bring her to the hospital.

And the guy who is here because he's been having "hot flashes" for three days. They're so bad he has to take off all his clothes and drink water until it passes. Let's see if he has one in the waiting room.

And one of our regulars (who has already been here twice today). His chief complaint? "my balls itch because someone at another hospital dipped them in a bedpan and got urine on them and are there any sandwiches?"

Our Smokin' President Elect!

Apparently our soon-to-be-leader is still smoking cigarettes! The Happy Hospitalist is having a debate on whether or not it's our business.

Personally, I don't understand why any intelligent person would smoke. I've never smoked cigarettes; I think they're gross. I've tried them, but ew. Blech. My mother, a nurse, smoked for years (and still does, despite having stage IV colon cancer). My sister smoked too, and watching her quit made me realize how difficult it is. When she was quitting, she would call me from payphones crying about how she couldn't believe she could never have a "smoky treat" again. It was very hard for her, and she ultimately had to use Zyban to quit. She stopped and has never smoked since. Smoking causes so many health problems, it smells, and it's a disgusting habit. I don't understand WHY anyone would ever start in this day and age.

THAT SAID: It's none of our business if the President smokes. And, I know from experience: Haranguing him to quit will not work. He's been under a lot of stress lately. He knows it's bad to smoke. He'll quit on his own.

Let's just hope he'll go outside the White House to light up!

Nurses, VOID YOUR BLADDER!

Us nurses are always bitching about not having enough time to pee during a shift, and not being able to drink water. I always accepted this as "just the way it is" when you work in a busy ED. Until now.

I'd been having some discomfort on urinating for a few days (weeks?), and didn't think much of it. (I have a history of UTIs--one required antibiotics for almost a year to get rid of it, but that was years ago.) Then, two days ago at work, the pain got worse. So I dipped my urine: positive for leukocytes and a small amount of blood. I started having chills and feeling crappy. I figured I'd gotten another UTI, so I got myself a big bottle of water, and figured I'd call my doctor the next day.

And then the back pain hit. Bilateral flank pain. Ow. One of the docs noticed and said, "You're walking around like a kidney stone patient--what's wrong?" I told her and she said, "You probably have pyelo." Pyelonephritis. ARGH!

One prescription for antibiotics, coming up! After two days, I feel much better. And now I remember what it's like to pee without pain. I think I had a low-grade UTI for weeks, and then not peeing and not drinking enough water made it worse, and then it got up to my kidneys.

So here's my public service announcement: Nurses, drink and pee! and that's an order.

I'm a cracka ass cracka!

At least according to the methadonian whose buzz I ruined today.

She's a COPDer who came in from her shelter lethargic, wheezing and short of breath. She couldn't stay awake enough to consistently breathe in the nebs we gave her, was satting only about 83 on 3 liters. When her arterial blood gas came back with a CO2 of 77, an O2 of 47, and a ph of 7.28, the decision was made to give her a little narcan to reverse the effects of the methadone to get her respirations up from about 6 to something useful. And we put her on bipap.

But before the respiratory therapist fitted the mask to her face, she informed me that if I ever gave her narcan again, she would "bust up my fucking face." Nice.