Tattoos

First just let me say, I love tattoos there is just something sexy that I like about them if they are tasteful, professional, and can be hidden if needed.

With that said.....

1. Don't get FTW tattooed across you forehead and expect people not to stare.

2. Don't be surprised when a nurse asks if you shoot up, we might get that idea from the bulls eye tattoo over your vein with a needle tattooed in the center.

3. Don't tell the nurse that you are afraid of needle when there is not one inch of skin not tattooed on you.

4.Don't be surprised when the nurse offers you a paper lab jacket to cover your tattoos of naked women in bondage while you are in the waiting room with young children.

5. If you are going to tattoo your girlfriends name of Jackie on your penis, make sure that you get her full name on there, don't stop at the name of Jack because it just hurts too much. If you do, don't be so surprise when you end up in the ER for stitches after Jackie threw a lamp at you when she saw Jack on your penis.

Hint To all Woman

Just a hint to all the women out there that might be wondering what is going on with their body.

1. If you don't have your menstrual for 9 months.... you could be pregnant

2. If you seem to just gain weight around your belly...... you could be pregnant

3. If after you have experienced 1 & 2 above, you feel severe cramping and a gush of fluid come between your legs..... you might be pregnant and about to give birth

4. If you come into the ER with all of the above symptoms and the nurse asks to take a look and tells you that you are crowning..... you are pregnant, in labor, and about to give birth

5. If you husband if with you that has been deployed for the last 18 months, you are busted!!! And no, he did not believe you when you curse at the nurse and say that she set you up and just happened to have a spare baby that she wanted to pawn off on you.


What is sad is that was the highlight of my day.

Merry Christmas

You know someone is a flyer when...
1. They are in the ED every holiday, and you start to think something REALLY happened to them if they don't make it in on your shift.

2. They send the ER staff cookies for Christmas, which we are afraid to eat.

3. They send a Christmas card to the ER and address it to everyone who works in the ER

Rigor: If limbs are sticking up.... CPR is not going to work

Just had to share this, it happened a few days prior to getting ill. Attempted to find a picture to place with this posting, but even i could not go as low as the ones I found. Anyway....

EMS call on the phone that should have been my first clue that it was something bad.
Apparently, family found grandma not breathing and bluish/black on one side of her body... that should have been my second clue. Family had started CPR when they found her. EMS arrived and attempted to inform them that there was nothing they could do and that grandma had been gone for a very long time. Family insist that EMS start CPR and EMS did. (No fault of their own, the situation they was in, I would have started also). Family then insist that one of them rides with grandma to the ER. In route, EMS call police and have them met them at the ER. I am called to the EMS bay.

This is what I find.....Picture it

Police are cuffing relative because he had pulled a gun on EMS to keep them doing CPR. Poor paramedics are bagging and doing compression on a very deceased grandma
....... Grandma had passed away sitting in her chair. She then had slumped over to her left side, which had pulled with all of her blood. Hence, one side of her body was about black. Wheeling her in, was interesting. There laid poor grandma on the stretcher with her arms and legs sticking straight up in the air.... She was in full rigor, basically in the sitting position.

I truly do feel bad for the family, not very educated, they did not know any better. Still... I have to tease the medics

Been Gone A While

I was ill for a bit. I had pneumonia and with all my extra hardware ended up with a septic knee, which got into blood stream and bacterial meningitis took hold.... really having the luck of the Irish there:)I was released from the prison, which was disguised as a hospital this AM.

I do have to say thank you to all of the emails and tweets asking where I was. Did not know that many people were reading my little rants.

So, since I have been off, I have no really interesting ER stories to share. However, being a patient for over 2 weeks....... I do have some horror stories :)

Sign this DNR Please

Patient was seen in minor medical area for his chronic low back pain, which shocked us because he is a drug seeking cardiac cripple. Doc deemed him non urgent, business office informed that he need to pay co-pay, or be seen by his primary care doctor, he utilized his extensive vocabulary of profanity. Then he reverted back to his old complaints of chest pain. This is were I was called to handle the problem. Told nurse to get a wheel chair. This is when Mr. dying decided to put on a show. Refused to get into wheel chair and to be taking back to the main ED. Stumbled out of the minor med area screaming that he was dying, stumbling into walls the whole way. Shaking and weaving c/o chest pain and dizziness. fell to floor in the middle of the waiting room screaming at the top of his lungs that we refuse to treat him unless he paid. Told us not to touch him and that we was going to attempt to walk the 30 miles to the better hospital for treatment, if he didn't die prior to getting there. Popping nitro and grabbing his chest while still refusing to have his chest pain evaluated. So, what was my response to all of this. Well being the charge nurse, I had to look out for the liability of what would happen if this patient really did code in the waiting room and we treated him against his wishes. I informed patient that he would not be treated for his back pain without a co-pay, but that we would be more than happy to eval him for his chest pain. Also, because he refused treatment at this time, it would be considered assault and battery if we picked him up off the floor and rushed him back for treatment. Further more, if he was serious regarding no treatment, then would you please sign this DNR, and I handed him the form.

Unbelievable!!!

52 year old female, c/0 left sided weakness last known well time yesterday at 1600. Brought into ER by family today because she became unresponsive. Family reported that yesterday her left side went limp. So why did family not bring her in earlier, like on first onset????? Well family was in town to celebrate thanksgiving on wednesday. Since everyone went home this morning, thought waiting a bit would be best. Long story short. woman is dead, who could have had TPA because family did not want to ruin their holiday. Now, family is threatening to sue us because we did not give TPA when she first presented to us....... this afternoon

Been a Few Days

My hospitals in the middle of this big buy out. Now, we are doing mandatory 16 hour shifts, reg at the beside, and still short. I don't see much in the way of all of the promised changes with the buy out. Same sit, just another boss. Main things I care about.
1. do I still have a job....... yes
2. Will I get a raise..... damn it.... nope, in fact we still are on a pay freeze
3. What will happen to all my vacation time?..... doesn't matter, I used it all a long time ago

Now,what I find funny, just got a notice that I am up for wage review and to make sure that I have all of my education and shot records up to date and turned back in, or I will not get my raise..... LMAO, what is the purpose of the review????? Am I missing something???? We have been on a pay freeze for 4 years, which means that I have not gotten a raise and will not get on for a long time. Freaking morons

Silly

I just had to giggle at this one:

Guy comes in with his wife. she had a laceration that needed to be sutured. He was all into looking at the wound, without a problem. The minute he saw the small needle that was going to be used to numb her, he passed out cold. He hit the ground, smacked his head, and was now in the need of stitches. Instead of his wife showing any concern, she just says he always does this when he sees a needle. Now, what I don't understand is:
If the sight of a needle makes you pass out, why are you watching us stitch your wife????
If you know that you husband is going to collapse when we pull out the needle, why not warn us? why not suggest that he sits down? why the hell have him in your room?

Translation

Dr. Hates women: always thinks it is funny when a women is charge instead of one of the guys, and calls the charge phone at least once an hour.
Today he questioned why the nurse pulled a Foley out without his order and he wanted them to be written up

Me: No, I am not writing them up, I told them to pull it, It was clogged, from nursing home with debris and green discharge, nursing home notes reported last changed 3 months ago, client had 900 ml of fluid in bladder per bedside bladder scanner. Here is the form, you can write me up!

His response: none
2 hours later received call from director about me being written up for ordering diagnostic lab without order. Dr. hates women neglected to list which test was done
Me: answered with written nursing protocol signed by medical director
What I should not have done was run protocol through language scanner for his native tongue(Arabic) and posted it on his locker... opps...bad nurse

I wonder how he would respond to this posted on his locker????


تقبيل الكاحل بلدي تبين بمقبض الأمريكية

You Did What????

What is it with people this month? I have had way to many objects where they should never be. 2am seems to be the magic time that I get the foreign bodies shove only god knows where. This morning was no different.
Pt came in c/o abd pain x 2 days. Fever, n/v, but was constipated and refused to give me any other details. He wanted a male doc only and he stressed this point over and over again. I have been doing this long enough to know that it is related to 2 things. He has a blockage or something shoved where it should be. Well he was out of luck, the only docs on where both female. Pt did not fess up to anything and lab work showed that he was septic. After coming out of his room, I noticed that the doc was staring at the x rays with her head cocked to the side, a look of puzzlement on her face. Anytime a doc gets this look, you have to just go see for yourself because it is something odd. The cause of this pt's pain and vomiting was indeed a blockage. 16inches worth of wooden broom handle had been inserted and broken off. Pt ended up going to surgery, going to ICU, and having his bowel redirected. The only story we got out of the guy.... He fell while sweeping and was to embarrassed to come in. I can't wait to see that surgical report.

How to REALLY tick me off

I have three pet peeves, and everyone that works with me knows them by heart, or at least I thought so. That was until the nurse that only works two days a week decided to make me want to snatch her by the back of the head by violating every single one of them.

1. Help your coworkers. I don't want to hear that it is not your room! If the rack is full, the waiting room is standing room only, I have patients lined up in strechers down the hall, waiting room is standing room only, and your patients are taking care of, please get off of you ass and help discharge. There is no I in emergency nursing, or any position in the emergency room, for that matter. Working in the ER is a team sport. That is the only way we can get everything and keep everything flowing. Especially, when I convince our docs to help discharge, you should not be sitting there goofing off.

2. Wipe a butt, place a Foley, wheel out patients, when the techs are getting their butts kicked Just because you are a RN, does not mean that you can not do personal care. As far as I am concerned, RN means that you can do EVERYTHING from CNA to RN. And if you talk down to my staff, I swear, that I will give you the next patient that has to have Kayexalate while convincing the Doc that they do not need a rectal tube!

3. Finally, but one of the most important.... the diet cherry limeade from sonic that EMS and Docs always bring me in is ... MINE, so keep your lazy, grubby, nursitis hands off. That is my crack of choice, if I don't get it one of my multiple personalities will come out and make your life hell!

The Items Nurses Take From Patients

After having my butt kicked by an 90 year old, maybe 89lb dementia patient today, which ended in me with bites, scratches, and tetanus shot and her in hard restraints. I found it humorous at what items that I end up taking form patients over the last few months.

Today, after a few bites from the above patient, I took her dentures. Now, she could only gum people.

After a homicidal/ suicidal pysc patient attempted to run away for the 3rd time, I took his artificial leg. Now, he could only hop away, which he attempted, but he was easier to catch.

I have taken a cane from a women that was attempting to hit my poor doc with it.

A bucket of snakes from some guy who was bitten catching snakes. Apparently, he was not the best snake charmer in this neck of the woods

Finally,the patients favorite, but my worst... a 10in vibrator from a patient with a lower GI bleed, who was c/o pain, but still attempting to use it.... Hmmm, wonder how he got the bleed!!!

Same Man, Two Calls & One Visit

First Call
Me: Hello XXXX ER, MLee, RN can I help you?
Them: I was there last night, sick and all, in bad pain
Me: Okay, what can I help you with
Them: I cant read what it says on the drug pad
Me: The prescriptions you can't read? Did you get them filled?
Them: Naw, didn't want to fill them unless it was some good shit, you know to take care of bad pain
Me: Give me you name and SSN, I will look you up and let you know what meds they wrote you
Them: Name and SSN
Me:He wrote for naproxen for pain
Them: Never had that, it any good?
Me: Yup, it is great for back pain

Second Call
Me: Hello XXXX ER, MLee, RN can I help you?
Them: Ya man, just talking to some chic, the bitch told me that the drugs the doc gave me were good
Me: Yes, That chic was me, Naproxen is a good pain reliever for chronic low back pain
Them: naw, it is just Aleve, I am allergic to Aleve, Cant the doc wright me something else? I'm in bad pain
Me: sorry, but our doctors are unable to write you anything stronger unless they see you because the doctor that saw you is not here at this time.

Visit
Pt came in with c/p low back pain x 2 years, stated he was in bad pain and that bitch (me) lied to him about Aleve being good.
Doctor saw pt,went through every one of his allergies and informed him of a new pain medication that he was not allergic to. I discharged him with a Celebrex script, he flipped me the bird and said told ya I get something good..... I can't wait till he sees the cost of the script

What is so frustrating is that this pt, along with many others abuse the ER for pain medications. When they do not get what they want, they keep showing up. I am sure that he will show up again and again. Hopefully, he will not get what he wants, less than two weeks ago, I took care of him for OD on prescription meds.

Mayo Stands

I thought to myself, how hard could it really be to put together a few Mayo stands. Hell I have directions and tools. Well, 3 hours later, I finally get the damn things together... Would have helped if the instructions were in English. or if I knew what the freak an Allen wench was!!

Husband + Nail Gun = ER

Was not really sure of where to post this one, my ER blog, or my home blog because it fits into both.

The other day I was just out puttering around with odd and end chores when I heard my husband scream. He was repairing part of the chicken coop, so that is the direction I headed thinking my god what happened, is he okay, and all the other wonderful things that run through a persons head when they think that someone they love is hurt. I find him yelling and screaming, yet I can't figure out why. Then I saw it, he had nailed his hand to the chicken coop. Once he calmed down, I was unable to keep a straight face. He was stuck and there was noway to get him unstuck without cutting the board that he was nailed to. I am positive that it was painful, but come on it was pretty funny,. what made it even funnier was that it was my husband. After taking him to the ER with board, nail and all, my poor hubby had to endure my friends and coworkers. Even the ER doc was unable to keep a straight face. His words to my husband, "if it was anyone else i would not tease ya, but that was not the smartest thing you have ever done."
Just for the record, that is not my husbands x-ray.
He is fine with no real damage, but pride
The chicken coop has been patched

Fetish with the ER.... WTF

Okay, I understand wanting to spice things up a bit. I have no problem with being adventurous, but checking into the ER just to get your rocks off is insane.

Apparently, a older man was going along for the ride with a much younger women. We have seen her before, all the ER's know her a little too well. She is the patient that complains of abdominal pain and vaginal conditions while requesting not to have anyone in the room with the doctor during her pelvic exams. She has a fetish for gyno beds and anything, male or female in a lab coat. Well, today was her day. She checked in for a headache, which shocked us because it meant no pelvic exam. However, she had a friend with her. I had to go and do the nursing assessment on her. As I walked into her room, I heard the shuffle of pants being pulled up. There she was buck naked, kneeling on the floor in front of this "friend", with a smirk on her face. He looked mortified, she just crawled over to me and stated, "I have always wanted to play with you" My first reaction, which I had to suppress, was to snatch her by the head and drag her out of the ER. However, I just walked out. The guy took off, security called the cops. After arresting her for lewd behavior and three other offenses, my poor ER doc still had to treat her for the headache prior to them taking her to jail. He gave her 1 gram of Tylenol

What I am wondering....
1. WTF would make her think anyone in the ER would allow her to touch us with a 10 foot pole?

2. WTF is would make her want to have sex in the ER?

3. Why was she completely naked to give a man head?

4. What is it with some people and the pelvic beds?

Long Day

Some days are just long days. Unfortunately, there are more and more days where we work shorthanded. People seem to be sicker every day, and to complicate the situation, more people seem to use the emergency room as their personal doctor’s office. Today was just one of those very long days. We see these days written in the body language of the doctors and nurses that are exiting the hospital. Head down, shoulders slumped, and exhaustion in their eyes. Today, I believe that I went through almost every emotion possible before I did the long walk to my truck with the day written all over my body.

Dread hit within minutes of clocking in and realizing that four of the nine nurses scheduled had called out with flu like symptoms. This means that not only will we be short today, but for at least a week.

Ah, shit hit after someone that had no real reason to, went asystole.

Anger spread when I hit the code button and no one responded because the secretary was bull shitting on the phone with her new boyfriend.

Sadness hit when a mother came running in with a 4 week old that was blue and lifeless.

Humor snuck in when I decided that it was the perfect time to payback a doctor for handing me a snake a few months ago. I slipped a glass eye into his coffee, what a shriek he made, as he went to sip and realized something was looking back at him. Revenge is great.

Homicidal thoughts kicked in when a patient had the balls to say, “I am going to just stand here and cough in your face so you get the flu, unless you get the doctor in here right now.”

Embarrassment struck when I realized that I had a handprint on my butt from the powered later gloves. (The handprint was my own, for the record)
Gratefulness hit around 1500 when one of my doctors thought to bring me some food because I had not eaten yet.

Relief and accomplishment kicked in when I got a tube a tough patient.

Joy finally kicked in when I saw my relief come walking through the EMS doors.

Basically.... It was a long day, but for all of the crap, I still enjoyed it. I am just feeling a little exhausted and beaten down right now.

Kids

There are so many crazy, insane, idiotic, and sad events that happen in the ER. However, every so often, there are those that make me smile, cry, laugh, or just think how lucky I am a to work where I do. Here are a few:

A 5 year old is brought into the ER, just yelling and screaming, complains of everything under the sun from belly ache to fever. Her parents are frantic because they have no clue what is wrong with their precious little child. Once I walked into the room and sat down to talk with her and get her to calm down a bit, she leaned over to me and asked if I could keep a secret. The horrible thoughts of what this child was going to tell were running through my head. She than produced a very small turtle out of her pocket and said I think he is hurt because he won't move. You have to fix him!!! Her big blue eyes full of tears just broke my heart. After looking at the turtle, I got a wash basin and place him in it. I explained to the child that he was just scared and was hiding. After a few minutes, he poked his head out and looked around. The little girl was so excited that she gave me the biggest hug I have ever had. She walked out with wash basin and a very alive turtle a happy camper.

While in triage, a little boy came in with classical symptoms of the influenza, plus a possible ear infection. I provide him with a mask and tried to explain that he needed to wear it so other people did not get what he had. After I put it on him, I looked away for just a minute, when I turned back around he had the mask over his ear. Trying not to laugh, I attempted to adjust the mask for him. He very logically stated," cough ain't bad, sneeze ain't bad, body hurting ain't that bad, but no one wants me to give them this ear!!!"

Common Experimental Drugs Country Folks Use

A friend of mine lives and works in NY. We talk every night about the type of patients that we see and what our locale trends are. She has never experience theses type of drug users, so this is for my city slicker friend.

It was just after lunch time, when five School students began showing classic symptoms that come after ingesting jimson weed. They began to have hallucinations, a lot of vomiting and wild-eyed looks...One of the children was so delirious, had to be restrained to get on the gurney to be put in the ambulance. When you ingest jimson weed seeds, a little will get you pretty high and too much will get you sick, or kill you. Another dosage or so, they would probably be dead, so it is very dangerous. Jimson weed, most commonly found in fertile fields, gardens and barn lots, can cause serious health complications, including rapid heartbeat, high fever, convulsions, blindness, coma, and death.

Shrooms are another natural drug that bored country kids go scouring the local farmer's field for. Had one teen come in after drinking his special tea completely tripped out. Apparently he was having a bad trip and everyone's eyes were leaking their color. Normally we just place them in a room and let them trip until the drug wears off, but some that are having bad trips we sedate.

Peyote users are one of my favorite to see coming strolling through the EMS doors. No matter how bad of a day a person has, one conversation with someone on their peyote trip will make you giggle and look at life in a new light. Many people think that it is the flower of this cactus, and become sick from attempting to gain a high form the flower. The peyote tea is made from the crown, which causes very vivid hallucinations that last about 12 hours. The main problem we see when someone comes in is n/v. However, we have had to help support a persons blood pressure before.

Yup, He is Deader than a Door Nail

Okay here I am enjoying a impromptu day off. Playing on computer, stuffing face with as much chocolate as possible, hanging out under the covers when my phone starts ringing. Dang, thought I had shut it off! Well the neighbour was calling because she had found her dear old gramps laying in bed not breathing. Estimated EMS for this area is 45 minutes to an hour. For the record I have 5 neighbors within a 30 mile radius, all who are very old. Anyway, my truck was stuck in the mud, which meant I had to ride down or walk down. I opted to ride down without the saddle, which I am paying for now. I get there and the family is performing CPR on this very OLD man.Just looking at the guy, anyone could tell he had been dead for awhile. His wife comes up to me and says, " I told them he was deader than a door nail, they just won't listen." I reached down, attempted to lift his arm, which he was in full rigor and I could only say, "yup, he is deader than a door nail." I am thinking that I might want to try and think prior to speaking. Man, life was better under my covers with the chocolate.

Crack heads of the day

Why would administration decide that all ER nurses have a in-service on defibrillators? All of us are ACLS, PALS, TNCC, CEN, and are in at-least 1 situation a day that we use the dang thing. What, they don't they think that we would know how to turn it on by now? Not only did they have us do the in-service, but they sent someone down from education who had to read out of a book in front of us, how to use it.... Only a crack head would come up with that idea

Who had the brilliant idea that the trauma room floors should be stripped and waxed during one of the busiest times of the shift? And, that they would do all the trauma rooms at the same time? Only a crack head

Who would write up a ER nurse for starting a IV and giving epi and atropine to a patient who was in cardiac arrest without a doctors order? Only a crack head float nurse would, who had no business being in my ER!!!

Who would think that sending 14 student nurses to the ER to train when there are only 8 ER nurses on duty would be a great idea because we were short handed? And, they had the thought that we would appreciate the extra help when they were in their 1st semester? Only a crack head would.

Lesson learned today, administration is using way to much crack!!!

Big John

I just love some of my patients. I have been taking care of one patient that is schizophrenic for about 10 years now. He doesn't like many people, but for some reason he has decided that I am a "good egg," and is just a little protective of those he likes. Now, to put him into perspective.

I will call him Big John, who is 270lbs of pure muscle and 6ft 9ins tall. He has a imaginary friend that I will call Harry. Big John becomes very violent because Harry tells him to kill everyone that is around him due to them wanting to kill Big John. Now, Big John knows that Harry is wrong and comes in before Harry can take complete control of him. Harry can only take complete control when he is all of the way out of the floor. Now the only reason why Harry thinks that I am okay, is because I kicked someone out of the room one day years ago that was yelling at Big John. So, I am safe, as Big John says, but I am always careful.

Now back to my story: Big john came in and was completely homicidal today. He would not let anyone around him, but me. I was very leery, because anything could always change the mind of a

schizophrenic. Anyway, we were trying to get another patient that was on PCP into one of the locked rooms that was next to Big John's locked room. The patient got loose of us and I was just in the wrong place at the wrong time (my fault). I ended up knocked on my butt. Well Big John saw this and thought that the other patient was going to hurt me. He broke down his door and knocked the other patient out cold. By this time we have police, techs, security all in this area, which Big John trusts none of them. He thought I was hurt and before I could say a word to calm him down, he just picked me up like a sack of potatoes and laid me down on a stretcher. I was scared to death to move. He sat down and yelled for one of our doctors to come and fix his friend.

Vomit

There are many reasons why people vomit, but there are always the few that just leave you shaking your head.

1. Pregnant patient states,
"every morning when I get up, I get sick and vomit all over the place, it goes away after an hour or so then it comes back the next day."

2. Patients says, "dude, can't you give me something for this vomiting and headache? I had one hell of a party last night and have plans tonight, I can't go out with a hangover."

3. A known drug seeker reports that his vomiting is killing him and he needs some pain medicine now for his life threatening pain. This has not been the first time this patient has requested pain meds for this complaint, so doctor tells me to tell that patient that he is not getting anything till we see some vomit. Patient says hold on and proceeds to shove his fingers down is throat.

4. 16 year old male came in violently vomiting. Come to find out he did not want to go to school so he ingested some good old fashion ipecac.

Rape Calls

HA... does administration really think that I am going to answer my phone to work on Halloween????? I am running out of town (without phone) and going to a college football game. It is bad enough that am on call tonight for sexual assaults. Before you get your tighty whities all tied up..... sexaul assaults are a serious events, but come on. 75% of the calls that I get dragged out of bed for at 2am are horse crap.

Examples of last Halloween:

1. Woman reported that the devil raped her..... Me thinking does she means rapist was in a costume???? Nope, she reported that she took a road trip to hell and when she said no, he stuck his pitchfork.... you can guess that one:) Come to find out she was just released from jail and had used their phone to call the hot line. She was thinking she could score some dilaudid for being raped.

2. Woman reported that she was raped because he only gave her $20 instead of the agreed $25 for a blow job.... I referred her to the police and suggested that she report theft of services.

3. Woman reported stranger rape, which to me is one of the most dangerous. I come flying off my secluded mountain, run and set up my cameras and kits for her arrival. She gets there, police in tow for them to wait on my results. I get her in the room, start questions and exam just to find out.... "I wasn't really raped, I was just worried about the smell and fluid coming out of me, the assholes in the ER told me that it would be awhile before they could take me back, do you think that you can just give me a antibiotic and a pain shot?" I about decked her.

Finally, my favorite....

4. Guy, dressed in drag for Halloween, reported that he had gotten a little drunk and was doing body shots with a some hot chic that he just met. After a while, they went back to his place, hot chic asked him if he wanted blow job he said yup, after he gets his rocks off hot chic asks how he feels about anal play, he reports that he said he was up for anything..... after having his salad tossed, he reported he just thought she had a strap on at first and it felt good, till he felt something hot shoot in him. Come to find out guy in drag for Halloween was drunk ended up in gay club and found another guy in drag.... How the hell is that sexual assault????? Why the hell did I drive 45 minutes into town at 4am for that????

With this being Halloween night, I am sure I will be in for some crap tonight.

What I found just too funny in the shift!!!

When I just can't control what comes out of my mouth :)

Hunting season:
We are just overrun with hunters doing stupid things this time of the year. Now don't get me wrong, I am 100% for hunting, as long as I don't have to clean the deer. But come on, a little common sense would help.

Patient came rolling in all dressed in camo and blood, I expected accidental shooting or some trauma. Nope. He had fallen out of his deer stand and had a bloody nose. This is were my mouth gets me in the most trouble. I ask, "did you get yourself a deer?" He says, "nope, but I saw a bunch of turkeys." I say, "yup, I see a bunch of them in here every day."

Halloween:
Just love seeing kids all dressed up. I understand wanting kids to be safe, but really??? have them line up and walk through the ER to collect candy? Is that the best way to prevent them from getting sick????? Anyway, I didn't know they were coming and I didn't have candy, yet trooping though the ER they come. Now they were just too cute holding out their bags with me having nothing to give. So, I grabbed band-aids and gave handed them out like they were the coolest thing on earth. Kids loved the special stickers, as I called them. They were 4 and 5 years old. However, a little boy had a clue, he told me in the most logical voice that "these are band-aids,"
I said, "yes they are," he said, "we don't need these, no treat we give a trick" Without thinking, I said, "yes, you do when they give you that flu shot down the hall." Man, the look on his face was pure horror, then he popped off with, "not me, I can't eat eggs and no eggs is no shot." Then he kicked me..... I laugh so hard tears started rolling down. That is when it just got cute... Little girl came running up and put her sponge bob square pants sticker right on my knee saying "don't cry, the shots don't really hurt.

Caught off Guard

Have dealt with death many times. It is a weekly and/or sometimes a daily occurrence. Most of the time I am able to separate myself and my emotions from the situation. We can show empathy without feeling the burden of the loss of a love one when we are there to support the family at their time of need. However, there are times that something just hits a cord and takes a person off guard. Thursday was one of those days.

Patient presented via POV, family ran in and yelled daddy is not breathing, out to parking lot we run, find guy pulse-less and not breathing. Onto the ground he goes, start compressions, call for gurney, bagging begins, run him to room while trying not to fall off of stretcher while giving compressions. Hook up to monitor, throw in a IO, rhythm check (asystole), start ACL meds. obtain ISAT, CBG, find his K+ to be 7.8, in goes bicarb, regular insulin, CA+, rhythm check (holy crap we have a rhythm, but it is v-tach). Shock him, resume compressions. on and on this goes, he gets a rhythm, we feel a pulse, we start hypothermia protocols, then he bradys down back down, loses pulse and here we go again. Over 3 hours we go and go because he his showing promise or at-least signs of promise, he comes back then we loss him. Then came the time that there was no more that we could not do anymore for him and time of death is called.

The death did not bother me, I knew that we had done everything possible. Dying is a part of life, at-least the last part of life. After everything we had done, after talking with family, after getting the body transported back to the morgue, my guard was let down. I was not in the mind frame to brace myself against families emotions and grief. That is when I was caught off guard. I rounded the corner and basically tripped over a young girl. She was just sitting in the corner of the room, lights off, with tears running down her face. her expression, her eyes, the sense of her complete loss was just over powering. There was nothing I could do, I just put my charts down and sat next fer her. I couldn't say or do anything that would make her feel better. We just sat on the floor in the dim room. It is not death or not being able to save everyone that bothers me, it is not being able to comfort those that are living.

Okay, now that I went off on my little rant, maybe I can get her out of my head.

Crappy Ghost

An extremely modest man was in the hospital for a series of tests, the last of which had left his bodily systems extremely upset. Upon making several false alarm trips to the bathroom, he decided the latest episode was another and stayed put. He suddenly filled his bed with diarrhea and was embarrassed beyond his ability to remain rational. In a complete loss of composure he jumped out of bed, gathered up the bed sheets, and threw them out the hospital window. A drunk was walking by the hospital when the sheets landed on him. He started yelling, cursing, and swinging his arms violently trying to get the unknown things off, and ended up with the soiled sheets in a tangled pile at his feet. As the drunk stood there, unsteady on his feet, staring down at the sheets, a hospital security guard, (barely containing his (laughter), and who had watched the whole incident, walked up and asked, "What the heck is going on here?" The drunk, still staring down replied: "I think I just beat the crap out of a ghost." Happy Halloween

Deserted...

Not sure what was going on today.... we all were looking around for a mass casualty to come in as the day was passing. It might have been the weather, today was the 1st nice non-raining day we have had in a month. In 8 hours I only counted 19 patients..... This is not something I am use to. God only knows we are going to make up for it tomorrow.
Now, I am just going to curl up to a stack of homework and applications for student funding.... Work was better!!!

Why it is not a good idea to use drugs!!!

Patient came in twitching, screaming, and wild eyed. It took three of us to get the guy into the "special room." We finally got to the bottom of this guys problem. He had taken some of his aunts medication and thought it would get him high, amitriptyline. After awhile he decided to smoke some pot because the amitriptyline had not gotten him high in the 20 mins since he took it. thirty minutes later, the fun began. He reported that the people came out of the TV and sat their talking to him. more disturbing was that it was aliens that he was watching on the tv. Over time the conversation turned on him and he started thinking that the aliens were going to dissect him while he was alive. This is when he took off running out the door. OH it does get better, apparently the aliens could track him via the GPS locator's thay had sewn into his clothes. police found him running down the street screaming and naked. later on, when the drugs in his system had worn off, patient reported that he always gets a little paranoid with pot. Combine that with the oddball very rare side effect of hallucinating with amitriptyline, this patient had one hell of a drug cocktail.
Lessons learned: don't take someones medications and stay away from drugs.

Too Funny

Strange laws that are still on the books.

Indiana:

You can get out of paying for a dependant's medical care by praying for him/her. (Good thing to keep in mind next time I am up there.... how does it go... Hail Mary???)

You may not bathe between October and March (I think some of my patients here must be from Indiana)

New York

The penalty for jumping off a building is death. (Hmmm.. wonder how they enforce that one?)

These just make no sense, not that the above ones did....

DELAWARE
Condoms may only be sold by doctors and wholesale druggists.
MAINE
Condom sellers must be licensed and the license must always be on public display.
NEVADA
The use of condoms in Nevada brothels is compulsory. (Really!!! )

Busy, Busy, Busy

Not sure what is going on, but we have had a increase in the acuity of the patients coming in. I wonder if all the hospitals are getting their butts kicked as hard. It had gotten so bad today that I opened up the rooms to hold 2 patients instead of the normal 1 patient per room and our trauma bay I opened up to 4 patients. 5 vents in the ER at the same time is not a fun day for a charge nurse, staff nurses, nor the Docs. To put the number of patients into perspective. We have 30 rooms in the back that can hold 60 patients, but normally we try to keep to them private rooms, and we have 2 trauma rooms that can hold 4 patients in each, 1 minor med area that has 6 rooms that can hold 2 patients each, plus our lovely stretchers we can place along the halls. I am on call for Sane the next 36 hours and looking forward to the TNCC class I have to teach the next 2 days. A little role playing trauma will be a nice break from the real trauma, and hopefully no one gets assaulted. Don't get me wrong, I love the trauma, codes, freak accidents, and at times the clinic side of working in the ER, but this week has really brunt me out. Need a recharge :)

ouch

Now this ends the day on a good note....
guy comes in and we are told that it is a possible stroke. One minute we are talking to him and hooking everything up, the next he stopped breathing. Felt for a pulse, found none, thumped him, that did no good, started CPR and after 10 to 15 compressions I hear, DAMN IT, I look down and he is awake, did rhythm check and he had a NSR. Now that is one of the reasons that I became a nurse. Outcome for him was that he did have a stroke, we have no clue why he arrested, but he should be fine.... Just a little sore for the 1 broke rib, opps

Okay, you are sick so you get to be a jerk

Some how, it has been commonly believed that when you are sick, you have the right to treat everyone like crap. I worked triage today and here are a few of the wonderful praises I received.


7am:
Him, "What do you mean I can't go right back, are you an idiot, can't you see I am in pain"

Me, "I know you do not feel well and I will get you a room as soon as possible"

Him, "You just let them cut in line on me, they came right in and you gave them a room, you are a racist cracker"

Me, "you have a back pain for 6 months, they cut off their finger, they get a room first"

8am:
Her, "this is bulls##@!, why can't I bring my McDonald's back, I paid for this"

Me, "It is policy that there is no food or drinks allowed in the back, as I point to the 4 large signs displayed in the waiting area. You should not be eating, you complain of abd pain, and n/v"

Her. "you bi@# h, you can't tell me what to do"

9am:
Them, "I have been here for 30 minutes waiting on a room, my head is killing me, can't you just take me back?"
Me, "Sorry, I do not have a room for you at this time, when one comes open I will place you in it"
Them, "you just expect me to sit out her with all of these people, I am going to catch the swine flu and then I am going to sue you"

10am
them, "i waited all this time and the doc sent me home with nothing, I have the flu and he won't give me an antibiotic"

Me, "the flu is a virus and an antibiotic will not help"

Them, "fine then you have it," then he spit on me

10:30
patient asked me what determines who gets seen first, I told him that the sickest have a higher priority, he then falls to the floor and look up at me and states with a straight face, "I keep fainting, you saw it, I get to go straight back now, right"

11am
Patient walks in and asks "are you busy today, can I be seen fast?
I say yes we are busy, but it depends on your acuity to how fast you get seen, the sickest are seen first.
then they just threw their clip board at me

these are just a few. Today I have had food, clipboards, soda and an unknown object thrown at me. I have been called every name in the book. I have been spit on and threatened with violence. All because people had to wait for a room, wait to be seen, not happy with the toradol prescription, and referred to walk in clinic.

I just love my job some days!!!

Bored and ranting

Okay, so it is raining and chilly out, which means that it would be dumb of me to go putter in the garden, play with the goats, chase the chickens, or do what ever chore that needs to be done. Due to the weather, my joints are stiff, swollen, and sore. Wow that makes me sound old. I am 33 years old and had bilateral knee replacements less than a year ago due to complications of EDS. So, no I am not that old. In fact, after my surgeries I would say that my quality of life has improved greatly. However, I do have my rough day, like today with the weather. I am one of those stubborn people who refuse to take medication for pain relief. This is for two reasons, 1. I am afraid of becoming addicted to narcotics. I have seen this too many times with clients coming and out of the ER searching for pain medications when they no longer needed them. I do not want to become one of those clients. Reason #2, I know that over the years I will need more surgeries. When that time comes, I do not want to have any tolerance built up with medications. I would like to be able to have the pain medication work without having to increase the doses over and over again to get just a little relief. So, back to being bored. Not sure what i am going to do. Maybe bake some bread, laundry, or something. What ever i do, I need to stop spending my day off from the ER looking at other ER blogs. :)

Sexual assault

I am awoken at 0330 to voice on the other end of the phone. A woman has been sexual assaulted and i need to come to town to examiner her. These calls always leave me with a sinking feeling. I do this work because someone needs to be there for these victims, but I wish that one day there would no longer be a need for my position. I doubt that that day will ever come. Statistics show that 50% of sexual assaults are not reported and that every 3 minutes someone is sexual assaulted. This is a shame. Even though most assaults are done my someone that knows the attacker, I have found that the most violent, dangerous, and life threatening victims that I examine are assaulted by strangers. (Please don't think that I am saying that known attackers are gentle, not all are). Thankfully, those assaults are not as prevalent as known attackers. This morning it was a stranger that had attack this woman. So, since I am knocking around the facts in my brain to unwind a bit. I thought I would post some stay safe information to maybe prevent at least one person from a stranger attack.

•In any situation you should always be aware of your surroundings.
•Stay in well-lit areas.
•Walk on the side of the street facing traffic. Walk confidently at a steady pace.
•Avoid walking were assailants can hide, such as doorways, bushes or alleys
•If you believe you are being followed, walk quickly to a lighted area and where there are people.
•If you believe a car is following you, turn around and walk in the opposite direction or on the other side of the street.
•If someone stops you and wants directions or anything else, reply to them from a distance. Do not get too close.
•If at any time you feel you are in danger or need help, attract people in any way you can. Scream as loud as you can. If you are carrying a self-defense product such as Mace, pepper spray or a stun gun, use it and run.
•When you are in your car, lock the doors. If you are not in your car, keep the doors locked so that no one is able to enter your car and hide in it.
•While walking to your car have your keys in hand and ready to unlock the door. Before you get in your car look inside to make sure no one is hiding inside.
•While driving, if you think you are being followed, either drive to a well-lit public area or drive to a police station.
•If your car breaks down, open the hood and attach a white cloth to the antenna and get back in your car and lock the doors. If someone stops to help, remain in your car with the doors locked and ask them to call the police.

Why is everything always wrong in the newspaper?

Today I found out that something was actually done to help protect a child that I filed a mandatory report on. I have been watching all over the news about a sex offender that was arrested, but never linked him to the report that I had made well over a month ago. It is great that something was done, but what frustrates me is that the facts behind the report that I filed were listed in the paper wrong, over and over again. The police report made it look like the cop found out about a crime due to a nurse "misunderstanding" the facts and mandatory reporting another possible abuse case. So frustrating. Thank god for laws that protect us when we mandatory report. I hope that officer feels good about the job he did making nurses look like idiots. At least something was done to protect that child. No matter how it came about.

Are you kidding me--- RANT

I just love being short staffed!!! I wish the suits could explain to me how in the world they expect someone not to be killed without staff. Over the past year, they cut or per diem, forced overtime, then cut overtime. Then they took away our sick time, decreased our PTO time, cut our hours, laid off staff, and told us if we had over time that we could be fired. Now, we are forced overtime again. I give up, are they kidding me, do they really think that what they are doing is staff. Today for example, had 3 resp distresses that we placed on vents, 2 with norepi, one with dopamine. Another one sent the to cath lab, which I had everything done in 19min (one heck of door to balloon). had 2 overdoses and one that was status epilepticus. this was all before 1300. during this time, I had one tech and a emt student. So the question is, HOW IN THE HELL IS THIS SAFE STAFFING???? Okay, that is just my little rant.

Pulmonary Edema

And we wondered why they were so sob. This had an oh crap factor to it!!! Per protocol, had x-ray done prior to doc coming in room, when I saw it, I grabbed a doc fast. We have four on and the first one I saw got dragged into the room.... He was not so happy at the selection process :)

Moms

I have no clue why people are so stupid. Here are two examples:

Mother did not fill prescription for albuterol updraft, son has asthma attack, so instead bring to ER, she give a tap water updraft because it looks just like the albuterol. Kid gets to the ED, is suffering from hypoxia. We have child on a simple mask and child's O2 Sat's goes up to 98%, off of O2, Sat's drop to 79% and child becomes confused and screams nonstop because he is "seeing" snakes allover the room. Tell mother to keep O2 on or child will end up on a vent. So what does mom do???? you guess it, she takes off the O2 stating that child is not comfortable. She than sneaks out to smoke and comes running in when child ends up in resp distress, which leads to cardiac arrest, we code child and he survives, but is probably has anoxic brain...... WAY TO GO MOM!!!!

6 year old comes in the ER with her heel basically shave off. Ask mom what happened, she was playing on the steps and cut foot on piece of glass that she broke the day before. Mom was mad because she told the 6 year old to pick up the glass and she got what she deserved. My questions are why did the mom not be a mom and pick up the glass herself when it was broken? My god this was a child.

My little rant

Everyday we walk through those EMS doors into the ER hoping for a good shift. We put up our walls to protect ourselves from the evil, sadness, shocking emotions and event we witness within our department. However, sometimes our walls that we built to keep us detached are not strong enough. All of us have the patients that we will always remember. For me I remember the ones that I could not help, or the ones that remind me how fragile life really is.
Today, I received a letter in the mail. It was from a child that I had taken care a few years back. Every year, on the same date, he sends me a little gift and note. I keep all of them tuck away where I do not see them and I cannot be reminded of that night I first encountered him. He and his family do not mean any harm. They are just sending their thanks and letting me know that I had made a change in their lives. Now, with that said, I became a nurse because I wanted to be able to make a change people’s lives. I did not know then, that making a helping someone would ever be painful.
So here is the story. Child is on vacation with father and they are driving to the child’s birthday party. It was a very dark, rainy night with thunderstorm warnings and tornados watches out. Drunk driver came across and struck the vehicle that the child and father were in. Father died instantly on impact and his body pinned the child down in the car. It took over 3 hours to get this child out. He then came to me. He had many injuries and his closest family was three states away. I took care of him, and when he would fall asleep, he would wake up in screaming. There was nothing that I could do to comfort him, but sit with him, hold him, and pray he did not ask about his father. His family that was driving in wanted to be the ones to tell, which I understand, but hell the boy already knew. He would tell me over and over what happened and finally, he just asked for the truth, which I was could not tell him. A few of us nurses ended up staying with him for the day while his family was on the way up. I felt guilty leaving him because I would hope that in the same situation someone would try to comfort my child. We had switch from acting as a nurse and now was acting as a protective mothers. As nurses, we tend to band together to protect our patients, especially children. The child had four older brothers, who are the ones that came to get him. For some reason the child had bonded with me and I to him. So every year he now sends me a thank you thinking of you letter.
Many ask why it bothers me so much. Shouldn’t I be happy that I did make a difference in someone’s life? So here is the back-story. I had two children who were killed by a drunk driver at the age of 6months and 3 years on my older son’s birthday. The night this child came in was the anniversary of their death and was the same age my child would have been if he was alive. It also did not help that he had the same name as my older son.
Here’s the point. Many people go through, read our medical blogs, and wonder how we can be so cold and find humor in everything. Our jokes and laughing are a way that we protect ourselves from everything that we see and hear. Moreover, there are times that our patient’s stories and situations break though our protective walls.

Ring Tones

People really should consider what type of ring tone that they have on their phone. I can't count the number of times some one has had their phone ring at the most inappropriate times with some of the funniest ring tones.

Examples:
1. In middle of chest compressions, we hear the song Ex-Girlfriend coming from the patients phone. His cause of death = shot by ex-girlfriend

2. In the middle of retrieving a "lost Tampon" woman's phone rings, Her ring tone "Hello in here, get me out, answer me, help it is dark in here." --- I could not help but laugh

3. My favorite to date, I all the sudden I hear a song, "Dear penis I don't like you anymore, you used to stare at me in the morning while i shave, now all you do is look down at the floor, It use to be me, you, a paper towel and a magazine was all we needed to get by," At this point and time, my tech was putting a Foley in the patient

So please be aware that your phone will ring at the most inopportune time, and I as your nurse, will attempt not to laugh my butt off!!!

Unresponsive----- Why???

Had an interesting patient today. Presented to the Ed responsive only to pain, pupils pinpoint and nonreactive. Was found by friends this AM, last known well time more than 24 hours ago. All BP, HR, RR, AP, Temp are wnl, CBG was normal. CT and EKG was normal. Lungs were diminished and pulse ox 92% on room air. Was vomiting. I pulled the ET tray "just in case," 1st year resident took the hint and we protected his airway. 20 minutes later his BP dropped like a rock and we could only get 43 systolic with a doppler. Since he is well known to us, we had admin narcan upon his arrival, with no response. All lab values were wnl, yet he was unresponsive, and now his BP was in the crapper. Hooked up rapid infuser and 2 boluses had no effect. Pulled out dopamine with the hope 1st year would get that hint. After he did not, I went to the ER doc and got order for dopamine, which in long run did not help, but at-least I got the ED doc to take over the case. We went to levophed, which got pressure up to 80/30. Still a crappy pressure in my book. As it stands right now, he is in ICU and they are still attempting to figure out what the heck is wrong with him.

Ethics of Preforming Codes

Today was a busy day. First client was a hospice client that family decided that they wanted everything done to try and save him. Problem is that he had cancer that had spread to his bones, most importantly it had spread to his ribs. I understand not wanting to watch you family member die, and my heart goes out to them. However, when your father is downing in fluid that is is his lungs, his heart has a tumor in it, he has a GI bleed, and is septic, enough is enough. As the nurse we must go proceeded with all life saving measures, even when we know that there is no hope. So, when he stopped breathing, we place an ET tube . When his heart stopped we did compressions, which ended up breaking every bone in his frail chest. Wehad to placed chest tubes. We went on and on. Every measure we did gave him an addition 30 minutes of suffering it seemed. I feel that he was in pain every time that we brought back, yet we are unable to give pain medication because it would hasten his death. We talked with family, yet they were in denial. Finally, I brought family in for them to witness the last set of compressions. I believe that they needed to see for themselves that by attempting to keep him alive, we were only prolonging his pain. After 3 hours of code after code, he finally past away. Even though we did everything for him, I feel that we were wrong for not letting him die in peace without pain.

Certifications

Every time I turn around, I need another certification. SANE, ACLS, PALS, TNCC, CEN, and now they are coming up with PNCC and GNCC. Yes, it is nice to have a review to work within the ED, but it is getting to the point that we, as nurses, are just paying for our little cards that say we have sat in that class. The last two days, I have sat in class with some very bright people. However, there is always that one person in the class who is a complete idiot. They ask questions that just demonstrate how idiotic they are and you just want to pull your hair out. For example, one woman, who has been a nurse for well over ten years, stated "we just irrigate with normal saline, and that just cleans everything right up." Now, we were talking about needle aspiration for priapism. after questioning what the heck she was talking about, we further learned that she was under the belief that priapism was an eye condition related to dust in the eyes.