The Bucket

After working in the emergency department for as long as I have, you think I would know what questions not to ask. However, I am a curious person and can;t resist asking the unaskable. For example, I have learned not to ask what is is your pocket, what is under your coat, what position where you in, and so on. You think that I would no better to ask what is in the bucket??? Nope, not I. I just have to know! Well a client came in with fracture arm after falling at the creek. He came in in swim shorts and muck boots.... that should have been my first clue. His attire included a 5 gallon bucket with the lid on tight that had small pin holes in top... That should have been my second clue, but no. My curiosity and the egging on from less bold co-workers lead me to ask the loaded question! What's in the bucket???? My first thought that it was bait, but when I picked up the bucket to move it it was heavy and no swishing of fluid. so I really had no clue and had developed increasing curiosity by the minute. The patient told me to go ahead and open it. Nope I have learned that lesson, which is an entirely different but related story. Anyway, he opened it for me and I nealy died. In the bucket was 17 diamond back rattlers!!! Just rattling away when he lifted the lid. Why did he have them, he was collecting them or research when he fell and broke his arm. Why did he bring them into the ER? He did not want them to die in his car. What would I have done if they were my snakes????? Had one hell of a barbecue, but definitely would not have caught, touched, and been anywhere near them while they were alive!!! Will I learn my lesson and stop asking always loaded, "what do you have there question?" nope, but will never open any container on my own!

Brazilian wax

Women came in with c/o labia pain. Prior to exam, the women bashfully explained that she had always wanted to have a brazilian wax, but was too shy to go to the salon. So here she is in the ER showing the ER nurse and ER doc the results of having her husband wax her. Her poor husband look sick, He did not mean to hurt her, yet there was blood everywhere. He had misunderstood her directions on not to put wax on the "lips." he had gotten a small portion on her labia and when he held the skin tight and pulled, he caused a avulsion labia. I am not sure who I felt more sorry for, the wife with the injury or the husband who felt horrible.

Moral of the story... if you want to wax down there go to someone who can do it and don't talk your poor hubby into it.

Tragic

Tonight one mother is waiting while her little boy receives a heart transplant that he has been waiting for his entire life. 100 miles away another mother watches over her child that is in the intensive care unit after a lung transplant. 2 other mothers are holding their children after their liver transplants while other mothers around the state are thankful for having another day with their child after their transplants. Tonight 14 children have received organs because of one tragic event.

a mother took her child while she committed a crime. The victim fought back and fired at the mother's car. The victim did not know there was a 14 month old in the car and the bullet went into one side of the child's head and out the other. We did everything that we could do to help and it was determined that the child was brain dead. The loss of this child is a tragic event. Some believe that some children would be better off dead, yet every child deserves a chance no matter what type of parents they have. In this case, this child did not have a chance. However, the loss of this soul has saved 14 other souls. Sometimes thing do not make any sense in the ED, this is one of them. Thankfully, something good has come of this tragic event. There might not be any family to mourn the loss of this soul, but everyone in our department feels the loss and mourns for her.

Urine Sample

Patient comes in confused, but has stayed confused for longer than expected. We attempt to get a urine sample from he, but are unable.

Picture this...
all nursing and doctor staff sitting around desk and talking, patient comes out of room. I attempt to get him back in room. There is a large column that block the view from the doctors desk, yet they hear me say, "no, no, put that back in your pants." At that time patient is whipping out his dick and proving his urine sample all over the chair that I was just sitting in, which of course bounces back up onto desk and into my fresh coffee. He than zips up and everyone is gaping at him. I am trying to get him back into room while everyone is just looking at him and me like he is crazy, which he was. It took me saying, "hey, how about a little help here prior to the male doctors and male nurses snapped out of it and came to my aid or the pissing patient.

First diet, than quit smoking and than someone pees in my coffee

Revenge: ER Style

I have ranted and rave about having EDS and the pain in the butt, or should I say the pain in the joints it is. Well my EDS help get a little sweet revenge on a new ER Doc today. With the help of a few other Docs:)

A few weeks ago, a new Doctor started. I have no clue where he is from, but I am positive the nurses held a party after he left.He some how believes that nurses only live to follow his commands. He does not understand that we as nurses follow protocols, which allows for nurses to order tests, give certain medications, and yes, even perform a full code with out the help of a doctor. (Not that we want to, but we can if we have to).

After making the last few weeks hell, the doctor's and us(nurses) developed a plan to teach this doc some manners. He has the habit of not looking when talking to the nurses and roughly handing the charts to us. Sort of slapping the charts in our hands, or down next to us. We have told him many times not to do that, but he just doesn't care.

This is where my EDS comes into play. Just for the record, it was not my idea, I just went along with it. I can dislocate most of my joints on demand, and at times the doctors have relocated me after having a few good laughs when I can't relocate myself.

Here is the set-up:
1. take ring braces off fingers and wait till new doc is not looking and slaps a chart down next to me.

2. Hyper-extend/ dislocate fingers and yell

3. When old doc, who is in on it, looks down holds hand and pretends to exam dislocated fingers, pop the shoulder out

4. Old doc calls over new doc, and asks him why he slapped my hand with the chart.

5. Wait till new doc looks at hand and grabs hand to exam to yell that he is pulling shoulder out.

6. New doc than sees shoulder is out, give him a few minutes of thinking he abused some poor nurse.... than pop shoulder back in, flex fingers back, and tell him to stop slapping charts down at the nurses.

It is comical to watch the emotions that crossed his face, but he has not slapped a chart in the hands or next to any nurse since then.

only draw back was that my ortho got called in for another patient and the doctors let the gag slip out of the bag to my ortho, who in turn gave me a lecture (another) on the hazards of voluntarily dislocations. Some how the doctors never let it slip that it was THEIR idea.

Soliciting the pity vote

Okay, I have been nominated for Doc D's nursing blog award, which is a great feeling because people do actually read my crazy rants. However, I am only second in the running, that is second to LAST.

So, come go on over to the Doc, and vote

Check out some of the other blogger, they are truly funny and while you are there read through some of our dear Doctor D's posts at Ask An MD They are very honest, which is at times hard to come by this day and age

Warning: What not to do in a Snow and Ice Strom

Well, I live in the south/ mid west, if that makes any sense. Anyway, we do not get many snow storms. Our average snow fall a year is less than an inch. We get plenty of Ice storms, but it is too cold for people to really go out and do dumb things. So, bring on the snow and all the idiots come out. This past week we had 4 to 8 inches of snow dependant on area. People did not know what to do!!!

1st pet peeve:
I had 5 of my 9 nurses call out of work.... for the week, not just the day! I figure if I live 40 miles from work and had double the amount of snow than those who live two blocks away that they should be able to make it if I did.... Not the case

2nd pet peeve:
If a person is spinning on a ice road, why do you decide to keep going once you hit the ditch??? Watch 2 of these geniuses from the shallow gene pool do just that.

WTF are these patient thinking????

We have all seen what happens when a person sticks their tongue to a frozen poll, yet I took care of at least ten patients that did that one thing. What is amazing is that nine of them were over the age of 30!

I have an idea, why not have billy-bob hook a metal drum lid to the back of the tractor and go down the hill??? What happens is the lid picks up speed and rear ends the tractor resulting in 2 broken arms.

Let's take the 4-wheeler and try to cross the creek. Hell it is covered in snow...so it must be frozen.... Nope, billy-bob was lucky, the creek was only a foot deep.


Let's bury our friend in the snow like they do on the beach with sand, I know it is in the middle of a snow storm, but it will be a a great picture.... with all the snow falling, they lost poor Billy-bob and search dogs had to locate him under 4 feet of snow, which they had piled on top of him.... No worries, a touch of hypothermia doesn't kill everyone.

My personal favorite....
Women with deformity to left ankle screaming that she wants pictures so she can sue the landlord for not clearing her driveway.... We took picture, but included the 4 inch stilettos that the women was wearing in them... Must be Billy-Bob's Sister

The nursing home dump.

99 year old male, agonal breathing, heart rate we are watching drop from 150 to asystole. Why are we not doing anything, because he is a full DNR. No Chest compressions, No airway management, No medications, No cardioversion, and No antibiotics. Are hands are tied and their is not a dang thing we can do. So, why do we have him in the ED?


Ah, it is a nursing home dump! Nursing home sent him over because of his agonal breathing and did not tell the EMS what his DNR until until after he was loaded in the rig. He arrived at the ED and we watched him die with in 5 minutes. Not coding him was the right thing to do, but still I am a fixer and that is why I work in the ED, standing there not being able to do a thing is hard for me.

Now,Back to the nursing homes... I figured I would make a short list of reason why a patient should not be sent to ED.

1. They have died (sorry, once dead there is not a dang thing we can do)

2. They are about to die and have a full DNR (Still we can not do anything)

3. If patient is normally confused; such as, dementia, don't send to ED for confusion. (I will send them right back)

4. patient has cloudy urine and fever, but just started treatment for UTI less than 24 hours ago (Can't do a thing on that but discharge back with instructions to continue home meds)

My favorite

5. Transfer to the ED due to short staffing is not a way to make friends with ED staff


As a side note, just because a person is in a nursing home, it does not mean that they are not human. I will call you and question why a person is in the condition they are when a simple bath and turning could have prevented their pain.

Going to Haiti

With everything going on in the world, there is always the need for volunteers. I am part of a disaster response team and every year I have the opportunity to help someone. It is just a way that I can help others like I was once help.

With this said. I am nervous and frustrated at this time. I am to go to Haiti and was set to go two days after the earthquake. However, due to the united nations taking over, nurses are right now not allowed to come in due to safety reasons. So, my questions are, why not? I was supposed to go with the troops, and work within their wire. To me, this would mean that I am very protected. Now, the UN wishes for us to work else where, yet they are delaying our deployment for up to 8 weeks. Haiti needs nurse now and we are left with our hands tied. I really can't stand red tape!

So why am I nervous? I have been in manydisasters, yet something about this just leads me to believe it will be the worst that I have ever seen.

Forget about that nuero consult!!!

Log roll patient, part of skull hit floor and baseball size piece of brain landed on foot. Yup, nuero is not going to do nothing with this! Forget about the burr holes we had requested earlier, you know us in the ER, we make our own.

When nuero called to ask why we cancelled, he thought I was joking when I said that they are on the floor. Nope, I was not teasing. Most on the floor and a few bits on my shoxs.

And no,Dr.sleepy, I am not being a smart-ass, just logical and stating the facts to you so you do not drag yourself out of bed for nothing. Next time, I will consult you on ever chronic HA at 3am to rule out a tumor if you keep being a snotty little boy

Make a Nurse Smile

People have asked me why do you work in the ED. Some days I really do not know why, after being belittled, yelled out, and dealing with some of the most persistent drug seekers. However, those above are only a sample of who I take care of in the ED, and some patients just make you smile all day.

1. Little old ladies, who have reached the age that they just do not care what comes out of their month. They can say some of the most insightful and interesting things that I have ever heard. Example: One day, a very special 87 year old women, , who was slightly affected by dementia, stated to the doctor, "She is cute why don't you just date the nurse, marry her, and have a bunch of kids, if you get laid, you will be a happier man and less grumpy!"

2. Children are also the funniest little patients that a nurse could have. There is a age where children are just brutally honest, yet they only understand what they have been told and what they see. One such child, 5 year old male, told a nurse that if she was not a home wrecker than she would not be fat with a bastard child. Apparently, the mother of the child had said why too much in front of her child. Her ex-husband's new wife was pregnant.

These are just few of the patients, there are hundreds that just know the right way to make a nurse smile.

Just a small touch!!!

It is amazing how a sternum rubs can bring a person back to life when they are on the brink of death!!! Had three unresponsive, 2 from the jail, who just would not respond at all to gentle shaking, nor talking to them. One appeared not to be breathing (holding breath). One little rub and they are good as new!!!



My question is, do people really think we are that stupid? What is the sense in playing possum????

Feral Child

I have experienced many things in the emergency room, yet everyday something amazes me and I learn something new. We had a feral child in our department and when the doctor told me that I should take over care because the child was feral and the newer nurse was not handling it well, my response was that it was that all children are feral at times. I did not know she was dead serious!

What is a feral child????
A feral child (feral, wild, or undomesticated) is a human child who has lived isolated from human contact from a very young age, and has no (or little) experience of human care, loving or social behavior, and, crucially, of human language.

This child that I was taking care of had been found in a dog cage at her others home. When she was found she was a little over 4 years old. When I encountered her, she was 9 years old. Now there are many sources out there that can explain the importance of human contact, care, love and human language that the child do not experience and the outward causes.

This child had not experience much in her first four years of life, and did not have any lauguage skills, was impulsive, and a true wild child. Any simulation she was bouncing off the walls, just because she still was curious about everything. I watch her in a blink of an eye jump on the bed then onto the overhead pelvic light and swing across the room before any of us could stop her. The foster mother, who must have a heart of gold, caught her. The doctor and I just attempted to distract her with the drawers full of supplies. This gave us time to get her discharged!!!

Exam room after discharge:

Over head light broken and sharps container ripped from wall: called maintenance
every single package of gauze wrap, ace wrap, bandages, and everything else that was in the drawers completely opened and around the room. ky jelly and saline flushes all of the floor. Basically the room was trashed.

What caused her to go completely nits was that the foster mom grabbed the wrong bottle of meds, not her fault, so the child's med level went low. Child needed up draft, we all know what updrafts do to children.

Why did we give the child everything in the draws???
We can't blame the child for her actions, we did not want to physically restrain her and put her through more mental anguish, so we distracted her knowing it would leave on hell of a mess.

Now the techs did not quite understand our laughter at the room and refused to help us clean it up. I just think that they did not understand. I did not want to force them to help, I could have. So the doctor and I cleaned the jelly up, washed the walls, had maintenance come and help with the ceiling. It was quite a learning experience for me.

I have to say, this doc an I seem to get into many a interesting cases. I have learned a lot from her and it is nice that when things come up like this, she stays at my side through the crazy parts and the clean up. She has no problem helping me clean fecal matter off a person or being my medication bitch (her words, not mine).

My Blooper

Woke up this morning, jumped in shower, coffee while I dressed. Proceeded to drive the 45min through country road to the city. Walked into work, clocked in, made assignments. While making assignments, I noticed that we had 1 too many nurses. Hmm... I thought, It will be a fight to decide who wants to go home because everyone does. 30 minutes later I realized it was my day off!

1. In my dummy defense, I have worked the last 11 days.
2. It would have been nice if someone gave me a heads up when I walked through the doors! Instead they found it funny.

3. Really need to work on life not being so automatic.


What is sad is that this was not the 1st time I have done this. I do it about once a year. Last time, I did not realize it was my day off till the end of the shift. I had 5 days on, 1 day off and another 7 days on. Somehow I was off a day on when day off was. With us always being short nurses, everyone thought I was called in.

Triage adventures

Between family, school and work, have not been able to post the last few days.



I normally do not work triage, but every once in a while I need a break from the code and trauma rooms. Triage is always frustrating and at times funny as hell.

1. Woman is brought in by family, C/O heart stopped last night for 4 hrs, my response was did you feel it stop? Do you have a defibrillator? What made you think it stopped? Her response, my doctor is crazy and said I had a perfect heart, but I use to work on the cardiac floor and I know something is wrong!!! I did compressions till it restarted.

2. Woman came in tweaking, C/O told to come here so that I could be admitted for surgery. My response, do you have direct admit orders? Who is the Doctor admitting you? Her response doctor said the only way that he would pull the two teeth that I have is if I get sick and am admitted, but I need meth patches while I am here... I really had no response after that (At Least not one I could verbalize)

3. Young woman came in, C/O bumps on clitoris. My response, when did they start? are they anywhere else. Her response, started after I felt bad for this guy and only charged him $10.00 to lick me, next time I'm gonna charge him $25.00......

4. 15 year old male came it with mother, C/O nonstop itching in genitals. Mother reports that she has found him in his room a just scratching and scratch, he told her it was itching and that is why his pants where down and that he only was using the lotion to help the itch...... Okay, give me a break here, mom needs to get a clue that her baby is no longer a baby.

I will never figure this out..

1. How a patient can walk into the emergency room, walk to their bed, undress, and get into bed. Then they hit their call light to be pulled up in bed because they are uncomfortable. Will never figure it out. Just wish some of these patient were a bit lighter!!!

2. How a patient can call 911 to go to the emergency room, then when they get there they say "nope, don't need a doctor, just needed a ride down town."

3. How a patient can have 10/10 abd pain, n/v, than proceed to ask for a cheese burger and coke form the cafeteria. My answer is, nope, don't want to reload you for projectile vomiting that you complained of.

4. How someone can really justify calling a nurse any number of names, and in some case threaten to assault them prior to the nurse giving them their pain shot. A little common sense would say that nurse get to pick what gauge needle she uses.

Child Abuse

The question that I pose to all of you is.... Can you really tell the difference between child abuse and a genetic disease? Do we that work in the ED think outside of the box when we see injuries that could be caused from abuse? Do we just become cynical and assume all suspicious injuries that we see are related to child abuse?

This might not be an entertaining or funny post, but after the news I received today, I believe that it is worth a mention.

Case: 9 year old male covered head to toe in bruises, sclera on left eye was red, shoulder dislocated.

mother reports that child just bruises easy, that child was swinging on monkey gym and fell screaming that his arm hurt.

Both mother and child wore what appeared to be older hand me down clothes. Mother might have completed 5th grade, but very doubtful that she went any higher. The child did not have any medical insurance, not even medicaid. When reviewing the chart, the child had been to our ED many times for dislocations, bloody noses, rectal bleeding, and sprains. This child had scars that looked like he had never had medical treatment, so some of his wounds turned to scars were wide and gaping.
So what would you think???? Looks like abuse, sounds like abuse, it is abuse... right????

Lucky, I work with some great doctors!!! The resident was assuming abuse and had the police on line. One of our ED doctors told him to hold on. Dr. Great came to me and asked about what I experienced with EDS as a child, and what type of injuries that my younger son had encountered. You see,Dr. Great thought there was something off about the abuse allegation because of the mother and son interaction. No, this doctor is not familiar with the disease process of EDS, but he had thought that it sounded some what similar to the injuries that my son and I suffer from.... So he asked, then he looked up the disease.

Some of the common injuries that come with Ehlers-Danlos syndrome (EDS), include dislocations, easy bruising, vessels in eyes are very fragile, the lining of the intestines can easily tear, which leads to rectal bleeding. Minor injuries heal poorly and leave wide gaping scars.

So, after the doctor found all of this out, he came up to me with a very odd request... Can I pull your skin, he asked. At first, my response was pardon me? He then proceeded to tell me what he was thinking and prior to him going into the room he wanted to see and feel how the skin reacted when pulled. Those with certain variants of EDS have very elastic skin. Anyway, long story longer.... Doctor Dx the child with EDS and sent him to a specialist for a biopsy to confirm the genetic disease. Today Dr. Great called me and told me that the child that everyone thought was abused indeed had EDS that was confirmed by the test. Social services have been set up to help this mother find the resources to help this child.


So what is my point???
1. Look at the whole story prior to calling it abuse.
2. Most cases are abuse, but for that 1 in 1,000, 1 in 10,000, or even 1 in 100,000 it is a disease.
3. If you do not understand or know something, go look it up or ask, no matter if that person is lower on the totem pole than you. Everyone knows a little something that another does not.

Ok, Done with my rant

Cold, Cold, Cold...

We normally do not get below 20*F, nor do we get snow!!! This year we have had snow twice and they are calling for -5*F, no that is not a typo -5*F!!! With the decrease in temperatures we are having an increase in homeless coming in looking to get warm. I normally talk with them prior to them checking in to see if they are cold or seeking treatment. Yes, I am a sap. I do not have the heart to kick them out of the waiting room. I just do not feel like having a bunch of bumsicles coming in with hypothermia and frost bite because I kicked them out of the waiting room.

23 weeks...

23 weeks and 23 visits. I can't wait till this pregnant female hits 24 weeks because than we can just divert her to L&D.

Week 1.... I missed my period and think I might me pregnant, can you test me? no, well I have abdominal pain.... Instant pregnancy test

Week 2 ... I get nausea in the morning, can i have a pain shot? No, well have abd pain..... instant treatment

Week 10... Can you do a ultrasound so I can tell the sex? No, I have abd pain and think I am spotting... instant ultrasound

Week 16.... I have abd pain can you tell me the sex of the baby now that I am further along?..... ultrasound.... it's a boy

Week 23.... How long before I can just give birth, so tired of being pregnant.... 40weeks!!!! I have abd pain, knee pain, nausea, sore throat, on and on... can I have a pain shot?

Now this can go on and on.... I could tell you every visit from week 1 to week 23, what a waste of medical resources....

My One Weakness

Well, I hate to admit my one and true weakness, but the cat was let out of the bag today. A person can puke, poop, pee,and bleed on me. However, mucus just gets to me. Most of the time I can hold the gag in or think pleasant thought. I have worked in my ER for over six years, with the same staff and same doctors and they never had an inkling to my aversion and my gag reflex when it comes to mucus. Well today, I was helping another nurse with one of her patients. This patient had a foul, rank, and obscene Odor to her. It was not fecal or urine, No clue what it was but it was bad! I turned away from her for one minute and when I turned back she had runny, snotty, foul mucus all over her face. The mucus combined with her unique smell just sent me over the edge. I made an attempt at a graceful departure towards the bathroom, but only made it as far as a trauma room. With my head over a biohazard can while I looked done at bloody towels and pads from our recent trauma I dry heaved till I thought I was going to pass out. When I finally thought I had composed myself, I made my way to the nearest bathroom. When I encounter the patient in the hall, but this time she reached out to grab my arm with her slimy hand. That is when I just couldn't hold it in anymore. I made a dash towards the bathroom and lost all of my cookies. Unfortunately, I had not locked the door.... Next thing I know one of my favorite doctors was in the bathroom with me holding a syringe filled with zofran. Between gagging I was trying to tell him that I was not nausea just disgusted and that last time I got a shot I passed out (Don't like needles:) Long story longer... he gave me the shot, I passed out, when I woke up I had half ER staff surrounding me on a gurney. (ER nurses worst nightmare!!!) At first they thought I had morning sickness, nope took about 15 minutes to convince them I was not pregnant, not sick, did not need 100 or so tests to dx my illness. I just got disgusted and gagged. Once they all figured it out, They spent the day making sniffing, snotting, and every noise possible that might make me gag..... The feeling of the ER love!!! Think it is going to be a while before they let up on me.