thelema13 5,424 Views
Joined Jun 13, '11 - from 'Florida'.
thelema13 is a ED RN, CHARGE NURSE.
He has '3' year(s) of experience and specializes in 'ED'.
Posts: 287 (48% Liked)
Just to follow up, I got questioned by my manager about the pt And I stated I think we did everything we could have, save giving her dilaudid. I was backed up by coworkers and charge nurse. Good thing I did a risk master just to cover my butt. Pt never cam back later in day like she stated.
Sorry also forgot to mention 500cc NS bolus.
Pt denied HA or hx of migraine. Pt kept asking for dilaudid by name. I felt bad for her, it's not nice to vomit so much. I advocated pain medication but doc wouldnt give it. Pt was a frequent flyer, and husband known to be a di** to staff. He picked her up on discharge and demanded the medical directors name and number, screaming he wasnt going to pay the bill and that he was going to get us all fired.
In my opinion, there was some psychological aspect to her condition, which played into her symptoms making them worse. It sounded like after the initial vomiting after being brought back from triage, she was wretching, trying to make herself throw up. Just my opinion, and I did speak to my charge nurse a few times about the pt. What got me is that she was telling me to tell the doctor what to order, "i need at least 4 shots of phenergen and 2 shots of dilaudid, plus one of each before i leave for the ride home." Upon discharge, pt refused wheelchair and stormed out angrily, without any s/s witnessed before. And to leave our ED is quite a walk since we are renovating.
Thanks again for all the replies!
This happens EVERY DAY. When people come to the emergency department for sniffles, stubbed toes and lacerations that have stopped bleeding on the ride over, you can expect this to continue and get worse.
That is why I staple an information sheet on our local urgent care clinics onto all visits I deem trivial. I am the king of treat and street.
The RN (me) that turned around and punched the wall after a patient/bed combo rolled over right foot. Boxer's fx and great toe fx, and a worker's comp claim in the works. Wonder how that will go?
51 year old male with a very large metal cock ring that was purchased a few sizes too small. He put it on and had a solid erection for 4+ hours PTA. No other medical history.
This is what we did:
1: Ice packs
2: Ice bath for penis and testicles
3: Copious surgi-gel and digital manipulation
4: IV neosynephrine, 10mg in 500cc NS wide open, did not affect BP more than 10 points systolic but had little effect on diminishing his erection.
5: Patient urinated x3, minimal size reduction
6: IVP toradol, morphine, etomidate, versed and brought out the ring cutter, then the ring cutter broke.... the ring was surgical stainless steel 8mm thick
7: A whole lot more surgi-gel and I sent a nurse home to grab his Dremel.
8: Used the Dremel on and off for 1.5 hours, allowing time to allow the metal ring to cool (iced surgi-gel helped here) We used tongue depressors as a barrier/guard in between the penis and ring.
9: Ring pried open with some monstrosity tool from the OR.
10: Patient took a cold shower for 30 minutes, then ended up going home with a urology consult, percocet and a lesson well learned....
He had the ring on and a solid erection for approximately 7 hours. He was a retired firefighter/EMT and was cracking jokes left and right. It was a very sensitive, delicate, dangerous situation.
What did you just learn???????? Buy a rubber ring, and invest in a Dremel for your ED!
I have a lady that dislocates her shoulder to get some moderate sedation and a RX for percocet.
Just the other day, I had a 75 year old male come in with chest pain. Poor guy was on the way out of town with his wife to go on a cruise. I triaged, got an EKG, started a line, drew labs and informed the doctor. Grabbed a 250cc bolus, aspirin and on his 2nd nitro pill, he bottomed out and coded. Got him back shortly after doing some compressions, dumped 3,500cc of saline into him, BP ~40/20s. During my triage he told me he took viagra, but not for 3 weeks. After we stablized him, I started asking him more questions, and he admitted he took a viagra before they left the house. This guy was in his 80's and was going to try and get his vacation started on the drive to the ship!
Had a woman come in for "seizures". She had a long list of meds including po morphine. On her allergies, morphine was listed. When I asked her about it, she told me she was allergic to IV morphine and had to have dilaudid instead. She then told me she was due for her pain meds and ativan and needed them immediately. I explained that she would have to wait to be seen by the MD prior to getting any meds. A few minutes later, she proceeded to have a "seizure". Another nurse and I went in and did the Oklahoma seizure test on her, which she passed with flying colors. To do the Oklahoma seizure test, have two nurses at the bedside, on next to the patient and the other at the foot of the bed. The nurse at the side of the bed asks the other nurse how to perform the test. The nurse at the foot of the bed explains (out loud) to rub the inside of the left foot (all while actually performing said task) and the right arm will twitch. Yep, my patient's right arm definitely started twitching when her left foot was rubbed. We were laughing so hard, we had to leave the room. Consequently, she received no meds during her stay.
Same old Ricky, fall due to drinking, off for his 10th CT this month.
Recently completed an ED travel assignment in Melbourne, FL. 13 weeks, take home ~$1200/wk. Overtime was triple time with the agency I was with, so I picked up shifts as often as possible. I used Medical Staffing Network/ InteliStaf. Stay away from HMA facilities, for-profit blood suckers!
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