marcicatherine

I had a patient come in the ER a few days ago. CP, diaphoresis, vomiting, SOB, and ST elevations through the roof. We did the whole nine yards on her, NTG, Heparin, and Retavase. Finally by the second dose of Retavase she started to reprofuse.....which, in itself, can be a touchy, scary time. Luckily she didn't fibrilate. I had her for about 90 minutes before I transported her to ICU. When I got to the unit with her, I attempted to give report to the nurse taking over, all she was concerned about was why the patient still had her pants on!!!! Who cares that we just freaking saved this lady's life! I calmed explained to her that removing the patients pants was not a high priority in an acute MI situation and walked out the door. Is it just me?? :angryfire

In our ER, we wear surgical scrubs which are provided to us. Get a pair off the cart, change, work, change, go home. It is very convient, especially with body fluids flying on a daily basis. We have the option of 2 colors, surgical blue or surgical green.......but hey, they're free, so who cares.

Helicopter brings in a 27 y/o OD on a Saturday morning. Pt took undetermined amount of Xanax, Lorcet and Methadone the night before. On arrival pt was intubated, he had aspirated huge amount of vomit. His lungs were about 3/4 full. We did what we could and sent him to ICU basically to die there. There was no telling how long this kid had been without adequate oxygen. About 3 months later the doctor who had taken care of this guy came and found me. He asked me to come see a patient in room 20 who had slipped and popped his knee out of joint. I went in the room and it was the OD guy!! He was alive and well and in a drug treatment house. After all the hugging and crying by him, the doc, and me..we popped his knee back in place (without any sedation, narcotics, or even Tylenol. He didn't want to mess up his recovery) put and immobilizer on him. I talked to him for a while later. He told me about the suicide attempt and the first thing he remembered was waking up in ICU and seeing his mom crying at his bedside.....that was the turning point in his life. Patients like him come along very seldom, but when they do, it is profound. It renewed my reasons for doing what I do. We do have a purpose and we do save/change lives.

Ok, man comes in today. C/O shortness of breath. I ask him if he is taking any meds. "Yes, I am taking an anniebioctic for my problem with barnacles" ??????????? Barnacles, barnacles, what the hell are barnacles? Daughter walks in, i ask what the antibiotic if for.....she replies bronchitis. How silly of my, i should have known. :roll

I had another one of those extremely unsafe days in the ER. Trauma 1: acute MI, bp too high for Retavase, needs NTG and heparin and prep for the cath lab Trauma 3: Severely dehydrated elderly man, BP 60 by doppler, needs fluids and careful monitoring (don't want to put him in CHF) Room 10: Women brought in with decreased LOC is now seizing, need IV access and Ativan. Room 9: LOL from the nsg home, family wants me to function as the nsg home aide ie..."she needs help to the potty, can we have some footies?, I think her gown is a little wet" "No s#it sherlock, she just pee'd on my leg! Room 7: A drug seeker who has decided to fake a kidney stone, very loudly and obnoxiously might I add These were all my rooms, and the only other nurse up front was just as busy. Will this madness never end???? :angryfire

I'm been on both sides of the fence. I worked ICU before I came to the ER. Yes, there are lots of skills and monitoring done in ICU that we seldom do in the ER. There are also lots of skills that I do more of (and better for that matter) in the ER. I have taken patients to the ICU several times since moving to the ER. Our ICU nurses look down on us as basically the scum from the basement......but I've been in their place. I remember thinking..."freaking lazy ER nurses can't even take the dudes pants off" and "what it with all the crap in the bed" i.e. EKG patches, alcohol preps, syringe tops..etc. I consider both areas highly skilled critical care areas....and we are a breed unto our own. You guys know what I mean:D I don't take it personally that we are not listed as critical care. We know we are critical care, and we are damn good at saving lives!

We rarely have residents in the ER. My post is, I witnessed a bad incident when a nurse gave succs and the doc couldn't intubate and the pt died. From that moment on I vowed to only give succs if the anesthesiologist is there to tube and maybe a select few ER docs. SCARY STUFF!!

When I transferred to the ER from ICU I was terrified of starting IV's on children and babies. There were other skills that I wasn't that confident in either....NGT, foley caths, and believe it or not IM injections. We just didn't do a lot of those in the unit. They were already done in the ER. To build up my skill level, I went to all the nurses every shift I worked and requested to do all the skills I could get my hands on. It really paid off. I rarely miss an IV stick now and I just got my merit badge in blind foley caths...hehehehe

Thanks for the support. Actually my nurse manager did get a laugh out of the complaint, she was just trying to get a point of view and wanted to know what I remembered about the patient. And your comments are exactly right. If I complained everytime a nsg home sent a patient covered in dried feces, (obviously not a recent BM) severely dehydrated, dirty, smelly, or etc.....I would be writing complaints all day. It's difficult when you feel like you've gone above and beyond your duties (remember..this was not my patient) and people still find something silly to complain about.

Not to worry! I just guide the starving patients to our lovely assortment of crackers.....we have regular saltines, low sodium saltines, graham crackers, and for the high society clients who are accustomed to fine dining...we have club crackers. Sorry, water is an extra charge. :chuckle

That's a great policy in a perfect world and a perfect ER. Our policy is....if you or your family asks for food, you get it. Otherwise we are stretched too thin to feed all the nursing home patients that we hold everyday. My point was...we provided the EMERGENT care that the patient needed (in the Emergency Room) and the only complant the nsg home could come up with is....she wasn't fed lunch.

Today I was called into the nurse managers's office. She had received a complaint from the director of a nursing home. They had sent us a patient several weeks ago with a head lac 2nd being pushed out of her wheelchair. I was not the patients primary nurse, but due to the patient being confused, I had redressed the head lac 4 times. She pulled it off several times. I also helped change her 2 times. We CT'd her head and the doc sewed her head. The time line was as follows *arrival and triage assessment 0900 *2nd nurse assessment 0915 *doc assessment 0925 *to CT @ 0955 *back from CT 1015 *from 0945 to 1115 head lac redressed 5 times, bed changed 2 times. VSx2, pain assessment, RN assessment...etc. *doc sewed lac at 1130 *called for ambulance transport back to NH 1200 *discharge with ambulance crew 1330 The complaint was that we didn't take good care of her. They stated she was incontinent of urine when they received her back at the nursing home (perhaps that happened on the ambulance ride home). The main complaint was......we didn't feed her lunch!! I couldn't believe that was the major complaint. Has this person ever been to an emergency room. I believe that same day we have 2 MI's and a resp diff. that had to be intubated...and we didn't feed her lunch. I understand that she needs to eat, but she had a family member with her (who was obviously the person who complained about us) and that person never said anything about food, or offered to feed her. The patient was non-verbal. Has anyone else out there ever received these kind of complaints? Am I over reacting by getting upset about this? We don't have the time and really don't have the staff to feed the nsg home patients that come in. Luckily admin. is on our side and luckily I(we) documented well.

I totally agree Magik Girl. When I first started working in the ER, I babied the difficult patients. I talked them into tests, blood work, taking meds, staying for treatment........Needless to say, that lasted about 2 months. I'm a little slow, it took me that long to realize that those type of patients don't give a crap how much you care. Their whole agenda is to see what they can get, how fast they can get it, and how much freaking s#it they can dish out. I have turned over a new leaf. If a patient refuses to talk to me...I walk out. If a patient refuses a med...I walk out. etc. Just today a patient came in c/o irregular very heavy periods.....she refused the CBC and beta HCG. I told the doc, and much to my pleasure he handed me the chart back and said "tell her to follow up with her doctor" ROCK ON DOC!!! We have enough patients that want care to deal with that. I love to say "This ain't Burger King, you can't have it your way":nono:

Along the same lines...a few years ago when i was still working in ICU, I was helping an elderly woman (78) take a bath. She let me do most of the scrubbing. When it came time to wash her genitals, she said "here let me have that rag, you don't want to get near old stinky" I thought I was going to fall in the floor laughing!!!:roll

I think on my last day in the ER I would: Tell the parents who think it is OK that their 14y/o daughter smokes a pack a day (and they buy them for her) "get the h&*# out of my ER The parents who don't give their baby Tylenol because they wanted me to see how high the fever could get. "get the h* out of my ER The patient who is on disablility for "anger control problems" "Yeah, me too.....get the h%$# out of my ER The patient who comes in....emphysema, asthma.....c/o SOB.....smokes 2 packs a day.......get the h$#& out of my ER ANYONE who comes in c/o Migraine and lists their allergies as Toradol, Ultram, Ultracet, Vistaril, Darvocet and all NSAIDS....oh yeah Tylenol and all migraine medicines.....get the h* out of my ER. gotta stop now, I could go on for days............... :chuckle