MedWorm.com provides a medical RSS filtering service. Over 5000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'ERnursey - An emergency room nurse blog' source. Sat, 16 Aug 2008 14:41:51 +0100 http://ernursey.blogspot.com/2007/11/attention-this-is-year-2007-you-can-buy.html Attention: This is the year 2007, you can buy six bars of soap for a dollar at the dollar store, public restrooms abound, most cities have homeless shelters where you can shower and do laundry, if not - there are plenty of streams and rivers.THERE IS NO EXCUSE FOR BEING DIRTY.I have sat in triage with people who obvious have not bathed or washed their clothes in months. Jeans that have been worn for so long that the persons body oil has completely soaked through them to give a shiny appearance - usually shiny black from filth. That comes accompanied by the smell of rancid oil and BO. Hair greasy, lank ropes. How do they stand it? Imagine being shut in a small ER room with someone like that. And invariably the chief complain is some sort of discharge from some unwashed part. ER docs, you amaze me with your fortitude. I can stand over to the side with some Vicks under my nose while you are planted square in front of the offending body part.The most offensive thing to me is when they bring in their babies. Babies not even walking with rings of dirt in their neck folds and suppurating rashes from not having their diapers changed properly. I have seen infants with lice!How can anyone think that this is OK? Can you really be so lacking in IQ that you don't realize it is not acceptable? (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1034712 Sun, 18 Nov 2007 03:01:00 +0100 1034712 http://ernursey.blogspot.com/2007/11/that-thing-is-bug.html I found this in my garage today, it was 3" long and clearly in its death throes. I have NEVER seen anything so incredibly disgusting in my life. I screamed so loud that I scared the dog. He spent the rest of the day following me around to ensure that I was OK. His idea of following is to walk three inches behind me so that whenever I change direction I either a)step on him or b)trip over him. Now I am afraid to go out into the garage. As a matter of fact, I'm kind of afraid to go outside either. I'm calling my bug guy first thing in the morning. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1033715 Sat, 17 Nov 2007 03:09:00 +0100 1033715 http://ernursey.blogspot.com/2007/11/change-of-shift_15.html Kim at Emergiblog is hosting Change of Shift this week so head on over there and check out the best posts of the week. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1030374 Thu, 15 Nov 2007 18:05:00 +0100 1030374 http://ernursey.blogspot.com/2007/11/im-not-as-dumb-as-you-think-you-are.html I was reading my comments lately and someone cautioned me to watch my apostrophes. I got a good long laugh out of that one. It has been a looooonnnnnggggg time since English and punctuation was never what I would call my strong suit anyway. So let me apologize about not knowing for sure where to put that dang apostrophe, not knowing when to use a semi-colon or a colon and for my tendency to engage in run on sentences. I must drive cranky professor insane!But seriously. Everyday at work I encounter people who tell me stories that are so patently ridiculous that I can only assume that a) They are complete idiots or b)they think I am a complete idiot.For instance, I recently triaged a man who came in with a complaint of flank pain, possible kidney stones. During the triage he let it slip that he had been seen at hospital X across town. I asked him why he had not returned there and he told me he had called them and they told him that they wait was very long and told him to go to our hospital. Riigghtt. I often tell people to go see our competitors. So now I'm thinking that he is either lying like a dog or was so horribly obnoxious when he was there that they did suggest he go to another hospital.Then there is the patient with a migraine who drives 50 miles and bypasses two hospitals to come to ours. When asked why, she states she "doesn't think they know what they are doing" at those hospitals. Sure. So they told you no more narcotics huh?And the guy with the gunshot in his left buttock who said the gun went off while he was cleaning it. how the heck were you cleaning it behind your back? I think the guy who's store you were robbing probably would tell a different story.The teenager with abdominal pain who swears she's not pregnant even as the babies head is crowning.The guy with back pain and 22 ER visits last year for the same thing tells me he didn't get his pain meds filled because he lost the prescription. Or the girl who claims her roommate stole her meds (maybe so but too bad.) Or I accidentally knocked the bottle over and they went down the drain.I hear all kind of stories but I take a lot of them with a grain of salt. It's not my first day on the playground. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1028380 Thu, 15 Nov 2007 04:06:00 +0100 1028380 http://ernursey.blogspot.com/2007/11/i-hate-this.html Do managers take special, secret classes in how to best aggravate and stress out their their staff members? I'm home on my day off, which happens to be a Friday, I've been out running errands and get home after five. I check the answering machine and I have a message from work. It is my manager: "We need to meet on Monday to discuss and issue, please come to my office before I start my shift." Arrrgh! Did you mean to leave that late Friday afternoon so there is no way I can get in touch with you and have to stew and worry all weekend? Of course you did.So I stew all weekend. What have I done? I thought I was being especially good, I haven't pissed off any of the floor nurses, my patients have all thanked me, I haven't dispositioned too many people to jail so what have I done? Did I make a med error and not realize it? I am fanatical about quadruple checking everything but it is always possible, oh my God, is the patient OK. Now I am freaking out. I don't sleep well either night and my mind is going round and round on the same track. I am cranky with the family and totally stressed out. I have a horrible weekend.Monday morning I show up way before my shift and spend a half an hour tracking my manager down. I'm so upset my stomach is in knots and I have had several bouts of diarrhea from the stress. We go into the office and she shuts the door. My heart is palpitating. What have I done? Am I going to get fired? "We have to collect data on pediatric moderate sedation's for PI and I immediately thought of you as I know you have a special interest in that area, would you consider taking that on."I sit staring at her, blinking in a stupefied fashion as my brain tries to get out of the endless track it has been on for two and a half days. What? You had to call me at home and leave an ominous sounding, cryptic message on Friday for THIS? Do you know how stressed out I have been all weekend? I thought I was in trouble for something for crying out loud.But do I say any of that? no, I'm too stunned. I agree to take on the PI project and go out to go to work. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1025573 Wed, 14 Nov 2007 04:23:00 +0100 1025573 http://ernursey.blogspot.com/2007/11/check-this-guy-out-what-imagination.html Check this guy out, what an imagination. Thanks Mielikki. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1022740 Tue, 13 Nov 2007 04:01:00 +0100 1022740 http://ernursey.blogspot.com/2007/11/being-rebel.html I never get up with the idea that I'm going to cause trouble, I swear I don't, but sometimes I just can't help it.....it's like the devil just moves on in and takes control.Take today for example. I got up and went to work like any other day. The ER nurses have been a little up in arms lately since we found out that the administration have decided to give the critical care nurses a 5% premium. We were told we are not critical care. Despite the fact that we routinely care for incredibly sick and unstable patients that we STABILIZE before they go to the ICU. Despite the fact that we routinely hold ICU patients because of lack of beds. Some nights it looks like ICU south. But apparently we are not qualified to do so. Fine. We are fighting that one with the union.So an hour into my shift we get in a trauma patient who is well and truly FUBAR'd. He is so messed up that he can't even go to the OR. The ER is slammed, the waiting room is full and we are on diversion. Another nurse and myself had been working with the Trauma Doc for over an hour to get the patient stabilized. Now he was doing better, with semi stable vital signs but they decided to wait to take him to surgery for his orthopedic injuries. We are going to take him to the ICU when the ICU doc informs us he is "Too unstable to go to the ICU." Huh? I was under the impression that the ICU took care of critically ill people, apparently better than the ER since we aren't "critical care nurses." So of course I said something along those lines to the doc. He was not amused. Neither was my boss who wasted no time telling me so.I don't go out of my way to agitate and cause trouble, but sometimes I just can't help it. Tomorrow is another day. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1022741 Tue, 13 Nov 2007 03:13:00 +0100 1022741 http://ernursey.blogspot.com/2007/11/for-all-those-who-have-served-in-past.html For all those who have served in the past and for all those who are currently serving our country my humble and heartfelt thanks.Thank you for all that you have done, the sacrifices made by you and your families to ensure that I can walk out in public with my face bare, my hair how I want it, my legs exposed when it is hot. Thank you for fighting and dying for this country so that I may bad mouth the government if I so choose without fear of torture or imprisonment. Thank you for the freedom to go to what ever church I believe in without fear of another religious group exterminating me. Thank you for a country where I can work, own a home, have plenty to eat, be college educated.Sure, our country has problems, but all in all - we have it really good. I've never known hunger, torture, government sanctioned rape or murder, religious sanctioned torture or murder, genital mutilation, being sold into marriage when I was a child. I'm not considered less than a servant by the males in my community or family. I have the freedom to think and say what I want without retribution or punishment.THANKS VETERANS FOR ALLOWING ME TO BE FREE! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1020112 Mon, 12 Nov 2007 04:08:00 +0100 1020112 http://ernursey.blogspot.com/2007/11/on-non-nursing-note.html What is the problem with people that they all feel free to treat the world as their garbage can? I was driving down the freeway today and all along the side of the road is garbage. Cups, paper, boxes, buckets, bottles etc. etc. etc. It looks awful. And cigarette debris. I think it is a fairly well known fact that California is an inferno waiting to happen in the summer, the grass is so dry that you could set a fire by looking at it wrong and yet that doesn't stop people from tossing lit cigarette butts out the window and setting fires by the thousands. Every so often you'll come across a blackened patch, sometimes small, sometimes many acres. Hello you morons, just because you are too lazy to use an ashtray you are putting peoples homes and lives at risk.So in ERnursey's world the penalties would be:Tossing anything out the window that could start a fire: Pulled out of your car and shot on the side of the road and left there to rot. A couple of those and everyone else would think twice about doing that again.Littering: 1st offense - 300 days of picking up litter on the side of the road wearing a bright orange vest that says 'I am a moron.' 2nd offense- see above.Drunk driving - 1st offense (as long as you didn't cause harm to another)1000 days of picking up garbage on the side of the road wearing a bright orange vest that says 'DRUNK DRIVER.' 2nd offense - see above.If there were actually some real penalties for peoples misbehavior, they would stop. In our country people know there are no swift, sure penalties so they feel free to do whatever they want. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1019181 Sun, 11 Nov 2007 03:09:00 +0100 1019181 http://ernursey.blogspot.com/2007/11/draft.html After a night of drug seekers and malingerers we got to talking about what will happen if they reinstate the draft. After the question was posed we looked around the ER, which was filled with 18 - 30 somethings, most of whom had never known a day of work and all of whom listed Vicodin, Oxycontin, Klonopin, Ativan and Soma in various combinations on their med lists, and decided our country was screwed.I think our perceptions get skewed by what we see on a daily basis and I truly hope these people are not an actual representation of that age group. Surely there must be some gainfully employed, non drug addled adults out there somewhere. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1018574 Sat, 10 Nov 2007 02:21:00 +0100 1018574 http://ernursey.blogspot.com/2007/11/this-isnt-my-definition-of-ecstasy.html Late one evening we got a call from EMS that they were bringing in a 20 year old female having seizures. When they arrived the patient was still seizing, the report was that it had been going on off and on for over 20 minutes. (At that time I lived in a community with no paramedics and mostly volunteer rescue squads)We swung into action, one nurse put oxygen on the patient and another started looking for an IV site, a third placed her on the monitor while I went and grabbed some IV Ativan, a medication like Valium that we give to people having seizures.When I got back to the room, the monitor was on, the patients HR was 180 and her BP was 224/130! As if that wasn't bad enough, a rectal temp was taken and it was 107! What the hell? We figured some sort of Amphetamines were involved, was she seizing from the high temp? We gave several doses of Ativan with no effect, the seizure continued unabated.Prolonged seizure can lead to massive muscle breakdown known as rhabdomyolysis. When muscle breaks down, large molecules are released into the blood and can clog up the filtering tubules in the kidneys causing kidney failure. We decided to paralyze, deeply sedate and intubate this patient. After intubation we started her on an IV beta blocker to bring down her HR and BP. We also started cooling her to get her body temp down. About that time her lab work came back with a serum sodium of 109, which is critically low - probably causing her seizures. Now we started sodium replacement and prepared to transport her to a tertiary facility.It was our first encounter with Ecstasy. A popular stimulant taken at clubs and parties to give the user a feeling of endless energy and well being. Overdose can lead to hyperthermia and cardiovascular collapse. Often the user feels thirsty which leads them to drink large amounts of fluids which causes dilutional hyponatremia and seizures. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1018008 Fri, 09 Nov 2007 15:20:00 +0100 1018008 http://ernursey.blogspot.com/2007/11/its-not-enough-that-several-childrens.html It's not enough that several children's toys have been found to have high levels of lead, now you can give your kid GHB too. What in the world is the matter with people that they think it is okay, in this day and age, to use these ingredients. It is not like it is a new thing that lead is bad for people, I believe that fact is fairly well known.I think we need to ban the export of all foreign goods, other countries seem to be viewing that as a cheap sneaky way to get rid of a few Americans.On the other hand, I bet there is a rush by the club crowd to buy these beads before they are completely yanked off the market. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1013561 Thu, 08 Nov 2007 14:41:00 +0100 1013561 http://ernursey.blogspot.com/2007/11/hey.html I just found out that...........IMPACTED NURSE IS BACK!!!!!!! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1010765 Wed, 07 Nov 2007 03:57:00 +0100 1010765 http://ernursey.blogspot.com/2007/11/new-approach-to-er-overcrowding.html Actually this is a very good idea but I imagine there are hospital administrators that are getting out the tar and feathers.h/t Scalpel (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1010766 Wed, 07 Nov 2007 03:43:00 +0100 1010766 http://ernursey.blogspot.com/2007/11/trauma-center.html The first edition of the new blog carnival, Trauma Center, is up at Straight Talk from the Stanford ER. This is an ER themed carnival and the next edition will be in two weeks. You can use the blog carnival thingie on my sidebar to submit. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1010767 Wed, 07 Nov 2007 03:40:00 +0100 1010767 http://ernursey.blogspot.com/2007/11/watching-mama-die.html The ETT is left in place but the ventilator is gone, along with the noise. The room is silent, the nurses motions are slow, gentle and hushed. Morphine has been given to allay any pain or air hunger.The lights are dim.In the distance the noise of the ER has receded like the dull roar of the surf, heard only faintly in the subconscious. All that matters is here, Grandmother to twelve, mother to four, beloved wife. Collapsed suddenly at lunch, CT shows brain full of blood, no hope of recovery or any sort of meaningful life the family has chosen to let her go.The children and elderly husband have gathered at the bedside, silent tears rolling down their cheeks.on the monitor, which is turned away from the families view the spikes grow further and further and further apart until they stop.The doctor pronounces time of death and expresses her condolences. The family wants to know if she knew what happened and did she suffer. We tell her that we don't think so, the injury to her brain was so sudden and devastating that she probably didn't know what happened.The family says their good byes and leaves. The nurse removes the tubes and IV's and prepares the body for the funeral home. While she works her own tears fall, her own mother is aging and someday in the future she knows she will on the other side of the bed. Plus it is very difficult to see other peoples grief and anguish and remain untouched. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1007817 Tue, 06 Nov 2007 03:38:00 +0100 1007817 http://ernursey.blogspot.com/2007/11/are-you-on-phone-or-just-nuts.html Ok, the freaking bluetooth earpieces are ridiculous. What is so important that people have to be yakking on the cellphone every minute of the day. But it has enabled me to come up with a new game to entertain myself when I am waiting in lines and whatnot.....when I see someone yakking away, apparently to themselves, I try to guess if they are wearing an ear piece or if they are psychotic. It can be endlessly amusing. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1003764 Mon, 05 Nov 2007 04:31:00 +0100 1003764 http://ernursey.blogspot.com/2007/11/burnout-and-death-with-no-dignity.html Came across a new blog today and read this. Reminded me of why I left the ICU setting, I am a firm believer in death with dignity. When I first started in the ICU, we went all out on those that could benefit and did comfort care on those that couldn't ie the patients with no hope of recovery. Over time I noticed that we were doing more and more on people that were going to die anyway and it began to feel like an endless torture of sick, elderly people. I saw doctors overturn patients DNR's when the family asked (when the patient was not able to speak for themselves) because they were afraid to get sued. I've participated in the intubation, insertion of multiple invasive lines and tubes in people with severe heart disease, diabetes, multiple amputations and strokes confined to a nursing home in their 90's for god sakes because the family 'wanted everything done.' At what point did medicine become 'have it your way' instead of what is medically indicated. Anyway, I couldn't take it anymore and left to go to the ER. Sigh.So check out this new blog, I suspect most of us have been in some form of burnout at one time or another, and with all the burdensome rules, regulations and paperwork - it'll only get worse. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1003765 Mon, 05 Nov 2007 03:37:00 +0100 1003765 http://ernursey.blogspot.com/2007/11/california-says-hah.html It was sunny and eighty degrees out today. I was wearing shorts and got a sunburn. For those of you that live in places where it didn't get above fifty today........HAH! Bet you aren't laughing at us now. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1002356 Sun, 04 Nov 2007 01:28:00 +0100 1002356 http://ernursey.blogspot.com/2007/11/politics-explained.html FEUDALISM: You have two cows. Your lord takes some of the milk. PURE SOCIALISM: You have two cows. The government takes them and puts them in a barn with everyone else's cows. You have to take care of all of the cows. The government gives you as much milk as you need. BUREAUCRATIC SOCIALISM: You have two cows. The government takes them and put them in a barn with everyone else's cows. They are cared for by ex-chicken farmers. You have to take care of the chickens the government took from the chicken farmers. The government gives you as much milk and eggs as the regulations say you need. FASCISM: You have two cows. The government takes both, hires you to take care of them and sells you the milk. PURE COMMUNISM: You have two cows. Your neighbors help you take care of them, and you all share the milk. RUSSIAN COMMUNISM: You have two cows. You have to take care of them, but the government takes all the milk. CAMBODIAN COMMUNISM: You have two cows. The government takes both of them and shoots you. DICTATORSHIP: You have two cows. The government takes both and drafts you. PURE DEMOCRACY: You have two cows. Your neighbors decide who gets the milk. REPRESENTATIVE DEMOCRACY: You have two cows. Your neighbors pick someone to tell you who gets the milk. BUREAUCRACY: You have two cows. At first the government regulates what you can feed them and when you can milk them. Then it pays you not to milk them. Then it takes both, shoots one, milks the other and pours the milk down the drain. Then it requires you to fill out forms accounting for the missing cows. PURE ANARCHY: You have two cows. Either you sell the milk at a fair price or your neighbors try to take the cows and kill you. LIBERTARIAN/ANARCHO-CAPITALISM: You have two cows. You sell one and buy a bull. SURREALISM: You have two giraffes. The government requires you to take harmonica lessons. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1002357 Sun, 04 Nov 2007 01:27:00 +0100 1002357 http://ernursey.blogspot.com/2007/11/etiquette.html Whitecoat Rants has a funny rant about cell phones. I hate it when a patient or their family member is talking on the cell phone when I am in the room but you know what I hate more? Nurses that carry a cell phone and have an audible ringer and answer the damn thing when the are supposed to be working. What in the heck is the matter with people? I obviously was raised in a different age, or by different parents anyway. I was taught that when you are at work you are working. And when your own work is done there is always someone that needs help or something that can be cleaned or sorted or tidied. You don't sit on your duff at work, you don't make or receive personal phone calls except in dire circumstances. You don't call in sick unless you really are sick because it causes a burden on your co-workers and employer.Most of the time that isn't the case. I see people everywhere on the phone when they should be doing something else. For instance, one day I was at Wally world trying to buy a new watch. The one I wanted to see was locked up and the jewelry counter person was standing with her back to the customers talking to her boyfriend about their upcoming date and what she should wear. I waited patiently for about five minutes before I went in search of the manager to tell him that they had lost a sale and all my further business because of poor customer service. At my own job, you will see one or two nurses running their asses off while some slacker does the minimum patient care and then sits at the computer answering email. That really steams me.Sometimes I wish I could go back to live in the fifties when people had some manners and some sort of a work ethic. Back before the welfare generation and the age of entitlement. But then I realize I may very well have been stuck being a housewife. ICK! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1002358 Sun, 04 Nov 2007 00:08:00 +0100 1002358 http://ernursey.blogspot.com/2007/11/how-to-go-wrong-with-epi-pen.html Wow, here's a new one on me, courtesy of Straight Talk From the Stanford ER. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1002359 Sun, 04 Nov 2007 00:03:00 +0100 1002359 http://ernursey.blogspot.com/2007/11/change-of-shift.html This week's Change of Shift is hosted by Mother Jones at Nurse Ratched's. I love the pictures and I bet you will too. Check it out! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=1001860 Sat, 03 Nov 2007 03:09:00 +0100 1001860 http://ernursey.blogspot.com/2007/11/keep-quiet-or-else.html The more things change the more they stay the same. Head on over to see what Girlvet has to say about it. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=999648 Fri, 02 Nov 2007 03:31:00 +0100 999648 http://ernursey.blogspot.com/2007/11/do-they-think-they-are-first.html Mental health patients are going to be dumped on ER's in Austin. Hmmmm. That certainly sounds familiar. A few months ago our county legislature, in their infinite wisdom (not), decided that it would help balance the budget if they closed the psychiatric hospital. So now, all the patients in psychiatric crisis come to one of the local ER's while we try to locate a bed for them elsewhere in the state, often fruitlessly. It is nothing for a patient to spend their whole 72-hour hold in the ER. When the 72-hours is up we have to let them go. In the meantime they have received no treatment and are in no better condition than when they arrived. Sickening.Some of these patients are a danger to staff and other patients. They are disruptive and upsetting to the sick and dying patients who are also in the ER. Staff have been hurt, several have quit in disgust. While the psychiatric patients are being held that is a room that can't be used to treat the ever growing backlog of ER patients.The ones that are placed are often sent to a hospital hours from their community and families. Some of them are discharged in worse condition then they were admitted in.The mentally ill are America's forgotten citizens. Our lawmakers find it easy to ignore them when handing out funds. Many have been de-institutionalized in a misguided effort by government to 'make things better.' Many are homeless, lost and mistreated. Why do we allow this to happen? (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=999649 Fri, 02 Nov 2007 03:12:00 +0100 999649 http://ernursey.blogspot.com/2007/10/what-really-happpens-in-er-at-night.html Thanks to Kim for this pictoral essay of a night shift in the ER. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=995240 Wed, 31 Oct 2007 16:21:00 +0100 995240 http://ernursey.blogspot.com/2007/10/alcoholim.html In a comment on my previous post about drunks Maria has a link to article about an apartment building in Seattle that the city built to house some of their chronic homeless inebriates. Of course there was the expected furor from the public because the residents are allowed to continue drinking. The public thinks "they should have to stop." Get a clue people, they aren't going to stop, they can't stop. On the street they drive up crime rates, drive down property values and cost you billions of dollars in taxes every year, sure I think they should just stop drinking too but obviously that isn't going to happen so how about an alternative to multiple ER visits and increased jail costs dragging them to the drunk tank.Two things about the article though, first it said that their had been 120 ambulance visits there and this was in 2006 so obviously they aren't doing enough to cut down on needless ER visits, how about hiring and training some care attendants of some sort to monitor those that have drank until they passed out or soiled and vomited themselves? Even if you had to pay nursing salaries and benefits it would be far cheaper than ER visits.Secondly, I was saddened that the article pointed out that a great number of these people are veterans. What a sad indictment of our society that we will send you off to war to fight for our freedom but when you comeback with mental problems from the stress and horror - well too bad, you're on your own. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=995241 Wed, 31 Oct 2007 16:01:00 +0100 995241 http://ernursey.blogspot.com/2007/10/drunks.html Today I had a drunk who was brought in by ambulance for the second time in 14 hours with a complaint of altered level of consciousness, duh....a BAC over .3 will do that to ya', you don't need a doctor to tell you that one. On the second visit he was found walking around with his broken IV tubing trailing along behind him dripping blood all over the ER. When asked why he bit his IV tubing in half he looked at it and said "Did I do that?" Steve Urkel lives.Seriously though, these people take up a huge amount of medical resources being paid for by your tax dollars. Since they can not appropriately take care of themselves they should be institutionalized which would be much cheaper for the taxpayers. And don't give me any crap about how we would be infringing upon their precious rights to drink themselves into a stupor every day and pass out in puddles of puke, shit and piss in public places so that someone has to call 911 to get them the heck out of there. That takes an ambulance out of service so that when someone's little old mom is having a big ole MI there is no ambulance to take her to the hospital. It takes up a hospital room so that when you are sitting in the waiting room dying from that kidney stone you have to just suck it up. It takes up BILLIONS OF DOLLARS of medical resources every year in my state alone. Sorry, I don't want to hear about their 'rights.' If you have such a bad substance abuse problem then you need to be taken care of for society's good. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=990076 Tue, 30 Oct 2007 02:18:00 +0100 990076 http://ernursey.blogspot.com/2007/10/hey-ernursey-patient-in-room-23-needs.html "hey ERnursey, the patient in room 23 needs a warm blanket" I was informed by the doctor who had just left the room, walk past the blanket warmer, the nurses station, one of the ER techs to find me in a room on the other side of the ER where I was starting an IV on a screaming, squirming infant.I just looked up at him and said "you are joking, right?" He didn't get it. After I finished with the IV I hunted him down. "you know, you walked past the blanket warmer and expended ten times more energy to hunt me down then if you had just gotten the patient the blanket to begin with. It is not beneath you to do that." He just looked at me blankly. "never mind."I shouldn't complain, I worked with a doc once that would come out and write an order 'give patient warm blanket.'Seriously though, even though some jobs are more clearly nursing or physician related, patient comfort is everyone's job so when a patient asks for a blanket or urinal - hand them one for crying out loud! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=987323 Mon, 29 Oct 2007 02:17:00 +0100 987323 http://ernursey.blogspot.com/2007/10/i-think-it-should-be-mandatory-for-all.html I think it should be mandatory for all nurses in management, utilization review and QRM to work one shift on the floor. After all, if they are going to spend their time making up ever more burdensome paperwork for nursing and medical staff to use they should be forced to use it on a regular basis. I'll bet that if they did the mountain of paperwork would start to diminish noticeably.New this week is a check sheet to check off that you have done all the paperwork. A piece of paper to prove that there is enough paper. Can you believe it? (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=985680 Sun, 28 Oct 2007 12:20:00 +0100 985680 http://ernursey.blogspot.com/2007/10/odd-things.html "My pain is a ten, it's really, realllllyyyyy baaaaad, zzzzzzzz, snort, it's the worstzzzzzzzzzzz" COME ON PEOPLE, if it is really bad you can't nod off while talking to someone, I've been there.Seen recently on a local off ramp is a man holding a sign 'Need money for pot.' I almost gave him a buck because I was so impressed he wasn't trying to scam me. I pass the same spot every day and sometimes will see the same pan-handler two or three times a week for months - "hey dude, you've been at this for quite awhile, haven't you got enough gas money to get home yet?"At the local supermarket I spot one of our regulars asleep in the landscaping, I inwardly groan and think that he'll beat me to work. Sure enough, a concerned citizen calls 911 fearing that there is a dead body and EMS duly delivers him to the ER for the 5th time this week.Terrified parents bring their toddler in for 'vomiting blood' in triage the child vomits a remarkable amount of day-glo red vomit. "look she's doing it again!" ummm, that is most definitely not blood, has she been eating everything red? Little brother pipes up "she drank my red koolaid!" Ahhh, another life saved. We all laugh and the parents are greatly relieved. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=985681 Sun, 28 Oct 2007 02:40:00 +0100 985681 http://ernursey.blogspot.com/2007/10/business-as-usual.html Don't go to these hospitals until the strike is over, I cannot over-stress the importance quality, skilled nursing care has in good outcomes. Part of quality is adequate orientation to the hospital, a one day orientation just doesn't cut it. Yes, travelers do it all the time but they also have skilled staff there as a resource. Would you want your loved one crashing and all the nursing staff have less than 2 days experience in the hospital? Hell no. Seconds can make a difference in a critical situation and if the nurses don't know how to operate the equipment or find a crucial piece of equipment that can mean life or death. These hospitals should be sanctioned by DHS and JCAHO for continuing all but emergency services under strike conditions, I hope that the people in these communities will take their business elsewhere. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=979606 Thu, 25 Oct 2007 13:48:00 +0100 979606 http://ernursey.blogspot.com/2007/10/grand-rounds_23.html Oh heck, I forgot to submit to Grand Rounds this week. Check out this weeks edition at Pallimed. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=974978 Wed, 24 Oct 2007 03:06:00 +0100 974978 http://ernursey.blogspot.com/2007/10/how-to-act-out-in-public.html OK, I shouldn't have to tell you this but here goes....if you are an employee in my hospital and you come to the ER I will do all I can to expedite things as a professional courtesy. I cannot whisk you immediately into a room if there were other sicker people waiting first but I will do my very best for you. Do not come to the ER in your place of employment and act like an asshole. Don't make unreasonable demands, if you are sitting in a packed waiting room and there is a pale, sweaty puking person in a chair across the room don't throw a fit when I bring them back to a room first. Do not call the nursing supervisor and have her call me five times to ask me why I'm not bringing you back to a room, I will bring you back to a room as soon as I can. Do not sneak back and follow me around the ER asking me when I will bring you back and for damn sure don't interrupt me when I am in a room with another patient. As an employee of the hospital I would expect you to be a grown-up professional person who knows how to act when out in public. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=974979 Wed, 24 Oct 2007 02:54:00 +0100 974979 http://ernursey.blogspot.com/2007/10/nurse-is-always-to-blame.html I was reading this post by Kim at Emergiblog and it really got my dander up. The hospital administration comes up with a stupid ass rule, the nurse is supposed to document exactly what medication and dose the patient says they are taking even if they know it is wrong and then when the doctor orders it incorrectly without verifying that the information is correct it is the nurses fault that it got ordered wrong.Excuse me? I don't think so doctor, you are a professional and as such are responsible for your own practice. I am not your babysitter. If you read the reconciliation sheet and it says Xanax 25mg you shouldn't just check off yes and move on. Of course the hospital administration is wrong in expecting the nurses to write down information that they know is erroneous but each of us is ultimately responsible for making sure our own practice is safe and without error.I worked at a hospital years ago that had gotten into trouble on the JCAHO survey because the doctors were not signing their telephone orders within 24 hours. So who got in trouble? The doctors who knew darn good and well that this was a requirement? No, of course not, it was the nursing staff. Apparently we were supposed to be chasing them up and down the halls with all their charts pointing out each and every order for their convenience and if they didn't get signed in 24 hours the nurse that had the patients got written up. Being the supreme rabble rouser that I am, my response to this was to refuse to take orders over the telephone except for emergency, which was the policy anyway. Imagine how that went....."hello doctor, your patients blood sugar is 351 and the order reads to call you for over 350. No I am sorry you will have to come in from home and write that order because my hospital policy states I cannot take routine orders over the phone." Then when I got into trouble for that I had to ask the Director of Nursing if she was asking me to go against hospital policy.Everyone of us is aware of the requirements of our job. No one has to follow me around and have me sign my med orders or point out where to fill in my check sheets. If I don't comply I get disciplined, plain and simple. That needs to be an expectation of medical staff also, yes sometimes the rules are ridiculous and cause us extra work and yes we don't like them but we are all grown ups and responsible for ourselves so grow up and don't try to blame your mistakes on someone else and don't expect me to follow you around and make me do your job.And if I didn't already know it, I would suspect Kim works in California, I've worked in a lot of states and this one is the worst for making up ridiculous rules and regulations and taking ridiculous rules and regulations and making them even more cumbersome than they already are. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=970347 Mon, 22 Oct 2007 20:26:00 +0100 970347 http://ernursey.blogspot.com/2007/10/sorry-for-light-blogging-this-week-i.html Sorry for the light blogging this week, I have been in full vacation mode! Here's a little story about something the ER son was involved in.I'll be back at work tomorrow and full of new fuel for the blog! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=967401 Sun, 21 Oct 2007 16:59:00 +0100 967401 http://ernursey.blogspot.com/2007/10/boarding-patients-in-er.html Boarding patients in the ER is a problem, a big problem. Anyone in the ER knows it. You cannot stop the flow of patients into the ER but all the roads out of it are blocked for one reason or another. It is going to have to come down to some sort of legislation that admitted patients MAY NOT stay in the ER, ever. It is not safe for the patients, it is not safe for the ER staff and it is definitely detrimental to the sick and dying patients that need urgent treatment waiting for an open bed. Hospitals must be held accountable to get the admitted patients out of the ER. They must quit performing elective surgeries when the hospital is over capacity even though they are big money makers. It has to stop being about the pocketbook and start being about what is best for the patients. They must either bring in contract labor for times of high census or the administrators need to put on their nursing shoes and get out on the floors. The ER needs to become as much of a priority as the cath lab or surgery even though the reimbursement for ER patients is less. Administrators need to spend less time in useless meetings and come up with some real solutions NOW! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=961902 Thu, 18 Oct 2007 22:17:00 +0100 961902 http://ernursey.blogspot.com/2007/10/grand-rounds_16.html Grand Rounds this week at NY Emergency Medicine, check it out! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=957537 Wed, 17 Oct 2007 04:07:00 +0100 957537 http://ernursey.blogspot.com/2007/10/do-you-know-what-nurse-knows.html Do you know what SIADH is and what drugs and conditions cause it and what the treatments are? Do you know what Diabetes Insipidus is and how to treat it? Do you know the different signs and symptoms associated with a right sided MI vs a lateral wall MI and the appropriate treatments? Do you know the signs and symptoms of a sub-arachnoid hemorrhage and the appropriate treatment? Do you know how to run a code or titrate 20 different vasoactive drips? Can you manage a vent, do you know what the alarms mean and how to find out what is wrong with the patient and how to fix it? Do you know how to make a CPS report? An APS report. Do you know the treatment for malignant hyperthermia? Do you know how to do post-code hypothermic therapy? Do you know the signs and symptoms of pneumonia and the appropriate antibiotic therapy? Do you know how to treat a patient in septic shock? Can you assist a Dr. in putting in a Swan-Ganz catheter, arterial line, Endotracheal tube, transvenous pacemaker, ICP monitor and can you tell the difference in the waveforms and what is normal and not? Do you know the drugs and dosages to treat pulmonary edema? Do you know how to care for a patient on a VAD or an IABP? Do you know the generic and trade names of thousands of drugs, the appropriate dosages and the adverse reactions associated with them? Do you know what tetralogy of Fallot is or how to care for an infant with transposition of the great vessels? Do you know the drugs that a transplant patient takes? Do you know what graft vs host disease is and how it is treated. Do you know the signs and symptoms of transplant rejection, blast crisis. Do you know what to look for after a patient has chemo? Do you know how to manage CVVH? Dialysis? These are just a few things that nurses do every day. This is why you need an experienced, trained, skilled nurse at your bedside. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=957538 Wed, 17 Oct 2007 03:55:00 +0100 957538 http://ernursey.blogspot.com/2007/10/strike.html If you are considering being a strikebreaker take a minute and think again. As a nurse do you like being so over-worked that you cannot provide good patient care? Do you like being so rushed for time that you have to scrimp on your charting or sacrifice time that could be spent on patient teaching so you can get all the paper work done. Do you like being treated like a criminal when you incur a half hour to complete your charting. Do you like the CEO getting a $300,000 dollar raise while they cut your medical insurance benefits? Are you satisfied working in an environment where the medical staff are allowed to abuse you? How about having to use all your vacation hours up when the census is low and being worked half to death when there are sick calls. Do you like mandatory overtime? Do you like having to work a bunch of overtime to pay your bills? Do you like it when a new hire makes the same amount of money you do after working there ten years. Do you like it when a less qualified staff member gets the promotion because the manager likes her better? Do you like not having any input into your own nursing practice?If you think that nurses strike over money you are dead wrong. Patient care issues are always at the heart of any strike and the decision to strike is heartbreaking to a nurse. It is the very last ditch effort. If nurses are striking then we need to band together and support them, they are trying to make it better for all of us.Nurses are professionals, we deserve to have control over our practice. We deserve to have the time to provide safe, quality patient care. Our hours should not always be the first to be cut to save the hospital a few dollars.WE WILL NEVER GET ANYWHERE AS A PROFESSION IF WE CAN'T STAND TOGETHER. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=952541 Tue, 16 Oct 2007 00:38:00 +0100 952541 http://ernursey.blogspot.com/2007/10/doctor-blogging-from-iraq.html Very powerful stuff can be found here. For those of us who forget sometimes that there is a war going on, and the whole world isn't like it is here. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=952542 Mon, 15 Oct 2007 16:33:00 +0100 952542 http://ernursey.blogspot.com/2007/10/publics-perception-of-nurse.html I used to come home from the trauma center emotionally and physically exhausted after caring for multiple codes and critical patients, doing the fast paced nursing dance that kept people alive or helped them die with some dignity and relatively pain free. My husbands attitude when I complained about how bad a day I'd had would be something along the lines of "how hard could it be? You are only a nurse." Like he thought I spent the entire day fluffing pillows and patting fevered brows. Need I mention that that attitude, among a host of other things contributed to the fact that he is no longer my husband.Lets talk about an ICU nurse. The doctors round once or twice a day for 10 minutes or so. The rest of the time it is a nurse at your bedside noticing the subtle changes that may indicate a problem and calling the doctor who, based on the nurses report, will give her orders over the phone without seeing the patient. Let's say the blood pressure is starting to drop and the fever is up. She'll call the doctor and he will order fluid boluses and blood, urine and sputum cultures. Then after that is all done she will call back because the pressure is still low and perhaps get an order for a potent vasopressor given as an IV drip. Now she does VS every five minutes or more while she titrates the medicine until the blood pressure stabilizes.In the ER the docs are often managing 10 or more patients at one time, they see the patients when they come in and give orders and rely on the nurse to update them. I often will be titrating pain med on one person, treating a shock patient in another room, prepping a heart attack victim to go to the cath lab in another room. All requiring frequent vital signs and assessments. The goal is to know when a problem is developing from subtle signs and not let the patient get into trouble.And still what do we see on TV? Five doctors in a room during a code and not a nurse in sight. Nurses playing the dumb blonde roll, nurses in low cut tight clothing and whole hospitals where the nurses either don't work there or are just shadowy figures pushing carts and pouring water in the background. Hollywood, get a clue!And you nurses out there, toot your own horns, please don't say " Oh I'm just a nurse." when someone asks what you do. Educate the public about the very important work that we do because the media sure won't. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948809 Sat, 13 Oct 2007 15:37:00 +0100 948809 http://ernursey.blogspot.com/2007/10/when-doctor-assaults-nurse.html I am fortunate to work with a great group of doctors, they are smart, funny, caring toward the patients and families and treat the rest of the staff, from nurse to clerk, like a valued and respected member of the team. I haven't always been so fortunate, one of my first jobs was in a small hospital where the nurses were treated like dirt by administration. Seeing that we had no respect or value by our employers some of the physicians felt free to mistreat us also. One was notorious for his especially foul and abusive behavior. When you would call about a patient he would belittle you, yell and swear at you and slam down the phone, that is on the rare occasion he deigned to return your page. When I first started working there I paged him to report a patient with a very high blood sugar, his office staff called back and tried to give me an order and was surprised when I wouldn't take it from her. Apparently that was the way 'it was always done.' Well not from me, I can only take an order direct from the physician so have him call me back. That kind of set the tone for our whole relationship.He was the doctor I was talking about in the post about the ridiculous codes on people that were long past dead.One day a man was brought in full arrest, he decided to put in a transvenous pacer. He was having a lot of trouble getting in the introducer so things were getting a little tense. He finally got it in and i had handed him the pacer wire, he started inserting it but it wouldn't thread, he kept pulling it back and trying again but it just wouldn't go. I asked him if he wanted me to open another wire as the one he had was kinked. He looked at me, pulled out the wire and threw it at me! The other people in the room just froze, no one knew what to do or say. It was a small hospital and the next hospital was an hour away, there wasn't many jobs and we didn't have a union. We knew administration would support him. I didn't much care, I was furious. After the code was called I confronted him. I should have called the police for assault with a deadly weapon. As suspected, I got no support from hospital administration, I didn't stay at that hospital for very long.That was almost twenty years ago. I hope things have changed, I don't know what do you think? I'd be interested in hearing your stories. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948810 Fri, 12 Oct 2007 03:08:00 +0100 948810 http://ernursey.blogspot.com/2007/10/another-type-of-entitlement.html you read a lot in blogs etc. about the sense of entitlement we see in a good portion of the poor, welfare dependent, 'disabled', medicaid population. It has always fascinated me that people who contribute nothing to society feel that society needs to drop everything and be at their beck and call. How do people get that way? were you raised that way? I sure wasn't. I was brought up in a family where you were expected to pull your own weight. I had a full-time job at 15, they weren't too particular about child labor laws then. I have worked full-time plus since then except for maternity leaves. We were expected to pitch in at home, we all had chores we did every day and if we didn't get them done......well let's just say we got them done because we respected our parents and we knew there would be consequences. And they never laid a hand on us. Where did that kind of society go?Well there is another type of person with a massive sense of entitlement, they are usually well-to-do with a white collar type of job. They think their wealth entitles them to special treatment and they are not nice about getting it. I was assaulted once by a family member who grabbed me by my arms and shoved me out of the room because the doctor hadn't met them when they arrived in the room after being force to wait with the riff raff in the lobby. They didn't like being told that the doctor was a little busy in a code at the moment. Then there are the ones who like to name drop, like they are friends with the CEO. Who cares, call him at home and see if he will come in and wipe you because I will not when you are perfectly able to do it yourself. Or "my husband is a cardiologist" well good for you, I hope he is nicer than the ones here, you still have to wait your turn.The ER is the great equalizer. Everyone will be seen according to the severity of their illness. If the crackhead is coding he gets to go first, I don't care if you are the president of the university. If the heroin OD isn't breathing Mrs. Doctors wife, you are going to have to wait a bit. Please don't try to impress me with your credentials. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948811 Thu, 11 Oct 2007 04:06:00 +0100 948811 http://ernursey.blogspot.com/2007/10/eat-sleep-work-repeat.html Eat, sleep, work, repeat.Eat, sleep, work, repeat.Vacation in three days yippee! But for now......SLEEP. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948812 Tue, 09 Oct 2007 03:53:00 +0100 948812 http://ernursey.blogspot.com/2007/10/send-airman-care-package.html Please visit this site and send a service man a care package, this is for airmen but they have lengths for other branches. Remember that the holidays are approaching and our servicemen and women are far from their homes and loved ones. Take the time to show how much you appreciated their efforts on your behalf. A good sized flat-rate box only costs $7.95 to send. Things that my son says are greatly appreciated are DVD's, toiletries, books, magazines, local papers and letters from home. My younger child is having his class write letters to his brother and since his birthday is approaching his grandmother is having her friends at the senior center all do birthday cards for him.Thanks EMS junkie for the link. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948813 Mon, 08 Oct 2007 03:46:00 +0100 948813 http://ernursey.blogspot.com/2007/10/endless-piles-of-bureaucratic-bullshit.html I have blogged ad nauseum about how I feel about JCAHO and the endless piles of paperwork their self-perpetuating bureaucratic regulations have spawned. Sigh.But when I am feeling sorry for myself I can just always go and read this post on Police Inspector Blog and realize I don't have it so bad after all. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948814 Mon, 08 Oct 2007 03:29:00 +0100 948814 http://ernursey.blogspot.com/2007/10/sadly-this-does-not-come-as-any.html Sadly, this does not come as any surprise to us that work in the ER. I've been told that Vicodin sell for $10 a pill on the street here, that's a quick $200 bucks you can make on a two hour ER visit for say a sprained ankle, especially when you have medicaid and aren't paying a dime for your visit. Fentanyl patches are becoming readily available around here as we have seen an upsurge in young people who are unconscious from the powerful narcotic. That's a dangerous game.Another fun party game is the pharm bowl, grab handfuls of pills out of mom and dads and grannies medicine chest and throw them in a bowl at a party and take unknown pills for fun. We've seen deaths and very near deaths from teens who have taken beta blockers and grannies anti-diabetic meds. Bet that wasn't all that fun to wake up in an ICU on a ventilator with tubes coming out of every orifice.What is so terrible about life that such a large portion of our society wants to spend every day drugged to the gills? And these same people are out there driving on the road with you and me, nice huh? Pretty soon it won't be too hard for another country to come and take us over, we'll all be to stoned to care. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948815 Sun, 07 Oct 2007 15:42:00 +0100 948815 http://ernursey.blogspot.com/2007/10/update-as-requested.html A couple of you have asked for an update on my son. He is doing good. He is aircrew on a big plane that flies over conflict at 35,000 feet and basically directs air warfare. They also do ground surveillance, in peace time one of their duties is anti-drug trafficking surveillance down in South America, before he was deployed he has been to Ecuador a couple of times. I feel a little better about him being over there because I know he is not on the ground where IED's are always a danger. He has been really busy flying which he likes but some of the flights are 20 hours long (I don't know where they are going and don't really want to think about it much.) so he is really tired. They fly all night and get back in the AM and get the rest of that day off. I have sent him a few care packages, the thing he likes best are movies so I have been hitting up all the stores for their cheap movies and also Blockbuster's used movies, he has become quite popular for his movie selection.He shares an 8 foot square room with three other men but it has air conditioning so that is good. He says the base is OK, it has a movie theater and even some fast food. They have not been allowed off base as it is Ramadan over there and after that is over they are only allowed off once a month. I don't know exactly where he is but I think it may be around Dubai, which tolerates Americans. I'd be just as happy if they never got to go off base at all.The picture is a flight suit, which is what he wears. He says it is like a pair of comfy pajama's. Air Crew are also popular with the girls, like he needs any help in that area!Thanks everyone for caring and all the support.SUPPORT OUR TROOPS! (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948816 Sun, 07 Oct 2007 01:43:00 +0100 948816 http://ernursey.blogspot.com/2007/10/um-doc-i-think-patient-is-f-dead.html When I was first a little baby ER nurse I worked in a little bitty rural hospital out in the butt-crack of nowhere. It had five beds and I was there alone with a PA. All the EMS were volunteer so if there was an ambulance call they had to leave their job (often in a barn somewhere) drive to the ambulance barn, get in the ambulance and go to the scene. Since we were in a very rural setting, the scene could be quite a ways away. When there was a code it could be 45 minutes or more before they got the patient to us and by then they were quite dead but that didn't stop us from coding them more, it was ridiculous.When we knew there was a code coming in we'd call the doctor on call. One of those doctors was infamous for running the longest codes in the history of the universe. He'd put in a transvenous pacer and the whole bit on these poor bodies that had been down for and hour, half of that with no CPR. We hated it when he was on call. And since there were only three Internal med docs affiliated with the hospital, he could do no wrong in administrations eyes. It was really frustrating and back then there really wasn't much recourse if you wanted to hang on to your job. With the next hospital an hour away, I really wanted to hang on to my job, even though I HATED it.One day we got a woman in that had been working near the river with her farmer husband. Something had happened and she lost her footing and went into the water, she didn't swim and neither did her husband. He had to hop on the tractor and drive to the closest phone then it took rescue awhile to get out there and even longer to find her, by then she was good and dead. EMS there was not allowed to call it in the field unless the body was decapitated or in full rigor so they started CPR and brought her to us. And of course DR. Lunatic showed up, had to put in a transvenous pacer and the whole nine yards. The code went on so long that in between rounds of epi the other nurse and I were cleaning up the room, emptying the trash and going out to check on the other patients. He didn't get the message. Hey doc are we trying for a resurrection here? Eventually the code was called but I decided I had enough and took a job at the other hospital even though it meant a long commute in the snow, believe me it was worth it. (Source: ERnursey - An emergency room nurse blog) ERnursey - An emergency room nurse blog blogs http://www.medworm.com/rss/comments.php?id=948817 Sat, 06 Oct 2007 15:20:00 +0100 948817