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 'madness: tales of an emergency room nurse' source. Sat, 16 Aug 2008 14:44:39 +0100 http://emergency-room-nurse.blogspot.com/2008/01/sometimes-you-just-get-weary.html You know its going to be a bad day when your first patient calls you a "motherf----r" and says "get out of my room, I'm not lettin' any of you do anything to me", as her alcohol tinged breath wafts across the room. Okay.....it's 9:15 and I have 11 hours and 45 minutes to go. Among the other patients was someone in for mental health because their grown son had just been sent to prison for life. Then there is the 55 year woman who has been fighting cancer for 10 years (and looks it) and this will be her last day of life. She will not go out quietly. Death isn't pretty a lot of the time. It involves noisy breathing that tortures family members. It can go on for a while. There is the young man found staggering around a local mall and when the doctor asks what's going on with him, he gives her the finger. OK then....There is the crack/pot abuser in her early 30's with seven children whose family brought her in because they don't know what to do with her anymore. There is the man from another country with both cancer and tuberculosis who is dying. Sometimes I just feel weary of the suffering and troubles. I'm human.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1167263 Tue, 22 Jan 2008 01:10:00 +0100 1167263 http://emergency-room-nurse.blogspot.com/2008/01/you-cant-roller-skate-in-buffalo-herd.html The buffalo herd blog title has nothing to do with this blog entry, I just thought it was a cool title. Anybody remember Roger Miller? ....but you can be happy if you've a mind to...An interesting thing has taken place in our ER in the last few years. The doctors have managed to palm off all the patients they really don't want to see onto the nurse practitioners. We have had nurse practitioners in our ER for as long as I have been there. They started with an area of their own. Then people in the lobby started complaining that people less sick than them were being seen and discharged before they got it. So the nurse practitioners were incorporated into the main department. They still saw the less ill patients, but if they were busy the docs saw them too. Well, in the last year we have open opened up 10 more beds in the ER in a space that was framed in for a new ER, but the new ER was put on a back burner. Those ten beds are now staffed only by nurse practitioners. Who do the nurse practitioners see in this area? They see back pain, any kind of chronic pain, STDs, migraines, lacerations, sprains and minor fractures, med refills or any other minor thing you choose to grace us with. In other words they get everyone the doctors consider a pain in the butt and can't stand seeing. Working in that area as a nurse is easier because there isn't as much to do, but it is mentally and emotionally exhausting to hear the tales of the drug seekers. And the nurse practitioners do this every day. This is all they do. I don't know how they do it. Its a burnout spot. The doctors love it. They have even come to the point that when one of the patients that would normally go to that area comes to them they question triage about why they were not put over there. The nurse practitioners are working harder, seeing more patients, up to ten at a time. Most of our docs don't see ten patients at a time. Its impossible. But that's what they expect of the NPs.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1165384 Mon, 21 Jan 2008 04:35:00 +0100 1165384 http://emergency-room-nurse.blogspot.com/2008/01/dont-tinkle-outside-in-cold.html It be cooooooooold up her in da northland. Temperature way below zero and with a little wind, the wind chill can easily go to 30-40 below zero. In other words anyone in their right mind would not venture outside unless they were dying. Frostbite can occur within 10-15 minutes in these kind of temperatures. Here are my suggestions for caring for yourself in these kind of conditions: 1) Don't take drugs, indulge in a lot of alcohol and then decide you are going to take a walk.2) Don't get lost. 3) Don't decide that you are going to take a pee against the tree outside. If you do the following will happen: 1) You will get frostbite.2) You will get frostbite in places you don't want to get frostbite. 3) It will hurt. A lot. 4) You probably won't be able to have children.5) 'nuff said.Now up here in the northland we have homeless like any other city. Most of them have the since to come in out of the cold. When you have a couple come in for something medical and they tell you they are homeless, you ascertain there is no shelter space available. What do you do? You can't exactly put them out in the cold when it is -30 below windchill outside. Frostbite and all that. So you put them in the lobby overnight. They'll get bus tokens in the morning, get on the bus and go somewhere where it is warm.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1162871 Sun, 20 Jan 2008 05:04:00 +0100 1162871 http://emergency-room-nurse.blogspot.com/2008/01/dear-doctori-have-this-pimple-on-my.html Latest and greatest in medical innovation: e-mail visits to your doctor. No muss, no fuss. Lounge in your flannel pjs in bed and use your lap top to describe the plethora of symptoms you are having. Get sympathetic email detailing how concerned, choked up, appalled your doctor is that this horror has struck you.....Some people think that this will be a large part of the future of medicine. It already is in Portland, Oregon where Greenfield Health now treats 40 percent of its patients by e-mail. The annual fee for this: $395. Pretty cheap. Hmmmmm...wonder how it works...how many times can you use it in a year? Is there a limit? I can see some people e-mailing Dr Joe everyday just to catch him up...at least he won't have to see you face to face every week....A fair amount of what doctors see and what we see in the ER is something that could be handled over the computer: flu symptoms, stomach viruses, earache, UTIs just for example. In the future everyone will have a web camera and doctors will be able to see what something looks like that you describe. He/she can get up close and personal with that draining boil. These web cams will have to be in a secured area because some people have a tendency to disrobe at the drop of a hat. I have seen them do it in triage. It will never replace face to face contact, but we're heading toward life in a virtual world now anyway, where human contact will be a low priority, so hale the future of medicine!emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1162063 Sat, 19 Jan 2008 00:35:00 +0100 1162063 http://emergency-room-nurse.blogspot.com/2008/01/skeptic-monkey-makes-debut.html As you can see I have adopted skeptic the monkey - lower left. Feel free to play with him if you are bored.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1159561 Fri, 18 Jan 2008 04:54:00 +0100 1159561 http://emergency-room-nurse.blogspot.com/2008/01/nurses-escape-from-hospital.html Oh the dregs of winter...we are in them up here in the northland. The snow is dirty with sporadic yellow spots. The sky is gray. This is the time of year we go into our caves, our lairs, dens and lick our wounds. We curl up in the corner of the cave on a piece of fur and watch reruns of Law and Order. What the hell else is there to do? I am not a snow bunny who skies, tubes, skates....I could break a hip doing that shit...Lord knows we don' need another broken bone in the madness house. This is the time of year when one sits back and contemplates the meaning of life....ponders one's very existence as a speck in the vast universe as it were. It starts me thinking after writing yesterdays entry in which I spoke of how overwhelming nursing is becoming with all the extra stuff they want us to do. What, my crazy monkeys (shout out to Craig Ferguson), is the future of the profession of nursing? With all the stress, increasingly numerous blank filling requirements, acuity of the patients, who will be a nurse in the future? If I were 22 and just getting out of school today, I would not work in a hospital. I would not be willing to spend the next 25-30 years of my life in that kind of environment. Nurses are expected to be superhuman and just take on more and more. A nurse I once worked with called working in the hospital "self abuse". That's really what it is. I think my generation (baby boomers) will be the last generation willing to spend their career in a hospital environment. Young nurses I work with, facing years in the hospital environment are choosing other options: nurse practitioners, CRNA, etc. There are lots of nurses in hospitals 10-15 years away from retirement and then there are the new grads. Where are the nurses in between? They have moved on to other aspects of nursing. Hospital nursing is going to change in the next couple of decades. I envision a time when the hospitals will be filled with nurses who contract with the hospital, through an outside agency, to work there for big money. That's the only way nurses are going to be willing to work in these stressful environments. For a lot more money then we are making now. We hear over and over about the coming crisis in medical care with the surge of boomers into old age. The crisis in medical care will be in nursing. Nurses will demand and get better working conditions and money, or they will abandon hospital work.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1159562 Thu, 17 Jan 2008 23:25:00 +0100 1159562 http://emergency-room-nurse.blogspot.com/2008/01/nurses-all-together-now-uncle.html Every year nurses have to go through mandatory education around things like hazardous waste, infectious agents, compliance with government regulations, etc etc etc. ad naseum. I went through such a class today. And all I have to say is: UNCLE!! UNCLE!! I GIVE UP!! I SURRENDER!!As I sat and listened to the "compliance officer" talk about the fact that they received 1200 communications about change from the Center for Medicaid and Medicare Services (CMS) alone, not to mention the The Joint Commission on the Accreditation of Health care Organizations (JCAHO), I wanted to run screaming from the room...This year CMS has decided that they will not pay for any hospital acquired post operative infections, any urinary tract infections, falls, stage 3 and 4 decubitus ulcers. Nice sentiments, but consider the fact that the patients we see are sicker and sicker. They are debilitated when they come in and easily susceptible to infection. More and more are over 80 and fall easily. We never have enough staff to do basic care half the time, let alone those niceties that prevent problems. We learn that our documentation can make or break payment from medicare or medicaid. Add to this the continuing addition of what we are supposed to screen patients for. As I triage you for your 10/10 abdominal pain, I am supposed to screen you for verbal/physical violence, signs of a virus, do you have signs of TB, have you ever had MRSA infection, do you have enough money for food, are you suicidal, do you have any visual, hearing, educational, emotional, cognitive, etc deficits? During this triage process I must ascertain all your allergies and your specific reaction to them. All your medication, dosage, frequency, route. When did you last take them. Your vital signs. Oh yeah and what was it that was wrong with you? Meanwhile as I do all this for you, there are 10 people at the window and they aren't happy I haven't helped them. \Now you are in your room. I have completely undressed you, hooked you to the monitor etc if need be. I must now do a head to toe assessment on you. We are expected to chart on all of your body systems. The doctor sees you and asks the same questions all over again. He/She orders stuff. I must chart start/stop times of IVs, IV antibiotics, any IV med infusion. I am to chart on you at least every one half hour to one hour. On an average I have 3 other patients besides you who require all of this too. I spend a lot of time these days charting and filling in blanks that are required by regulatory agencies and hospital administration. That leaves less time to provide the human touch that is the basis for nursing. I have come to the conclusion that it is not possible for me to do all the blank filling a lot of the time. It is humanly impossible. I'm not going to feel bad about it anymore. They are overwhelming us with irrelevant tasks and I for one, say enough!!!. I concentrate on what really has to be done to help you and if I have time to fill in the blanks of some of the other nonsense I do. If I don't the hell with them....emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1156818 Thu, 17 Jan 2008 01:42:00 +0100 1156818 http://emergency-room-nurse.blogspot.com/2008/01/everyone-makes-mistakesunfortunately.html There is an article on AOL today about Dennis Quaid and the medication error with his twins. He and his wife are saying that the family was not notified when the error was discovered. They expressed concern that they would not have been there to say goodbye had the babies died. It is all really sad. On both sides. Mistakes. There is not a nurse who hasn't made one. You can't be a nurse for many many years and not have made a couple of mistakes. The vast majority of the time it does nothing to harm the patient. To be honest I am shocked that we don't make a lot more mistakes. Especially in an ER environment. There are many times when I am running to the pyxis (drug dispensing machine) in an emergency and am in a big hurry. It would be very, very easy to make a mistake in a situation like that. It would be easy to make a mistake when you are busy period. When you are tired. When you are stressed. We now have messages that come up on our pyxis screen warning us of similarities between drugs that we have to acknowledge before we can go forward. Why haven't I made a lot more mistakes? Some it has to do with familiarity. We work with the same drugs most of the time and know what they are supposed to look like. I check them at least 3 times. I put the empty vials and containers in my pocket and I empty them at the end of the shift. I just got into this habit in case anything would every come up about something I have given. Sometimes I think I have an angel on my shoulder because I have caught myself before I made a mistake.I consider myself blessed and lucky that I have never harmed anyone. When I hear of an incident where someone is harmed I know that could have been me making that mistake. Because I am human too. Not only do I feel sorry for the victim of the mistake, but also for the health care worker. I'm not sure I would be able to keep working knowing I hurt somebody. It's hard to see all the emphasis now on medical mistakes. I know they happen, but when you consider the thousands of drugs, procedures done every day, those in medicine really do an outstanding job.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1154064 Wed, 16 Jan 2008 01:15:00 +0100 1154064 http://emergency-room-nurse.blogspot.com/2008/01/madness-personification-of-evil.html Dere is people out dere who be thinkin' dat madness is a cynic, a real bitch. I don' give dose drug seekers the benefit of the doubt and all dat. I am a hard, burned out old witch of a nurse....that goes without sayin', but in my defense...I have been in the ER for many a year. My job is similar to a cops, only I have to keep my mouth shut. The cop can tell your sorry ass to shut the f--- up, I can't. I could but I would lose my job. Need the job, so don't. Cops have guns, madness don'. But we do deal with all the same people. From one end of the spectrum to another. So excuse me if I have developed jus' a little bit of suspicion, caution, you gotta prove you ain' oneadose drug seekin' idiots attitude. I, along with many of my nurse pals, have been burned. Big. What folks don' understand about drug seekers is that they are ADDICTS. They will do anything to get the fix. They will lie, fake, tell whoppin' stories...they are really pretty dangerous people. I have seen them get out of control when they don't get what they want. Suddenly that back pain is out the window and they are fightin' security on the floor. I have seen drug seekers tell MAJOR stories that we all believed. What they are willing to do for the fix would floor you. So check your attitude about me not carin', giving the benefit of the doubt, etc. I have big time intuition about people. I can spot a faker at 50 paces with 99.9% accuracy. Whether you like it or not. They waste my time, your money. (yeah, dats right mr/mrs taxpayer your money - you don't think they are payin' do ya?)Picture this scenario: your mom is having a heart attack and you bring her to us. I can't help her right away because I am down the hall dealing with the out of control drug seeker....emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1149795 Mon, 14 Jan 2008 17:27:00 +0100 1149795 http://emergency-room-nurse.blogspot.com/2008/01/gettin-high-on-cough-syrup.html Here's something I didn't know and more to worry about with teenagers and drug use. Apparently the abuse of over the counter cough medicines and cough syrup is becoming more and more popular. Just walk into a drugstore and walk out with your drug of choice. Dextromethrophan is a cough=suppressing ingredient in a variety of over the counter cold medicines. This drug can cause hallucinations and can last up to six hours. Its effects are similar to PCP. Most of the abuse is in kids 9-17 years old, with the average age of 16. Because using large amounts of cough syrup can cause vomiting, the dextromethrophan is being extracted and made into pills and sold over the internet. Street names for it: Candy, c-c-c, dex, dm, drex, red devils, robo rojo, skittles. Among the more serious effects of this drug are, irregular heartbeat, high blood pressure, loss of consciousness, seizures, brain damage, even death. It can also cause hyperthermia or high fever. A lot of kids think if it is over the counter it must be safe. It isn't. Kids have died from its use.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1148227 Mon, 14 Jan 2008 03:36:00 +0100 1148227 http://emergency-room-nurse.blogspot.com/2008/01/ahthe-small-things-in-life.html Life is good as the son of madness has lost about a foot of cast.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1148228 Mon, 14 Jan 2008 03:13:00 +0100 1148228 http://emergency-room-nurse.blogspot.com/2008/01/ethical-dilemna.html This week I faced an ethical dilemma. I gave narcs to someone I knew was a drug seeker. I spoke of her yesterday. She is someone our other docs refused to give narcotics to in her past visits. Lucky for her she landed on soft touch doc's side of the ER yesterday. I really didn't feel comfortable giving this woman drugs. Yet I felt like I had to follow the doctors orders. As I thought about it later, I have considered asking our manager what we are supposed to do in this type of situation. Can we refuse to do it? This comes up periodically. We have regulars in our ER who even have care plans around their chronic headaches in which they can receive specific narcotics once a month. Most I would give the benefit of the doubt to, but there are a couple of them you know are fake. They make me uncomfortable. I feel like I am enabling them to continue their drug seeking behavior. I am not the only one who thinks this. It is a widespread feeling among the nurses. What do you do in this situation? Any other nurses dealt with this? I pointed out yesterday to the doctor the past visits and other doctors decision regarding pain medication for this woman. I really think some docs take the easy way out because they just don't want to deal with confrontation. Its easier to just give in and pass it along to the next doc to deal with. It feels unethical. I don't like being put in this position.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1146606 Sun, 13 Jan 2008 00:35:00 +0100 1146606 http://emergency-room-nurse.blogspot.com/2008/01/hello-this-is-woman-in-room-2.html Some people who read medical blogs think we are mean and cruel and bad people when we talk trash about drug seekers. Who cares what they think...Drug seekers are amazing. If they put half the effort they put into their lives as they put into drug seeking they would be millionaires. A woman comes in with "chronic back pain" blah blah blah. She fell down went boom at home (and I've got some swampland in Florida...). She had 12 mg of morphine en route - no relief of course....she takes 400 mg of Oxycontin a day at home. So I interview miss drama queen. Put her up for doc to see...uh oh its soft touch doc...I peruse her past visits. Last 3 visits she has received the following from our docs: 0. They confronted her about her drug seeker behavior.Of course soft touch doc orders morphine. I point out past visits to soft touch doc. Soft touch doc says give her 2 does of 4 mg morphine. Orders a couple of 1,000 dollar CTs. Now this is going to tax your brain, come on you can do it - guess what the results of those CTs were? A big fat nothing. Before CT results are back soft touch doc gives her another 4 mg. Patient spends most of visit on the phone. Her cart is over by the wall next to the phone, call light doesn't reach there. At one point she asks for the number to the ER. I give it to her assuming she will give it to a relative. Within a few minutes she calls our ER from her room and asks for ME. So I talk to her on the phone form 10 feet away. She tells me if she doesn't get more pain meds she is going to start screaming. Oh my....knock yourself out sweetheart.Soft touch doc wants to see if she can walk. Up to this point she has bent her knees while lying flat, sat up in bed, has brought herself down to the end of the bed to sit on the end. We get up to walk, can she bear weight? Of course not you fool. She tells me she thinks she needs to go to a nursing home for physical therapy because she can't take care of herself. She is in her mid 50's. By the way did I mention that she tells me she has a masters in psychology. She went to Yale and to law school. She gave that all up to be a sculptor and she gets thousands for her pieces. Did I mention she was just diagnosed with "hasimotos disease 1 week ago"? This is a disease of the thyroid. She says her neck has been swelling and she is unable to swollen her pain meds...(I still got that swampland). Guess what: she is admitted to waste every ones time and money. These are the fools that waste an ERs time....grrrrrremergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1146607 Sat, 12 Jan 2008 04:55:00 +0100 1146607 http://emergency-room-nurse.blogspot.com/2008/01/can-you-give-safe-patient-care-working.html Some days I get home from the ER and I am physically drained. Mentally or emotionally drained. I wonder to myself how much longer can I do these 12 hour shifts. I say to myself I'm getting old. But I'm not sure that's it. Twelve hours are hard for anyone at any job. In an ER it's crazy. Yet so many of us do it. In my ER there are very few people who work 8 hour shifts. Its mostly twelve and some ten hour shifts. We tell ourselves that we get more days off this way. But at what price? They say working nights take some years off of your life. I am willing to bet working twelve hour shifts does the same. I may get more days off but I am not fully productive the next day. After a couple of shifts in a row, the next day is unproductive. I won't do three in a row anymore. A lot of people do though. Take a twelve hour shift and add into it no lunch or dinner break or one that is delayed for a couple of hours and what kind of nurse do you have? An unsafe nurse? That's what happened to me yesterday. Started at nine AM, got lunch at 2 PM. Got dinner at 7 PM. It was a VERY busy day and sometimes you can't leave in the middle of something. Blood sugar was running low. By the time I got off work I felt like I had been hit by a truck. I have noticed that about 10 hours into the shift, I start getting really tired. It worries me. Am I as alert, as quick as I should be? I don't worry about critical situations, adrenaline helps clear the mind. Its the routine times that are concerning. I worry about making a mistake. I'm sure we all do when we are tired. The question I have is: Is it safe for nurses to work twelve hour shifts? Can we be effective and safe with these kind of hours? Sometimes I think these long shifts should be stopped. I know they won't be. There would be an outcry from nurses. One of the big perks of the job is flexibility. There are lots of studies about working the night shift. Someone should do a study about twelve hour shifts and nursing. Why do nurses do this to themselves? Because they like days off. Because they have families and it allows for more flexibility. Because as nurses and caretakers, we are willing to kill ourselves to do the job. We are harming ourselves with the exhaustion. Especially in todays health care environment. To be honest, I don't think its safe for the patients....will it change? No. It's food for thought.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1142542 Thu, 10 Jan 2008 12:17:00 +0100 1142542 http://emergency-room-nurse.blogspot.com/2008/01/behind-that-scarf-is-iron-will.html The things you run into in the ER. There is a woman who was a refugee in another country and came to this country. She had been doing fine in her own country. When she got here they discovered that she had kidney failure and she was started on dialysis. She went to dialysis this AM and they noted that she had a heart rate in the 150's so they wouldn't do the dialysis and sent her to our ER. While she was in ER she converted to sinus rhythm. Went back to dialysis where she was once again noted to be in a tachycardia 140's so back she comes to our ER. An IV was inserted and she was given a medication called adenosine that converts most people back to a sinus rhythm. Well she did convert for a few seconds and then went right back into the tachycardia. So then they decided to try another medication. At this point the patient refused any further medication. By the way, did I mention that she doesn't speak english? Fortunately we have an interpreter (we have to by law). The resident docs who were admitting her had a long discussion with her about if she didn't get her heart rate slowed they would not be able to do dialysis and she would die. Still said no. She said she felt fine and that medications they were giving her were making her have these problems. "I don't want anything more, God will take care of it". The discussion went on for 20 minutes. She talked with her son by phone. She wanted to go home. He was going to come in and get her. We finally got her to agree to go to a room while she waited for her son. Still wouldn't take meds. What struck me is that a lot of Americans view women from some Muslim countries as being submissive, but really the opposite is the case. These are very strong women who are very capable of standing up for themselves. As I left she was still in the hospital, agreeing only to take oral meds. She seemed to wonder why when she has felt OK in her life, why is she having to do things like dialysis, take medication? I think she was just fed up. Understandable I guess, but it puts us in a really hard position. We can't force her to take treatment and at the same time we are obligated to try and explain consequences and convince her to go along with us. When you are from a different culture, don't speak the language, probably don't trust western medicine, it makes it ten times as hard. More and more we deal with a vast diversity of cultures. Its the future of this country whether we like it or not. There is bound to be more and more clash of cultures.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1141008 Thu, 10 Jan 2008 03:57:00 +0100 1141008 http://emergency-room-nurse.blogspot.com/2008/01/no-one-should-die-alone-especially-in.html You know you are having a bad day when you can't find time to wrap up your patient who died to go to the morgue....Very sad case of a mentally disabled man with no family, only a conservator (who hadn't seen him for seven years). The patient was a do not resuscitate on arrival. They came in with respiratory distress and the oxygen saturation was gong down as time went on. After the doctor spoke with the conservator, it was decided to make the patient comfort care only. He was taken off the BiPap machine (one step down from a ventilator) and the monitor was turned off. By that time his breathing had already changed. He was making more of a big effort to breathe. I knew he wouldn't last long. Because he had no family with him, I stayed in the room with her til he died 45 minutes later. It's not fun to watch someone die. To watch someone's breaths get shallower and shallower. I stayed with him because I thought no one should die alone...Death is complicated in an emergency room. Every death has to be reported to the medical examiner. Everyone has to be asked or their death has to be reported to an organ donor agency. Even if you are dead, your eyes and tissue can still be used. The conservator has to be notified. Funeral home information has to be found. It takes a lot of time...Meanwhile there are 25 people waiting in the lobby and the ER is full to bursting....emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1138133 Wed, 09 Jan 2008 04:33:00 +0100 1138133 http://emergency-room-nurse.blogspot.com/2008/01/toofless-nurse.html I now have a gaping hole in my mouth. I swear its like the grand canyon in there. If someone yelled in there it would echo down to the jawbone it was viciously ripped out of. I tried folks...oh I tried to think of an excuse to postpone the dental appt today. Last week I called and asked if it would hurt afterwords (what a wuss!) because I have to work the next two days. I had hoped they would say, oh Miss Madness, we should reschedule for a time when you have a couple of weeks off. But NOOOOOOOOO....they said it shouldn't be a problem. So I go in and he numbs up the entire right side of my body. A little bit more, Mr. Dentist, a little bit more....There would be some "pushing and pulling" he said....After I signed the form stating that he wasn't responsible FOR ANYTHING, ANYTHING AT ALL THAT WOULD HAPPEN IN THE NEXT 15 MINUTES OR FOR TEN YEARS AFTER, he asked me if I was "ready". Then he got up on the dental chair standing above me, with a fiendish look on his face, and the assistant handed him what looked like ice tongs and he came at my mouth....I passed out....hahahaha just kidding!Seriously he asked the dental assistant for some "cow something or other" (I kid you not). He started moving the tooth back and forth, back and forth....I heard this crackling which I assume was the root being ripped from the jaw bone. Then he stretched one side of my mouth so far over with some barbaric device that I thought it would rip open I would need stitches. He levered back, and with a grunt, extracted the damn thing...then he had to "resect" the root pieces because they were broken up. Just do it, don't tell me. It was over. All I had was a wad of gauze in my mouth. Its 6 hours later and I feel fine....damn! I was hoping for an excuse to call in sick tomorrow...emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1134684 Tue, 08 Jan 2008 01:03:00 +0100 1134684 http://emergency-room-nurse.blogspot.com/2008/01/cficn-certified-fastest-incontinence.html I have attended two Emergency Nurses Association conventions. One thing I noticed right away after registration was how inadequate I really am. They gave me a plastic encased name tag and below that was a ribbon that had "RN" on it. I looked around me and I noted that a lot of the other attendees had many more ribbons than I did. Their ribbons said they were CEN, CCRN, ARNP, FAAN. WTF? Where are the rest of my ribbons? I went back to the registration table and asked where I get the rest of my ribbons...do you have certification in anything....ah no..I am just an ordinary staff nurse....Well sorry those ribbon are for those who have chosen to certify in various areas BEYOND STAFF NURSING....Okaaaay I said and slinked away to find my room. I passed nurses with so many certifications and initials that they had to sling them over their shoulders to keep from tripping over them. It was as if they were mocking me....I saw them looking at my single ribbon and whispering in their friends ear and snickering....I never really figured out what all those letters stood for but I noticed that those nurses tended to dress like they worked in a bank. So recently I decided to look up and find out what all these certifications were for. I looked on the American Nurses Association website and found out that there is a section called the American Nurse Credentially Center (ANCC). They decide what should be certified and design the tests and run the program. There are 118 certifications one can get as a nurse. Among them: here's a frightening one - CNAA certified in nursing administration, advancedCNLCP certified nurse life care practitionerCTN certified transcultural nurseCCCN certified continence care nurse (ewww!)I have of course decided to come up with my own certifications as follows:CATKASFITN certified able to keep a straight face in triage nurseCDVSGBN certified doesn't vomit smelling a GI bleed nurse CCTAAPPDN certified can talk a psych patient down nurseCDPTPWION certified doesn't punch the obnoxious pt nurseCCTDBN certified covers the doctors butt nurse The list could go on and on....I know the ribbons would have to be wider...oh well...we deserve recognition too!emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1132209 Sun, 06 Jan 2008 22:30:00 +0100 1132209 http://emergency-room-nurse.blogspot.com/2008/01/happy-birthday.html Happy Birthday to my son on his 15th birthday. Only more week til the below the knee cast. Yeah!emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1131971 Sun, 06 Jan 2008 04:26:00 +0100 1131971 http://emergency-room-nurse.blogspot.com/2008/01/rent-womb.html Anybody see this recent news item? It seems that pregnancy is now being outsourced to India. For 10,000 dollars an Indian woman will carry your fetus to term. This is becoming a more popular option for infertile couples in the United States. Rather than spend the thousands of dollars they are spending on infertility treatments they are turning to a cheaper option. Some of these women live together in house where they are cared for by maids, doctors and cooks. They live much better in these houses of 10 to 15 pregnant than they live in their own daily lives. They earn several thousand dollars for their part in the pregnancy, a fortune for many of them who make as little as $25 a month. There are, or have been, 50 women pregnant with babies slated to go to the United States in one city in India alone. Is the future baby farms? There is concern that this could become an alternative way of having a family for the wealthy. Pregnancy is too much trouble, farm it out to someone else. In our narcissistic culture where concern about appearance is so high, there will be none of those annoying stretch marks, pregnancy weight gain, no tedious labor and delivery. Its like something out of a futuristic nightmare...any thoughts?emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1131146 Fri, 04 Jan 2008 23:12:00 +0100 1131146 http://emergency-room-nurse.blogspot.com/2008/01/youve-been-warned.html No blog entry today.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1128828 Fri, 04 Jan 2008 01:35:00 +0100 1128828 http://emergency-room-nurse.blogspot.com/2008/01/why-do-i-stay-in-er-after-all-i-always.html Why do I stay in the ER? After all, I always complaining about the patients. I point out their stupidity on a regular basis. Good question really. Top ten reasons I stay in the ER: 1) I have found a place that is never boring. Well, that's not true it is boring sometimes, but usually not. You never know what or who will come through the door next. 2) It is always changing. Even though I complain about all the emails, all the changes, I really thrive on it. I like doing new things, learning new equipment, doing different things. 3) Every time I go to work, something surprises me. A patient does something weird or comes in for something weird. Someone is determined (unfortunately most of the time) to have something I am not familiar with, so I look it up and learn about it. 4) I'm good at it. I have been doing my job for a long time and I am really good at it. I know how to handle most situations. I am good under pressure. 5) I like my co-workers. People who work in ER are adventurous types with many different backgrounds. They are an interesting group of folks. They have a great sense of humor. We have fun. 6) I like the short term patient contact. If a patient is annoying, I know that they will eventually leave or be admitted. I don't have to spend 8-12 hours with them. 7) I love to hear people's stories. I really enjoy meeting people and hearing about their lives. I have met some fascinating people. 8) We really do help people. We save people. We relieve pain. We comfort people. We make people feel better. 9) The diversity is interesting. We see people from all walks of life. From the crack addict to the professional athlete to the cab driver to the wealthy socialite. It makes it interesting. 10) Not a day goes by that I don't realize how lucky I am or my family is. We have our health.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1127408 Thu, 03 Jan 2008 04:11:00 +0100 1127408 http://emergency-room-nurse.blogspot.com/2008/01/madness-hits-100000.html I am over 100,000 visits to the blog. Cool.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1126311 Wed, 02 Jan 2008 16:06:00 +0100 1126311 http://emergency-room-nurse.blogspot.com/2008/01/funny-christmas-decorations.html yes there is a thing of doing too much...who thought of inflatables anyway?emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1124395 Wed, 02 Jan 2008 01:39:00 +0100 1124395 http://emergency-room-nurse.blogspot.com/2008/01/another-year-over-new-one-just-begun.html Ah tis the new year and the slate has been wiped clean. The past is gone, the future awaits....I haven't gone out for New Years in years...too old...can't hold my liquor like I used to. All that carryin' on is for the young uns. So I spent last night watchin' New Years Rockin' Eve. Dick Clark looked very good for his age and considering the fact that he had a stroke. I thought he was really brave to do the show knowing that his voice was slurred. Go Dick! It was implied last night that Ryan Seacreast may replace Dick - oh say it isn't so! Ryan Seacreast is one of the most annoying people on earth...We considered going to New York for New Years Eve this year to be in times square but then figured it was just too expensive. I read on a blog that people are herded into fenced pens starting at about 5 or 6 PM. They are expected to stay there. Doesn't sound like much fun to me...also there were 1 MILLION PEOPLE there. Too many people. A scary amount of people. I have to say that I am in love with New York City after visiting there this year with husband and son. So its January 1st. It really doesn't feel that much different than 2 days ago...I was thinking yesterday about New Years resolutions. My only resolution would be (cue the violins but alas it is true): to be thankful and to realize how precious each day is. My life experience has taught me that what it all comes down to is one thing: family. They are the most important. Every day I tell God I am thankful for our good health, safety, shelter, food, good job, love we have for one another. All the rest is a bonus. Didn't think madness had it in her did ya?emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1124396 Wed, 02 Jan 2008 01:11:00 +0100 1124396 http://emergency-room-nurse.blogspot.com/2007/12/those-warm-family-get-togethers.html On the holidays we all feel this sort of obligation to get together with the family even if we only see them once a year, even if we can't really stand them. It is what families are supposed to do. It is what we have been brought up to do. We are supposed to tolerate perverted Uncle Harry on Christmas or your drunk nephew Bob. The rest of the year, you wouldn't have anything to do with them, but on Christmas you feel a little warm spot in your heart for them, they are family after all....So it all starts well, the relatives arrive one by one to a festively decorated home. Hugs and kisses all around. Refreshments are offered. Everyone settles down to catch up on who has been arrested, whose teenage daughter is pregnant, who died. Then you run out of conversation. Some people have had a few cocktails. They start getting louder. Grandma looks annoyed. Son starts getting annoyed with Dad. Son pops dad in the mouth and they wrestle on the floor. Down the street obnoxious Uncle Ralph says the wrong thing and gets popped in the eye by nephew. The warm family get togethers breaks up as various family members retire to lick their wounds, vowing they will never ask that fool over again. Dad heads to the ER where it is discovered son has broken his jaw. He is sent home with instructions to only drink liquids till he sees an oral surgeon tomorrow. Drunk Uncle Ralph has an orbital fracture. I love the holidays....emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1123407 Mon, 31 Dec 2007 23:10:00 +0100 1123407 http://emergency-room-nurse.blogspot.com/2007/12/miss-thang-and-mr-duhhhh-want-8th-child.html Ah the holiday season continues....and in these two rooms we have a tag team - mom and dad and the kids have had a cough for 24 hours!! Call the ENT doctor! Get the oxygen!! Call RT!!! Mom and Dad are put up for doctor to see...before doctor can get in there mom and dad and the kids leave....about an hour later here comes a call from dad's work....it seems dad went to work and gave employer a note from a doctor in OUR ER stating that he was unable to work today....employer wanted to know if dad had been there and the doctor gave him the note....ah..no...BUSTED FOOL!!And in this corner we have a woman coming in for a PREGNANCY TEST. She is given an hour therapeutic wait in el lobby. Back she comes and I draw the short straw and go into her room. Yes its true she is really here ONLY for a pregnancy test....now being the cantankerous bitch that I am I tell her that it is inappropriate for her to come to the ER for a pregnancy test, that it would be more appropriate to see her doctor or buy a test at the drugstore. This 28 year old woman says: "I have had seven children and I always come to the emergency room for my pregnancy tests. Besides I have insurance (guess what kind of "insurance" she has? 3 guesses and the 1st two don't count. Yes folks I know you didn't guess - its MEDICAID!!). I tell her that I noted that this is her 5th visit to an emergency room in the last 3 weeks - 3 times at another hospital in our system and now twice with us. Each of these times she had a pregnancy test which were - now hold your breath - NEGATIVE. I ask her does she want to get pregnant? Yes I do she says. I say that her last pregnancy test was within 2 weeks. She says that she had her period a week ago and she could be pregnant now. I count to ten and tell her that that the test would not show pregnancy this soon anyway. Now she's pissed: I KNOW MY RIGHTS!!! GET OUT OF MY ROOM!! I WANT TO SEE THE DOCTOR!! Someone will see you when you calm down Miss Thang. Miss Thang has already obtained a urine sample assuming we would run a pregnancy test. Nurse practitioner comes in and REFUSES (my hero) to do the test and Miss thang and significant other (who sat there this whole time with a duhhhhhh look on his face) stomp out. And these are the people who are reproducing at an alarming rate....they are populating the world of tomorrow.....argh!emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1122560 Mon, 31 Dec 2007 02:46:00 +0100 1122560 http://emergency-room-nurse.blogspot.com/2007/12/mommy-and-sonny-visit-er.html Tis the season to be jolly, etc etc etc....Back to work after 2 days and guess what? Nothing has changed...No miracle has taken place making the general public more polite, grateful, respectful.Now I know some of you guys out there are really close to your mothers. You have a special relationship, but please may I give some advice for men with STD symptoms: don't bring your mother with you. If you bring your mother with you, don't bring her into the room with you. The ER staff will think you are a STRANGE person if you are over the age of lets say 16 and bring mommy in when things are going drip, drip, drip....If you are old enough to do the dirty then you are old enough to handle your idiocy on your own. And oh by the way, at the end of the visit when I am giving you instructions tell your mother to shut the F--- up when she asks how long do YOU have to wait to have intercourse?!! I will tell her and YOU that this is an inappropriate question for HER to ask...how about you wait forever....you and mom have BOUNDARY problems my boy and I don't want you to bring anybody else into the world til you resolve them...emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1121980 Sun, 30 Dec 2007 03:58:00 +0100 1121980 http://emergency-room-nurse.blogspot.com/2007/12/we-aint-in-army-now-mr-doctor.html Oh, the discussions that go on in the medical blogosphere. Scalpel opened a can of worms with his story of a psychotic patient (nursing ethics) who needed sedation and the nurse refused to give it without the patients knowledge and dear Scalpel ended up giving it. Sounds like something that the nurse manager needs to deal with to make clear the policy around this situation. The thing about this is psychotic patients are dangerous and can be violent and hurt the staff (I've seen it happen), so everybody needs to be crystal clear on what to do in this situation. Me, I'd give it in a heartbeat cause I don't want anyone to get hurt....The more interesting part of this discussion were the docs comments.....do you remember that old bumper sticker that says: "question authority"? Well that sums up my attitude in a nutshell. So when people start talkin' about ERs having a military hierarchy (in which I assume the doctors would be the generals of course...), and that nurses are expected to "damn well carry out my orders", it gets under my skin. When doctors start to say things like if your nurses don't do what you want them to do, then you need "to obtain new ones", like we are interchangeable, I feel my blood pressure rising. And even on the blogosphere, nurses don't tell said doctors where to put these kinds of attitudes...That is why my dear readers nurses remain in the position they are. Doctors DO give the orders in medicine. Nurses do carry them out...but nurses DO have a perfect right and RESPONSIBILITY to question anything that doesn't seem right. Any nurse who has been in ER long enough knows exactly want will happen in 99% of the cases that come in. In emergencies we know the routine and go about it automatically. Any nurse who hesitates in an emergency(including a potentially violent one)needs to rethink whether they belong in an ER.Point taken. What chaps my ass is the superior, condescending attitude of some doctors who think that because they have an MD license they can never be questioned. Well guess what fair doctor, this is one nurse who will be questioning your ass when I feel it is appropriate and if you don't like it you know where you can put it...!emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1119338 Fri, 28 Dec 2007 00:28:00 +0100 1119338 http://emergency-room-nurse.blogspot.com/2007/12/evil-barbarian-dentists-part-ii.html So when it rains it pours. Today I went for the root canal. I think I was too tired to be nervous this time. Just numb me up and get it over with. So there was a lot of preparation going on behind me. Hmmmmm....here comes the needle. They did topical numbing first so not so bad...Then they put his thing to hold my mouth open on one side. Then they put this wire think in my mouth with some kind of rubber thing over it. God....felt like I couldn't swallow...I thought to myself man I am glad I'm not claustrophobic. Start the drilling, get out the needles...think how much better it'll be when its all over....oh...need some pictures during the procedure...OK....tiny camera takes 5 or 6 pictures...suddenly light goes off and everything comes out of mouth.....WTF?Turns out I have a fracture in the root of my tooth and the root canal cannot be done!!! The dentist says the tooth has to come out...then I have a choice of a bridge or implanting a tooth in there. He says "I'm sorry to be the bearer of bad news....". Yeah right..I see the dollar signs flashing in your eyes buddy....this will finance a trip to Mexico!The crown involves putting crowns on both sides of the lost tooth and then having like a 3 crowns in a row thing cemented on those three teeth. OK.....why me???!!The alternative is to leave the tooth out, problem is it is in back and chewing would be a problem. So have to get the crown. The other thing is way too expensive. So I walk out to the desk in a daze, one side of my face numbed up like I had a stroke...Fork over 200 dollars I already owe. I am shown the "estimates"....lets just say I can cancel any winter vacation plans....Dejectedly I walk out but I swear I heard the sound of some celebrating going on as I headed out....some Mexican music started to play....emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1117814 Wed, 26 Dec 2007 19:41:00 +0100 1117814 http://emergency-room-nurse.blogspot.com/2007/12/post-op-ponderings.html So two weeks tomorrow my son broke his fibula during basketball practice. Went to ER, got posterior splint above the knee. Referred to ortho. Monday that following week got below the knee cast. Yeah! Was able to start using crutches. Bumped cast on Tuesday. Had more pain. Elevated more. Didn't stop hurting. Went to ortho to check it on Thursday. Had another xray. Ending up having a CT because doctor "saw something in CT". It turns out there was a widening or something between the tibia and fibula (not related to bump). Also had a chipped tibia. Anyway, widening had to be brought back together in order to prevent problems with walking. So he was scheduled for surgery the next day on Friday. Wow. My son has never had surgery. My husband or I have never had surgery. My son was very scared. He was worried he would die during surgery. With much reassurance we went the next day. He started crying in the pre op area. Mind you this is my almost 15 year old linebacker size son crying....the people there were so nice and explained everything to him so well. So in he goes to surgery and out go me and Dad to the waiting room. Longest 3 hours of my life. He ended up with 3 screws. Everything went fine. He will have to have a repeat surgery in a month and a half to get 2 screws out. We managed to get him home with his above the knee 20 pound cast and onto the couch. He is pretty much off pain meds now and is up using the computer via wheelchair. Today I'm having him try the crutches. In 3 weeks he gets a below the knee cast which will be nice. So our Christmas was subdued, but still nice. I'm tired. Haven't slept well in 2 weeks. I've been off work since the accident, set to go back this weekend. All is well in the madness household. Thanks for your concern, all of you. The hardest part is seeing your kid go through all of this and wishing it could be you instead.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1117815 Wed, 26 Dec 2007 19:13:00 +0100 1117815 http://emergency-room-nurse.blogspot.com/2007/12/santa-comes-to-er-or-ers-night-before_24.html 'Twas the night before Christmas,the ER is jumpin,I'm headin' to bed four for a good stomach pumpin',The charts are all stacked in the new patient bin,I think to myself: we NEVER can win,The patients are nestled all snug in their beds, while visions of Dilaudid dance in their heads.The doc has his gloves on, and I have the tray, Its off to that abscess, as I lead the way,When out in the lobby there arose such a clatter, I sprinted for triage to see what was the matter,The lobby was chaos, a sight to behold, every other person seemed to have a bad cold,When what to my disbelievin' eyes did appear, a frequent flier named herman we do not hold all that dear,With a shuffle, a groan and blood curdling scream, (oh no this can't be happenin' its all a bad dream!), He's a man with a backpack, along with a sack, he shouted quite loudly: there's somethin' wrong with my back!He was cursin' and cryin' and carryin' on, he looked around widely and asked for nurse Don, Or Susan or Wendy or Alan or Fred, Do something somebody and get me a bed!By the way I'm hungry, haven't eaten in a week, I need a warm blanket and footies for my feet, I need a glass of water with a whole lotta ice, Now go please hurry, I don't wanna ask twice!He went on a cart, told you gotta wait your turn, you been here enough, when are you gonna learn?I turned back to triage and looked straight ahead, trying to stave off that feeling of dread, As I stifled a yawn and was turning around, Up to the window Santa came with a bound, He was dressed as a doctor except with a red and white cap, His face appeared tired, like he jus' woke from a nap, He was pushing a cart that was laden with sweets,the hospital administration had come through with the treats. He asked to be let in, and rolled the cart through, stopped at the reg desk to give a cookie or two, He walked back to the HUC desk, gave a wink to the crew, Asked everybody: What can I get for you? He resembled santa in a very odd way, He smiled and laughed and had this to say:Tomorrow is Christmas, oh what can I bring?What can I bring to make your heart sing? Oh santa, dear santa, Somebody spoke up and said: we just want some peace, We want all that terrible racket to cease,Santa nodded and said he'd see what he could do, to make a nice christmas for this emergency crew."Goodbye!" Santa said as he rolled the cart out, "Merry Chirstmas to all!" he said with a shout, I went back to triage to see what difference I could make,As i walked out there I did a quick double take, Herman was gone, his bed was tied up in a bow, I asked another nurse: where did Herman go? He was here just a minute ago, I swear it, carryin' on, throwin' his usual fit, We searched back and forth and to and fro too, Then we all sat down and gave one collective: Whew!Oh Santa had been there we all knew it clearly, the man with scrubs had blessed us quite dearly.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1115152 Mon, 24 Dec 2007 21:50:00 +0100 1115152 http://emergency-room-nurse.blogspot.com/2007/12/blog-post_23.html emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1114475 Mon, 24 Dec 2007 05:06:00 +0100 1114475 http://emergency-room-nurse.blogspot.com/2007/12/blog-post.html emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1113466 Sun, 23 Dec 2007 00:51:00 +0100 1113466 http://emergency-room-nurse.blogspot.com/2007/12/see-you-in-few-days.html I started this as a journal. A place to blow off steam. I have always used writing since I was a teenager to record my thoughts, feelings. So pardon me sometimes if I get personal....My son is going to have surgery tomorrow. They have to put a screw in his leg. This was unexpected. He had been having more pain since he bumped the cast so we took him in to the doctor today and they found too much space between the tibia and fibula on a CT. My son was shocked. He is really scared. I think his biggest fear is being put under for the operation. He's afraid something bad will happen. So I'm trying to reassure him. It will be under general anesthesia. It's scary for me too. Putting my kid in someone elses hands and trusting them. But I don't have a choice. He comes home the same day. That just floors me. Modern medicine....I guess we'll manage ok...This has been a trying time especially since it has come around the holidays. This whole thing is going to take about 3 months to be healed completely. I can't even imagine what it is like for a parent of a critically ill child or a child with the need for repeated surgeries.....I am really greatful for the kind and caring, professional people at our childrens hospital. I'll be gone a few days....Merry Christmas to all.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1108738 Fri, 21 Dec 2007 00:50:00 +0100 1108738 http://emergency-room-nurse.blogspot.com/2007/12/sumdood-spak.html One of my favorite bloggers tells of a return visit of sumdood. Its at monkeygirl.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1108739 Thu, 20 Dec 2007 15:59:00 +0100 1108739 http://emergency-room-nurse.blogspot.com/2007/12/well-heres-what-i-think-of-that.html Here's an interesting development. An insurer that is nationwide and also based in my state has decided to start a web site in which patients can write their opinions about doctors and hospitals. So I went to the site and there are already about 15 pages of opinions. Large majority are favorable. They do mention specific doctors by name. Also hospitals. I have to say that it isn't real user friendly because I tried to put a comment about our city's children's hospital because they have done such a great job with my son's fracture but it was tedious to get through the "registration" process. I can't decide what I really think about this. On the one hand I guess people should be able to share their experiences. On the other hand doctor and hospital visits are subjective. Everyone's expectations and results are seen according to their own pre-existing thoughts about medicine, so this really is not an objective review of anything. Their objective they say is to help consumers make: "smart, informed decisions". Of course the concern is that someone may be unhappy that they didn't get what they wanted from the doctor or hospital (i.e. lets say....ah...narcotics) and decide to trash those people on the site. There is a "code of conduct". In it there are instructions on what not to do: misrepresent yourself, give false info, provide addresses and phone numbers of individuals, etc. Because they have this "code of conduct", do they intend to monitor the site? Will they erase anything unacceptable? In the end I really don't think this is such a good idea....my concern being that there are a lot of nuts out there and angry people who could make a doctors life a living hell with this. They could destroy reputations. I guess my thought would be that it is much more useful to post statistics about care. What kind of patients does a doctor see. Satisfaction with the doctor or group. With hospitals - mortality rates, rates of hospital acquired infections, etc. I'm not really sure what the insurance company's aim is with this kind of addition to their site. I suppose they would say they are providing a service to members, but is there something else at work here? I don't know...what do you think?emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1106313 Wed, 19 Dec 2007 19:38:00 +0100 1106313 http://emergency-room-nurse.blogspot.com/2007/12/doctors-come-in-all-shapes-and-sizes.html Even though I sometimes poke a stick at and make fun of doctors on this blog, I have the utmost respect for 15 out of 16 of the docs I work with (OK I'd like to dropkick number 16). That being said, I take you on a tour of types of ER docs: THE ENERGIZER BUNNY - This doc (usually not too far out of residency) is sometimes standing at the door as you bring them to the room from triage. They are like a dog with a bone. AMOS ADD ON: This doc will initially order some stuff and then as that comes back he will order more tests and then more and then more....THE ABSENT MINDED PROFESSOR - This doc is really too smart for their own good. When someone has vague symptoms they will go off half cocked looking into whether this could be some rare exotic disease. Wanders off easily. Messy. JACKHAMMER JACKIE: They learned how to do an extensive history and physical in a short period of time and by God, they are going to do it on every patient. Patients is often confused and can't keep up when doc says: do you have this symptom? this? this? this?....in a rapid fire manner.OVER ORDER OLLIE: This doc orders everything under the sun and then some. Damn it, I'm going to order everything, there's got to be something wrong with you and I'm going to find out what it is!! Keeps CT and MRI in business.PANICKY POLLY: Voice goes up 10 octaves in any emergency situation. They are so nervous they make everybody else nervous too. Creates chaos at the beginning. She's the kind of doc you want to slap across the face and say: "Stop it! You're hysterical!" (Usually an internal med doc working in an ER - sorry IM docs)MACHO MIGUEL: You set up everything perfect for that procedure and it goes without a hitch. But alas, macho miguel will point out one small thing that you should have done differently....to keep you in your place and reinforce WHO IS THE DOCTOR HERE.....NANCY NICE: This doc is SO nice and kind to EVERY PATIENT. Never raises their voice. Never gets angry. You know one day they will probably go postal and it won't be a pretty sight...NO BULLSHIT BILL: Doesn't allow those drug seekers to get drugs. Cuts off the chronic painers after a couple of pain shots. Throws out those abusive patients. The nurses best friend. Lest you think that ER nurses have nothing but negative things to say about docs, oh contraire dear reader...here is the ideal doc in an ER nurses eyes: DREAM DOCTOR: Is very good at his/her job. Respects nurses. Goes to the doctor's lounge and brings back cookies. Occasionally gets the patient a drink of water or warm blanket THEMSELVES. Buys an occasional pizza. Has a sense of humor. Looks like Patrick Dempsey (har har har). Been around a while, been there done that, doesn't get too excited about stuff. Calm under pressure. TOR:emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1103540 Tue, 18 Dec 2007 18:36:00 +0100 1103540 http://emergency-room-nurse.blogspot.com/2007/12/when-heart-goes-pitter-patter-too-fast.html It seems like we are seeing more and more atrial fibrillation in the ER these days. I know we are doing more cardioversions (a timed, predetermined amount of electricity is sent to the heart to try and convert it back to a regular rhythm). Cardioversion has become the intervention of choice for this condition for people who have had A fib in the past and are already on blood thinners. I bet we do at least two a day. It used to be that we tried medication first. A lot of times it didn't work. I assume cardioversions are a faster way to convert people especially when you are worried about clots. One thing nice about cardioversion is that we sedate you with medication that makes it so you don't remember anything. You wake up back to normal. Most people who have had a fib before are discharged within an hour of the procedure. Nice for them. My last patient who had atrial fib had a device implanted that I had never seen before. He could take this device and hold it up to the implanted device and it would tell him if he was in atrial fibrillation. It was somehow also capable of delivering a very low level shock to try and convert him back to a normal rhythm. The patient can activate the shock I guess. This patient said that he had never done that because SHOCKS HURT! He said that he would only use it if he was somewhere where there was not medical help available. Looking on the internet apparently there are devices that will automatically deliver a shock if you go into a rapid a fib. I guess you can even get them that are a pacemaker, defibrillator for v tach and device for a fib all together. Yikes! Technology is advancing so fast, it is truly amazing.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1100239 Tue, 18 Dec 2007 00:49:00 +0100 1100239 http://emergency-room-nurse.blogspot.com/2007/12/it.html got around to putting up the madness Christmas tree. No gifts yet though...Here are more gift selections:For that co-worker who thinks their shit don't stink: For my fellow bloggers from Texas who don't have room for a horse: For your co-workers when you have one of those days when you have to cordon off those people a few sandwiches short of a picnic: This will keep your patients and their families busy during those long waits: emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1097748 Mon, 17 Dec 2007 01:26:00 +0100 1097748 http://emergency-room-nurse.blogspot.com/2007/12/essence-of-nursing.html It hasn't been a good week at our house. I have new found respect for ortho nurses as I assist my linebacker size son to the bathroom with his broken leg. As I helped him wash up and brush his teeth this morning, I appreciated the small things that nurses do every day in hospitals to make patients feel better. Just having a clean face can make a big difference to someone who is not feeling well or in pain. These things are done a thousand times across the country by nurses on a daily basis. I appreciate so much how those same nurses who try so hard to get their patients into a comfortable position. All these seemingly small things(that aren't so small) make such a great difference to someone who feels vulnerable and out of control. Its easy to lose sight of the small things nurses do everyday when you realize the complexity of some nursing jobs. Its easy to say that those who work in an ICU or an ER have more skill than those whose job is not as technical. I would venture to guess that patients remember those small caring gestures a lot more than they remember your skill with machinery. Being with my son and having to perform these basic nursing tasks has brought me back to the essence of nursing: caring. It is so easy to lose perspective on this most essential characteristic of nursing when you are trying to juggle all of the technology and information that becomes an increasing part of our daily job. The most important part of nursing at the end of the day is that human to human interaction between nurse and patient. It is what is at the core of being a nurse. That can never be replaced. Its the reason we became nurses. Its the reason we can feel good about being a nurse. Its the knowledge that a small caring gesture can make all the difference in someones life.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1097490 Sun, 16 Dec 2007 03:34:00 +0100 1097490 http://emergency-room-nurse.blogspot.com/2007/12/somethings-fishy-in-medical-blogosphere.html Something feels fishy in the medical blogosphere lately. I get the feeling that there is a person or maybe more than one person who goes to different blogs and tries to provoke controversy. Usually these people are anonymous or if they do have a name they don't have a blog themselves. They seem to have a lot of time to spend in the blogosphere and track other comments closely because they answer any comments quickly directed at them. Maybe its somebody who blogs, I don't know. Sometimes I wonder if it is someone who blogs because what would a person who doesn't blog have to gain from all this? No doubt that blogs attract a fair amount of nuts. Both those who read them and write them. I guess it's a chance you take when you blog. The silliness that goes on seems like a waste of time to me, but that's just my opinion...I really don't have time for it...I started blogging as a place to let off steam, to capture stories from my job. I enjoy writing. I have grown to like the camaraderie that comes with blogging. Its fun. If its starts becoming unfun, I'm out...and its moving toward unfun lately...anybody have any thoughts?emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1097287 Sat, 15 Dec 2007 14:41:00 +0100 1097287 http://emergency-room-nurse.blogspot.com/2007/12/when-trauma-hits-home.html It all started last night at work about 7:30 pm. I got a call that my son had been injured during basketball practice. My 14 year old said, "Mom I think I broke my ankle". I told him, no it's probably a sprain. He and my husband headed to the children's ER. Since it is about a 1/2 block from where I work, I left work and walked over. Turns out he has a fractured fibula and sprained ankle. So they put him in a splint. Its a long posterior splint that is above the knee. Its hard for him to use the crutches. This poor kid. He has been in such pain all night. It is so hard to watch your kid be in pain. It just breaks my heart. If I could, I would take his place. The people at the children's ER were so nice. I so appreciated their kindness and caring.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1094267 Fri, 14 Dec 2007 11:40:00 +0100 1094267 http://emergency-room-nurse.blogspot.com/2007/12/tired.html As I read through some of my links tonight I find myself growing weary. Tired. Maybe its the winter....Maybe its time for a time out...emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1091426 Thu, 13 Dec 2007 02:27:00 +0100 1091426 http://emergency-room-nurse.blogspot.com/2007/12/little-johnnys-gettin-high-off-your.html News of late that drug use among teenagers is down. That is drugs like crack, pot, heroin. However prescription drug use is on the rise. It is estimated that 20% of teenagers have used prescription narcotics taken from mom and dad's or grandmas medicine cabinet. Drugs like Vicodin and Oxycotin are sold in schools like pot used to be. Real easy to get. This leads me to the question of why is vicodin and drugs like it passed out like candy these days? I recently had a BAD toothache that started at work. Now I could have gone and asked an MD or NP to prescribe me something for pain and they may have done it. The thing is I would never even think of doing that. I tried orajel and viscous lidocaine and aleve. Somehow I managed to get through until I got to the dentist and he gave me an antibiotic. I didn't ask him for anything for pain either. I just kept taking the Aleve. When did this society become one in which it is not okay to have any discomfort at all? When did patients start expecting to get powerful narcotics for every little discomfort? When did doctors feel like they had to prescribe narcotics for any pain? It really has gotten out of control. I gotta say I blame a lot of it on the doctors. They keep prescribing all this stuff and raising peoples expectations and enabling them to keep expecting the same treatment. It really feels uncomfortable what we gave those narc scripts for sometimes. Pretty soon we will be a nation of addicts, if we aren't already. Some of it is our quick-fix society. Pharmaceutical companies make millions off of our quick fix mentality. We see commercial after commercial such as: can't sleep: take this pill. stressed out: take this pill. Legs move too much: take this pill. Etc etc etc. I don't remember when I was a kid anyone taking anything more than an aspirin or Tylenol for the pain of a sprain, muscle strain, back pain, etc. We just did waited for it to heal up and let nature take its course. I still sort of have that mentality. I don't want to be doped up for minor things. I guess I'm in the minority. The more this kind of mentality spreads in our society, the more acceptable it will be for teenagers to say to themselves: hey mom and dad pop pills to feel better, why can't I? How bad can they be? A doctor prescribed them after all. The thing is these medications are highly addictive. With the way things are going, every house will have to have a locked cabinet for medications...is that what we want?emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1090560 Wed, 12 Dec 2007 21:06:00 +0100 1090560 http://emergency-room-nurse.blogspot.com/2007/12/nurses-twelve-days-of-christmas.html In my never ending quest to be of service to the medical blogosphere, I offer the following Christmas song to sing around the HUC desk this year:On the first day of Christmasmy patient gave to me: a tale about her inability to peeOn the second day of Christmas my patient gave to me: two depends diapers, and a tale about her inability to peeOn the third day of Christmasmy patient gave to me:3 anxious daughters,2 depends diapersand a tale about her inability to peeOn the fourth day of Christmasmy patient gave to me: 4 requests for water.3 anxious daughters, 2 depends diapers and a tale about her inability to peeOn the fifth day of Christmas my patient gave to me: FIVE DROPS OF PEE!4 requests for water,3 anxious daughters,2 depends diapers and a tale about her inability to peeOn the sixth day of Christmasmy patient gave to me: 6 calls to be repositioned, FIVE DROPS OF PEE!4 requests for water,3 anxious daughters,2 depends diapersand a tale about her inability to peeOn the seventh day of Christmasmy patient gave to me: 7 relatives a callin',6 calls to be repositioned,FIVE DROPS OF PEE!4 requests for water,3 anxious daughters,2 depends diapers,and a tale about her inability to peeOn the eighth day of Christmas my patient gave to me:8 blinking call lights, 7 relatives a callin'6 calls to be repositionedFIVE DROPS OF PEE!4 requests for water,3 anxious daughters,2 depends diapers,and a tale about her inability topeeON the ninth day of Christmasmy patient gave to me:9 requests for a bedpan, 8 blinking call lights,7 relatives a callin'6 calls to be repositionedFIVE DROPS OF PEE!4 requests for water3 anxious daughters,2 depends diapers and a tale about her inability topeeOn the tenth day of Christmas my patient gave to me:10 word answers,9 requests for a bedpan,8 blinking call lights, 7 relatives a callin',6 calls to be repositioned,FIVE DROPS OF PEE!4 requests for water3 anxious daughters2 depends diapersand a tale about her inability topeeOn the eleventh day of Christmas my patient gave to me:an 11 minute lunchtime, 10 word answers,9 requests for a bedpan, 8 blinking call lights,7 relatives a callin',6 calls to be repositioned,FIVE DROPS OF PEE!4 requests for water3 anxious daughters2 depends diapersand a tale about her inability to peeOn the twelfth day of Christmas my patient gave to me:12 more more like her in the lobby,an 11 minute lunchtime10 word answers,9 nine calls for a bedpan,8 blinking call lights,7 relatives a callin'6 requests to be repositioned,FIVE DROPS OF PEE!4 glasses of water,3 anxious daughters, 2 depends diapers, (big finish)AND A TALE ABOUT HER INABILITY TOPEE!!(Applause) Yeah.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1087682 Mon, 10 Dec 2007 22:46:00 +0100 1087682 http://emergency-room-nurse.blogspot.com/2007/12/too-many-marys.html You would think that the neighborhood doorknobs with their small complaints would be the most difficult to deal with, people with stds, sore throats, 8 hours of vomiting. For me, they aren't as hard to deal as are the chronically ill. Or lets say the people who see themselves as chronically ill. These are the people whose life started in the midst of a lot of stress and as a result they became very anxious people. Due to that anxiety and no doubt depression, they developed conditions where all those emotions manifested physically. They have very minimal coping skills. So when they have a physical illness or physical symptoms it throws them into a complete tizzy. But they soon figure out that when they have these physical symptoms they get a lot of attention, so that minor problem blows up into a major problem because it meets their neurotic needs. I think doctors, not knowing what to do with these people who return over and over, have actually created some names for these conditions just to give these people something to hang their hat on, so they'll leave them alone. These aren't the kind of people who will deal with the fact that they are anxious or depressed. For some reason that isn't acceptable to them. But some kind of medical label allows them to tell themselves and anyone who will listen, "see I told you, I am sick..." "I have -----."Another factor that plays into labelling these vague anxiety and depression based symptoms, is that drug companies can come up with new drugs to "treat" these "illnesses" and make lots and lots of money.So in comes "chronically ill" Mary with her "physical illness" that has been exacerbated due to some new stress in her life. She' got a long list of vague complaints. She is the kind of person who sucks the life out of a nurse. She is exhausting with her many requests and long tale of woe. She has often become very manipulative to get what she wants. Sometimes she is addicted to narcotics and every once in a while needs a boost because what the doc prescribed for her to take home ain't working these days. And she will do anything to get it. Threats, crying, yelling....you name it, Mary will completely humiliate herself if need be to get what she wants. Often if the doctor doesn't do what she wants, she will demand a new doctor, sometimes another nurse too. She is very familiar with the patient complaint department of the hospital. She may even be so clever as to throw JCAHO around or threaten to sue you or even report your lack of concern to the local TV station, stating "well, I think station ----will be real interesting in the lack of care here at -------hospital". She often wants to talk to " the supervisor". Mary is so bent on getting her way that she will fake fainting, seizures, all in her pathetic attempt for attention. You see Marys minor problem has become the center of her existence. It has become her identity. No one is going to take it away from her. She often is so good she sucks her husband John into the drama too. She will hospital hop til she finds a sympathetic ear and then wears out her welcome at that place. Unfortunately what happens with people like Mary is that the nurses are so busy, and trying to save their own sanity, and often times its easier to just let Mary rant and rave. It is not worth the energy to try and deal with her any differently. After all, the nurse is only human and she just wants Mary to go away.emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1084326 Mon, 10 Dec 2007 14:35:00 +0100 1084326 http://emergency-room-nurse.blogspot.com/2007/12/hunkof-week.html emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1081804 Sun, 09 Dec 2007 05:18:00 +0100 1081804 http://emergency-room-nurse.blogspot.com/2007/12/pockets-and-nuts.html Pharmacy God did this once and I thought it was kind of interesting: what's in your pocket at the end of the shift: empty vials of: benadryldroperidoldecadroncompazinezofran x 4pepcidempty syringes of: morphine x 4a needle coveran ativan tab cover3 alcohols swabstapecharge phonecharge beeperhersey bar wrapperschedule for next set of hourscash carddrivers license As you can see stomach viruses are in full force right now. A "new American" came into the ER a day ago for abdominal pain and was put in our observation unit (less than 24 hour stay). Two hours after she was discharged here comes her and the family to the triage desk because she was still "sick". She was triaged and placed in the waiting room. A member of her family came to the window many times to say, "she is dying out here" etc. They were told she would have to wait her turn. It was busy and no one noticed that the patient and her family left and didn't tell anybody. As soon as they got home they called an ambulance to bring her back to our emergency room. We had her come to triage and she was put back in the waiting room......it doesn't seem to take long sometimes for the newcomers to this country to learn the system....A woman is at the grocery store and is talking to another customer about her eye and how it is bothering her. Her fellow customer advises her to go immediately to the emergency room for evaluation and she takes their advice....of course she is nuts...(those grocery store customers are drumming up business for us now!)A man who came in for anxiety yesterday and was cabbed back to his shelter, comes in today for a new problem. He goes to the waiting room to await triaging. In two minutes he comes up to the window 3 times for various things, one of which is to ask if we were going to give him another cab voucher back to the shelter today.....ah no that won't be happening, we will give you a bus token....at the end of the visit he asks where to get a bus, goes down the halls and then comes back to the triage desk and says, "I need to see a doctor, I can't find the bus stop"....emergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1081805 Sun, 09 Dec 2007 04:41:00 +0100 1081805 http://emergency-room-nurse.blogspot.com/2007/12/not-everybody-is-home-for-christmas.html As we go about our Christmas planning, present buying...don't forget those soldiers in Iraq and Afghanistan and around the world. There is nothing better than being able to call home on Christmas. Here is a place you can donate money for phone cards for troops: operation uplinkemergency room nurse (Source: madness: tales of an emergency room nurse) madness: tales of an emergency room nurse blogs http://www.medworm.com/rss/comments.php?id=1080445 Sat, 08 Dec 2007 02:22:00 +0100 1080445