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Sunday, March 31, 2013

Another Day, Another Carnie

We've had a string of carnies (you know, as in folks traveling with the carnival) coming into our ER because there's a fair in town.  Wow.

None of them are your average patient.  One was totally wasted with track marks everywhere (ok, that's normal).  But, he was there because his best friend stabbed him in the back.  His plan was to go stab his buddy to get even.  He said it was "carnie code."  

Last night was a dude whose feet were so swollen, dry, and cracked he could barely walk on them.  And, nine days before coming in, he had fallen down some steel stairs and "scraped" his shin.  

Yeah, that was some scrape.  I pulled up his pants leg to find a four inch diameter hole in his shin.  Yep, the bone was just sittin' there.  All out for God and the world to see.  He said it had been like this for nine days!  Didn't want to go to the hospital because he makes commission off of what his carnie booth (known as a "joint" in the carnie world) brings in.

The best part is, I learned a hell of a lot more than I'd ever want to know about the ins and outs of the carnie world.  Interesting stuff!

Never Again. . .

. . . will I take a sore throat for granted.  That's what she came in for today.

Four days ago, this chick in her early 20's comes in for sore throat, worried it's Strep.  We check.  It's not.  But her tonsils are swollen pretty good.  Script for antibiotics with instructions to follow up with primary doc.

Never follows up with primary doc.  Never fills prescription.  Why?  Can't afford it.  It's four dollars!  Yet, she certainly has no problem indulging her pack-a-day smoking habit.

Comes back yesterday because of continuing concern for swelling.  Yep, everything's ok.  Follow up with doc.  Take antibiotics.  Again, never follows up.  Never fills script.  Still smoking.

Comes back last night.  Same thing.  Same thing.  Same thing.

Comes back again later the same night.  Says her throat is really sore.  After a little while, the girl states that she "feels like she's drowning."  Her throat is swelling up.  Can't talk to us.  You can hear the voice changes when she does try to talk.  Everything else is hand written communication.  Sats are 95% on arrival.  Soon, they're 93.  Then 90.  Shit.

Steroids and anti-inflammatories given.  Doc says, "time to intubate and transfer."  Pt says no.  Can't afford transfer.  Husband (who I'm pretty sure is in his fifties) says too bad.  Do it.  Pt says no.  I want to go home now.  I feel better.  Doc says, "Ok.  Go home.  You're going to die.  See ya on the other side."  Pt says, via pen and paper, "ok, let's do it."

Pt intubated.  Husband is drama.  Pt saved.  Pt transferred.  Everything went great.  The doc, who is my favorite doc we have, says it was a pretty difficult intubation, even though he got it fast and on the first try.

Another life saved.  Strong work, team.

Saturday, March 30, 2013

Yep, I've Heard That Before. . .

. . . and it drives me crazy.

Check out this post to see what I'm talking about:

My *favorite* thing to hear

Please Just Go Away. . .

. . . other people need this bed.  Sick people.  People who aren't perfectly fine!

I understand you came in because you were scared.  You started taking a new medication and started breaking out in a rash.  I get it.  Then you called your primary doc and he told you to come in.  I get that too.

But the ER doctor has examined you.  I've assessed you.  The triage nurse has assessed you.  You have a few red spots on your belly.  Yes, they are really itchy. . . but they aren't life threatening.  No swelling of tongue, lips, or throat.  You, yourself, are telling me that you feel fine. . . just itchy.  And you're already on hydroxizine because your doc thought you might get a rash.

So, when I discharge you with instructions from the doc to stop taking your new medication and to continue the hydroxizine, please don't argue with me.  Have peace of mind that you have been looked at by three trained professionals and nobody thinks you are in any danger.

Please don't go out to the lobby, call your primary doc, and have him call to interrogate us for sending you home. . . especially when he hasn't even seen what you look like to assess you!

Does Day Shift Have Any Idea?

I often wonder if the day shift folks have any idea what goes on at night.  Personally, I believe that they think it's slow.  That nobody comes in at night.  That we all just sit around catching up on our continuing education, shooting the shit, and messing around.

Nothing could be further from the truth.  I feel like, more often than not, we clear everything out by discharging patients and transferring people upstairs about fifteen to thirty minutes before they get here.

Then, they show up and see four people on the board.  I'm pretty sure they have no idea and wouldn't believe me if I explained it to them. . .

I Don't Know What It Was

I don't know what it was about last night, but it sucked the soul out of every nurse, doctor, tech, and clerk who worked last night.

To be honest, it wasn't even that busy.  We didn't have anybody that was super sick.  We didn't have drug seekers or drama queens.  No ETOHers.  No psych patients.  It was a fairly reasonable night.  For some reason, it sapped everything out of me and all the other staff tonight.

I actually feel kinda bad.  I usually try to leave the day shift folks with the best situation possible.  I will even stay to make sure stuff is done that they don't have to do.  But, this was not the day for that.  I left my relief in sort of a mess.  I felt bad, but obviously not bad enough to stay any later. . .

Tonight's Winner

Chief complaint of the night.  17 year old male.

"Possible rock in nose"

Man, I love my job.

Friday, March 29, 2013

ANOTHER Stubbed Toe

It is truly ridiculous how many people go to an ER for stubbing their toe.  We had one who was a teenage girl, which always adds drama to the mix.
NurseHubba: So, what happened to your toe?
*Great toe looks relatively uninjured with the exception of the nail having been bent back a bit.
Teen With 'tude: I got attacked!
*Mom facepalms and shakes her head, giving 'Tude a dirty look.
NurseHubba: You got attacked?  What happened? 
 'Tude: A stupid chair decided to attack me!
*Now I'm facepalming. . . internally, of course.
NurseHubba: So, what really happened?
'Tude: That's what really happened!
NurseHubba (getting frustrated after a long night): So, what really happened?
'Tude: It attacked me!
NurseHubba (wondering if I'd get in trouble for slapping her): Just tell me what happened.
Embarrassed Mom:  Just tell him!
'Tude: Fiiiiiiine!  I stubbed my toe on a chair in my room and it bent my nail back. . .
People drive me nuts, sometimes.

Here Comes Santa Clause

The night started off great.  We only had about eight or nine patients on the board.  Everything had been done.  We had only to wait on some results before decided whether to admit or discharge.  Nobody was in pain.  Nobody was short of breath.  Nobody was puking.  

Then, one of the registrars did it.  She said the dreaded Q-word.  I don't even want to say what the Q-word is on this blog for fear the ER gods will take their revenge tonight at work.  I don't know what the hell the registrar was thinking.  She's not new.  I know she knows better!

Within an hour, we were full with three ambulances on their way in with two chest pains and one shortness of breath.  No discharges were in our near future.  We had New Doc, who moves painfully slow and over-does work ups.  Even when somebody is admitted with orders and report called, New Doc usually still hasn't finished her T-sheet yet, so we have to wait to send them up.  Grrrrrr.  Time to move people into the halls.

As this was happening, the unit clerk came around a corner looking pale.  "I need help!  This guy outside is huge and looks really sick!"  I grabbed the only empty stretcher and another nurse grabbed an ambu-bag.  We headed outside to find the tech and another nurse already trying with futility to lift this man out of the back seat of the van and into a wheelchair.  Once the other two of us showed up, we were able to get him onto the stretcher.  

This guy was huge!  He was taller than the stretcher had room for and was very stout and very wide.  
Yep, that's him.  Only he was taller
I'd estimate weight around 350 pounds.  Once we got him on the stretcher and started checking signs of life (ABCs), we found he was breathing and had a pulse, but was rather gurgly.  He'd have to wait for suction, though, until he got outside.  Anyway, I noticed his face.  It was Santa Clause.  Same beard, same jolly, red face.  It looked just who I imagined he looked like as a kid.  

He could respond to commands, but couldn't really talk at us well.  I checked bilateral hand grip, foot strength, etc while we were wheeling him back to a room.  Yep, left sided weakness.  Droopy face.  Shit.  Santa was having a stroke.  

We flew into the room, got in three IVs at once, got an EKG, doc came in and evaluated, and he went to CT.  Shortly, we had the scan in our hands, and he was definitely having an ischemic stroke.  New Doc did an awesome job.  The nurses did an awesome job.  The tech did an awesome job.  The unit clerk did an awesome job.  We had this guy with tPA running and the helicopter picking him up in record time.  By the time he left, he was already having some improvement.  Found out the guy is doing great.  Santa will be on his toy run once again this year.

These moments. . . these truly life-saving moments, are what I got into emergency nursing for.  I love being able to be a part of saving a life.  

Unfortunately, the fact that we dared take time to save somebody's life really pissed off some of our toothaches, abdominal pains, back pains, and ETOHers.  Even after explaining to them what the wait was all about, they just don't care.  What the hell is wrong with people?

Thursday, March 28, 2013

The New Doc

We have this new doc in the ER.  I've posted about her briefly before.

The other week, she was ordering a full cardiac workup on just about everyone.  As I was starting an IV on a 5 year old kid with severe nausea and vomiting for a while to give him some fluids and get blood, the lab tech came up behind me to collect the tubes, and said:

"I'll just go ahead and start the I-Stat Troponin now."

I Just Had To Walk Away. . .

A while ago, I got into a little bit of a Facebook argument (I know, real mature, right?) with some lady. A friend was in a bad place with some back pain he was having and wan't sure what to do.  Not having insurance, he wanted to try to find something other than the ER, since he intended on paying his bill, and didn't want to pay so much money.

He was on Facebook asking for recommendations on what to do.  I gave him some recommendations on places he could go get checked out for relatively low cost in our community.

Well, some other lady told him just to go to the ER.  She said it would be expensive, but not to worry about it because she just walked away from her bill and it never showed up on her credit report, so he should just go for it.

Weeeellllll, as you can imagine, that just really pissed me off, and I wasn't able to go on without responding to her idiocy.  I mentioned how people walking away from their bill means less money for the hospital, which means freeze on raises, freeze on 401k match, freeze on hiring to help reduce other nurses' work loads, freeze on tuition assistance, and suspension of other benefits.  I explained to her that the ones who suffer are the ones who provide her the care, not some big money grubbing corporation (not that it would be ok then either).

Her response?

"It was a LIFE or DEATH situation where I was having an ALLERGIC REACTION!!!  I had to go!  Besides, it took an hour for them to see me and all they did for me was give me Benadryl, so the bill was outrageous anyway!"
At this point, I "walked" away from the conversation.  I wanted to give her a lesson on financial responsibility, but I didn't.

I wanted to tell her that, if it was a life or death situation, then the ER staff obviously saved her life since she is still thieving oxygen alive today.  I wanted to tell her that if, indeed, the ER staff saved her life, then isn't forking over a little bit of dough so that they can have a cost of living raise at the end of the year a small price to pay for her life?  Is there really such a thing as a ridiculous bill for saving one's life?

Also, I truly don't think it could have been that much of a life or death situation if they felt comfortable letting you wait for an hour while they saw to people who were probably coding and bleeding out.  An hour really isn't a very long wait anyway.

I understanding that she was probably scared, which is why she went to the ER, but does that really excuse her behavior of just walking away from her bill?  Then recommending somebody else do the same thing?

What do you think?

Wait. . . Wouldn't You KNOW That?!?!

Chief complaint of the day:

"I think I may have shot myself"

You don't know?!?!

Turns out the guy was cleaning up his house for family to arrive and was putting his rifle in the closet where it was out of view.  The guy needs work on his firearm safety practices.  Well, his thumb hit the trigger and the rifle fired.  The muzzle was pointing completely away from him and he had no body parts anywhere near the muzzle.  He just wanted somebody else to make sure for him.

Wednesday, March 27, 2013

A Question For You All. . .

Ok, all you experienced docs (ok, fellow nurses too) out there, I have a question for you.

Patient stats:

Male, 45 years old.
Hx of MI and "other cardiac issues" as it was put to me by the doc

Pt presents to ER c/o cough, congestion, body aches, mild nausea, "a little bit of lethargy" x1 week.  Pt states that his chest hurts only when he coughs.

New ER doc orders complete cardiac workup.

EKG normal sinus rhythm, not paced.
All labs come back normal.
Chest x-ray unremarkable.

Question for you guy is:

Was that workup reasonable?  Too much?  Given the information presented, what would you do with this patient?  Admit?  Discharge to follow up with primary doc?  Discharge to follow up with cardiologist?

Please answer in the comments.  I'll tell you what happened with the patient in the comments section after I get some answers. . .

Just Another Gastroenteritis

This last fall and winter, we had a huge influx of patients with gastroenteritis, aka "stomach flu."  It seemed like three quarters of our peeps came in with nausea, vomiting, and abdominal pain.  It became pretty routine: Zofran, fluids, maybe something for pain, discharge with Zofran ODT script.

One lady came in who was maybe in her 50s with the same ol' symptoms.  So, what did we do?  Well, the plan was to do the same ol' thing we do for all of them.  However, this one was a really difficult stick.  I couldn't get it and neither could the charge nurse.

So, we gave her some IM meds and held out on the fluids, but the doc really wanted us to have IV access because he was pretty sure she was gonna need fluids.  Luckily, she felt better after the IM stuff and Dr. Discharge was getting ready to let her go.  When I went to do the discharge, though, her pain came back in the worst way and she started retching again.

I let the doc know.  Nothing was super out of whack on her labs and her xray showed a little bit of constipation, but the doc didn't think it was necessary to do a CT.  He ordered a repeat of the same IM meds we gave earlier.  Success!  Until I took her discharge papers in.  Same thing happened again.  Ordinarily, we'd say, "ok, lady, come on."  But she had no history of being in there or any other hospital that we could find.  So, doc gave her the benefit of the doubt.

This cycle of meds, then retching/pain went on one more time.  Finally, the doc said, and I quote, "Fuck it.  Let's just order the damn CT."

He wanted contrast, so we needed the IV.  But, like I said, she was a tough stick.  We had five different nurses try.  The doc tried with an ultrasound machine.  Nobody could stick this lady.  We don't have the benefit of a PICC team on night shift.  This poor lady kept getting stuck over and over and over.  Finally, one of the nurses asked for another shot, and she got it!  Away she went to CT.

In a little while, we got the results back. . . Ischemic Colitis. . . Oops!  Time for surgery!

Sooo. . . Which Is It, Then?

Frequent Flyer, a dude in his 50s, comes up to the ER registration desk and signs in, giving the chief complaint of "left shoulder injury."

Now, just like any other day, it's really busy, so people with a musculoskeletal injury tend to get put on the back-burner while we see the more ill patients.  Mr. Flyer must be noticing that a bunch of people who got there after him are getting to go back before him.

Finally, Triage Nurse Gigantor calls back Mr. Flyer:
Gigantor: What brings you in today?
Mr. Flyer (clutching stomach with both hands): Oooooooh, my stomach huuuuurts soooo baaaaad!!!
Gigantor: Sir, it says you signed in with a left shoulder injury.
Mr. Flyer: Noooo, I don't know why it saaaaaays thaaaaat.  My stooooomaaaaach!!!
Gigantor: Fine, sir. . . (continues triage process) 
Mr. Flyer moves up a little bit to get ahead of some of the other folks and ends up in one of my rooms.  Being as busy as we were, I wasn't able to get in to see him right away, as I was trying to get a critical patients squared away to go to ICU.  I come out of Mrs. Critical's room and see one of my favorite docs, who is notorious for taking no shit come out of Mr. Flyer's room.

Doctor Takes No Shit makes eye contact with me and rolls her eyes.  She comes up and asks me what the hell is wrong with this guy since the triage note says one thing and he's now complaining to the doc about back pain.  I told her I didn't know, but would investigate.   She sits down at her desk and says, "oh, I see.  NurseHubba, look at this."  I look over her shoulder and see that this guy has been given "the mark."  This tells us that the guy is on the narcotics watch list, is not allowed to receive narcs, and has gotten both a letter from the medical director of our ER and a visit from the case manager.

Hmmmm.  Curious, I go in to see Mr. Flyer.
NurseHubba: So, what brings you in today?
Mr. Flyer: My left shoulder is killing me!
No drugs for you!
NurseHubba: Sir, please help explain something to me.  You came in with shoulder pain, told the triage nurse abdominal pain, told the doc back pain, now you're telling me shoulder pain.  Which is it?!?! 
Mr. Flyer: Well. . . ummmm. . . It's all of it.
NurseHubba: Which one is the worst?
Mr. Flyer (without the slightest grimace): Oh, definitely the shoulder.  It's 10/10 pain!
NurseHubba: Uh-huh.  
Since I was helping out to cover shifts, this was during the day, which meant we had a case manager there.  She was the next person to go see Mr. Flyer to explain that he wasn't getting narcotic pain meds. Next thing I know, I hear him yell, "This is bullshit!  This is the worse hospital I've ever been to!"

He takes off his gown and throws it with his "injured" left shoulder and stomps out of the ER.


Nurses Who Happen To Be Dudes

I'm no expert, but I've done a little bit of research into the history of men in nursing.  Here's a summary of a few articles I've been looking at this morning on the subject:

Did you know that around the turn of the last millenium, women weren't allowed into nursing?  That's according to this post on allnurses.com, anyway.  In fact, that post has a pretty interesting timeline of the history of men in nursing.

The first nursing school, according to the article/post, was founded around 250 B.C. and was exclusively for men because women were considered to be not pure enough.

It wasn't until just after the turn into the 20th century that men went nearly extinct from the profession.  In fact, according to this Medscape article, nursing schools for men were relatively common in America around 1900.  In just 30 years, the percentage of nurses who happen to be dudes dropped down to less than 1%.

So, what's the reason for this?  Well, there are a few theories.  One, talked about in this article, posits that men found "other, more lucrative occupations" and, slowly, left the field.  I'm not sold on this, however.

Personally, I'm more apt to believe the theory set forth in the previously mentioned Medscape article.  The hero of nursing, Florence Nightingale, lobbied women to take up the call to care for the sick and injured.  Also, she lobbied governments to make it more difficult for men to become nurses, saying that men were "not suited to nursing."  She is actually pretty well known as one of the reasons for the downfall of men in nursing.  Lots of nurses don't know about this, though, because "Flo" is always so strongly doted on as a hero for the profession.  I suppose she is, but she sure made it difficult for dudes.

Graduating class of 1899 from Victoria General Hospital, Halifax, Nova Scotia
(from this Medscape article)
In 1972, it became illegal for education programs to discriminate based on gender (again, from previous Medscape article).  After this, the numbers of men in nursing began climbing again. . . slowly. . . oh, so slowly.  By 1980, we made up 2.7%.  By 2008, 6.6%.

It's a long, slow climb, but we're getting there.  Nursing went from being the doman of men only to becoming known as "women's work."  It's taking a while, but we're working on swinging that pendulum back towards the middle of the spectrum.

Tuesday, March 26, 2013

One Badass Granny

This was one hell of a night.  Tons of patients.  Full waiting room.  One ambulance after another.  And it wasn't your every day, run of the mill, group of complaints.  Every single patient was sick as shit.

I was triaging that night in our pull 'til full (a system of immediate bedding for patients with triage at bedside) ER.  A lady was brought in by EMS from a nursing home with altered mental status.

One of the first things we do for that here is get a urine sample for a UA.  Also, we will usually get an IV going so that meds like Ativan can be administered easily via IV.  Awesome plan.

Well, this 93 year old lady, who probably weighed less than her age, seemed to have super human strength, as it took about six of us to hold her down for the IV and the Foley that we were putting in.  The whole time, she's screaming at us.  She's dropping f-bombs, cussing us out, and telling us to go to hell.

Then, she suddenly looks at her primary nurse (the one putting in the catheter) and says, "I hope your mother dies, goes to hell, and Satan eats out her p**sy!!!" in one of the most satanic voices I've ever heard.

Add This To Your Bucket List

You just haven't lived until you've seen an extremely combative drunk guy/gal hog tied and carried out of the ER by police.

The Follow Up

One of the frustrating things about working in emergency nursing/medicine is the difficulty in following up with patient outcomes.

We get people in sometimes who get stabilizing treatment, then air lifted or driven to another hospital with services that we don't have, like neurology or level 1 trauma.

Unfortunately, we don't always get to find out what happens to those folks.  One of the amazing things about being in the medical field is being able to make a difference in life or death situations.  The really critical trauma patients that we transfer disappear sometimes into the vast space that is the hospital system and we never know anything about them again.

I often wonder about some of these patients.  In my mind, they've recovered thanks to the excellent care they've received and are living their lives to the fullest.

Monday, March 25, 2013

These Phone Calls. . .

*Phone rings and I'm the only one at the nurse's station*

NurseHubba: Emergency Room, this is NurseHubba.

Ladies Man: Hi, I uh, well. . .

NurseHubba: Yes?

Ladies Man: Well, how do I, ummm, you know. . .

NurseHubba: Sir, how can I help you?

Ladies Man: How do I put on a condom?

NurseHubba: Say again?

Ladies Man: How do I use a condom?

*I'm definitely not going to explain this to a dude over the phone*

NurseHubba: I can't give advice over the phone, sir.  Google it.

Ladies Man: Oh, that's a good idea!  Thanks!


A Friendly Tip. . .

If you check your blood pressure once and it's too high:

Give it a few minutes.  Sit down and relax.  Do you have a headache, dizziness, etc?  No?  Good.  Now, after about 15 minutes, re-check your blood pressure.  It's normal?  Good.  Have a wonderful day.

Don't call EMS if your blood pressure is 175/95 after you've been running around your house all day cleaning up for guests coming in from out of town.  Most likely, your pressure will drop a little bit after you've been sitting for awhile.  Sometimes (last night), your pressure will be down to 150s over 80s by the time EMS arrives.  Also, sometimes (last night), your pressure will be down to 130s over 70s by the time you arrive in the ER.

If you do that, and Dr. Discharge doesn't see anything wrong with you (no, you're not getting a full cardiac work-up with labs, etc), he's going to discharge you very quickly and you will have spent more time in the ambulance than in the ER. . . especially if you live an hour away.

That's Definitely NOT An Emergency

Ok, people, it is not ok to call EMS for "weakness," then tell ER staff that your chief complaint is:

"I just want somebody to hold me."

That's going to get you out the door pretty much just as fast as you came in here.

Figure Of Speech

Most of the time, it's a merely a figure of speech to say,

"My best friend stabbed me in the back!"

Sometimes, it's quite literal.

Oh, No. . . Please Stop. . .

. . . talking, that is.

I really don't need to hear all about your day in order for you to tell me what is wrong right now.  Please, for the love of all that is Holy, please just get to the point.

Usually, when triaging, patients are fairly cooperative.  They answer questions.  If I need more information, then I ask them further questions.  It's a simple system, really.  I ask.  You answer.  I walk out of room (we use a "pull 'til full" system).  Simple.

Usually, when I go in to a room to triage, I introduce myself, explain what I'm doing (triage process), then start with the question, "So, what brings you in today?"

The answer is usually, "I'm seeking drugs."  Ok, that's not usually the answer they say, but it is usually short and sweet like that.  "My leg hurts."  Or, "I've been throwing up."  You get the point.

Sometimes, though, the patient starts with what they ate for breakfast, what route they took to work today, why they were fifteen minutes late, who they had messages from on their desk phone, etc.  Finally, they get to the point.  It's an art as an emergency nurse or doc to get past all this crap and get the person to get to the point without threatening our beloved Press-Ganey scores.  Most, I think, are pretty decent at doing this.  However, every now and then, there is that one guy.

The one that no matter how much you hold up your hand and say, "Sir, so please tell me what brought you in today," they continue down their rabbit hole.  On and on and on.  The guy that causes the doc, lab tech, or x-ray tech to give you a pleading look as you walk by, hoping that you can please just bail them out from this conversation.  The guy who causes you to, prior to starting an IV or other procedure, ask the unit clerk to page you over the intercom a few minutes into you entering the room.

The point of all this?  Please, please, please just answer the questions.  I have others to triage. . .

Saturday, March 23, 2013

You Can't NOT Give Them To Him

Look, corrections officer dude, I get that your facility is tough on the inmates.  I get that patients don't get certain luxuries.  I get that jail is supposed to be painful.

But, that doesn't mean you can not give a guy his Dilantin for seizures.  Your little trip to bring this inmate down to my ER could have been totally preventable if you had just, you know, given the guy his damn seizure medication! 

I know you know he has seizures.  You have the medication with the jail nurse.  In fact, how is the jail nurse allowing the corrections officers to tell her the inmate/patient can't come get his meds?!?!

It took two phone calls today (one from me and one from the doc) to speak to both the jail nurse and some other jail administrator in order to get this dude the ability to take his three a day Dilantin medications to prevent seizures.

Wanna bet I know who is paying for this little jailbird visit?

Dude. . . Really?

A dude comes in with scrotal pain.  Triage Nurse Gigantor tells him we're going to need a urine sample.  So, he gives him a cup along with the wipes to provide the sample, walks him to the bathroom, and gives him instructions for how to provide a mid-stream, clean-catch specimen.  Dude says okay and returns to the triage nurse a few minutes later, handing him this:

This is actually a duplicate I made to compare
to the actual sample.  They were identical.

Not sure if you can tell, exactly, but what you see is this:  Some clear liquid that is a little bit cloudy with a film of bubbles on top.  Now, I know what urine looks like.  I deal with it just about every day I work.  So does our gigantic triage nurse.

Triage nurse comes back to the ER from the triage area holding up this cup in the little biohazard bag and starts asking every other nurse he finds, just to confirm, "Does this look like urine to you?"  Everyone pretty much laughs and confirms his suspicions that it is not, in fact urine.  Even the doctor (one of my favorites because she doesn't take shit from anybody) chimes in.  One nurse says that it actually looks like soapy water.  Everybody looks at the "sample" again and decides that it probably is exactly that.

This pisses off our awesome doc who takes no shit.  She says that whoever ends up taking care of this guy is going to be giving him an in & out catheter (which is a horrific experience, by the way) in order to obtain a proper sample.

Once the guy finally gets back to a room and gets his cath, of course, the urine looks like. . . well, urine.  Not soapy water.

When doc confronts the guy about the first ridiculous sample:
Dude: What, that's just what I pissed out. (with defensive attitude, posturing and tone) 
Doc: Come on.  You're talking to a doctor and a bunch of experienced nurses here.  We deal with actual urine every single day.  Did you really think we wouldn't notice? 
Dude (sticking to story): No, really, that's just what I pissed out. 
Doc: *shakes head and walks out of room*
What a moron.  Why would he give us soap and water as a urine sample?  Was he afraid we'd drug test him?  For those of you who don't know this, we don't give a shit (legally speaking) if you're using drugs.  We're not gonna call the cops on you.  And, in a case like this, we most likely aren't even going to do a tox screen.  We're just trying to figure out what's going on with you.  And, frankly, if you're ever going to want to provide a real sample to figure out what's wrong, it's probably going to be when you're having scrotal pain.  Wouldn't you want to get accurate answers for that?  I know I would!

Gotta give the guy some credit, though, for sticking to his story until the bitter end. . .

Friday, March 22, 2013

Imagine This. . .

You're a 5'4" 160lb dude in his late 30s playing a friendly game of softball in a community league.


From right field, you see the ball fly up in the air heading towards that gray area between right field and center field.  You've got tunnel vision, and all you can see is that softball floating through the air as you sprint, full speed, in order to make the play.

Unfortunately, for you, the 6'4" 250lb center fielder also has tunnel vision for that softball and is sprinting toward the same spot.


An unholy crunch echoes through the field as the two of you collide, the larger dude basically running right over you.  With his height, your *ahem* lack of height, and the two of you both sprinting, this lines up two horrible, horrible body parts that one never wishes to have lined up in this way. . .

Yeah, the 6'4" 250lb dude's knee is lined up with your crotch.  The result of the crash is a direct blow to the nuts at full speed by a linebacker-sized guy's knee.

That's why you're in the ER today.  And that's why I've rarely felt so much empathy for any of my patients. . .

Sooooo. . . Are You Going Home, Then?

*Pt comes to room via wheelchair for severe left knee pain x1 week with no injury*

The knee looked fine.  No redness or swelling.  Distal pulses and circulation were fine.  The patient just had pain.  She wasn't even yelling or screaming in pain.  She was pretty stoic.  Turned out the pain was just above the knee, but whatever.  Doc orders some x-rays and a Toradol shot.

NurseHubba:  I've got some pain medicine for you (explains medication).

Patient:  I don't want that.

NurseHubba:  Okaaay, well that's what the doc ordered.  What is it you're looking for? (Now, I think I know what she's gonna say: Morphine or that Dila-something med)

Patient:  Nothing.

NurseHubba:  You don't want any pain medicine for your 10/10 pain?

Patient:  Nope.

*X-ray tech enters room with portable scanner*

Tech:  Okay, I'm here to take a couple of x-rays of your knee so we can figure out what's going on.

Patient:  I don't want that.

Tech:  Wait. . . you don't want the x-rays?

Patient:  Nope.

Doc is informed and NurseHubba goes with him to talk to patient.  Never figured out just why the hell this lady came in to the ER, but she refused any and all treatment along with any and all screening exams.

Yep, That'll Do It


*Relatively young woman in her 30s walks in to lobby complaining of her heart racing and "shakiness"*

Since she's complaining of something cardiac, we thrown her on the monitor and do an EKG, which shows Sinus Tachycardia around 130bpm.

Asking all the usual questions: When did this start?  Pain or pressure?  Dizziness?  Nausea?  Etc. . .

NurseHubba:  Have you taken anything today?  Energy drinks?  Medications?

Speedy Gonzales:  No.  It just started.

NurseHubba:  Ok, so no recreational drugs?

Speedy:  Well. . .

NurseHubba:  Look, I don't care, but I need to know.  What did you take?

Speedy:  Just some meth. . .

*JUST some meth!?!?*

NurseHubba:  Well, that'll do it. . .

Came to find out later that it was her first time every trying it, but she had been doing it pretty much all day.  She was eventually discharged and walked out, but she was sobbing on the way out because she felt really dumb for doing that.  People, please don't do meth.  Hope she learned her lesson. . .

Thursday, March 21, 2013



I read this blog post today from one of the ER blogs I frequent.  This one is written by an ER physician.

I'm wondering just how in the hell this lady managed to score these guys. . .

Shaking My Head. . .

People are seriously jacked up.  Some of the things I see in this ER really make me question my faith in humanity.  A friend of mine at work (let's call him Nurse Burns) reminded me of this case (see disclaimer):

A guy comes in to us via EMS.  All we know from report is that the guy was assaulted, is pretty beat up and bloody, and has bilateral above the knee amputations and bilateral above the elbow amputations.  Anyway, the guy shows up on a stretcher alert and oriented being pushed by EMS.  Behind EMS walks in four local police officers in order to help the guy finalize some of the report for pressing charges. 

Yep, that's her
Well, after talking to the guy, the police, and EMS, we found out the full story of what exactly brought this poor gentleman in.  Turns out that dude was at a fast food joint with his girlfriend (who was probably about 250 to 300 pounds with missing teeth and, as you'll see, is both pretty strong and psycho).  While there, the she-zilla got pissed about something or other and decided to take it out on her electric wheelchair bound, quadruple amputee boyfriend.  

The story would end mercifully if she merely started throwing punches at him.  But, unfortunately, no.  The creature from the black lagoon grabbed the poor man by his crotch, and yanked him out of his wheelchair with one hand while beating him about the face with her other hand.  Once he was on the ground, she starting kicking a defenseless man with no arms or legs about the chest, back, belly, head, and face.

Luckily, all the guy had wrong with him were superficial wounds, and he was able to be discharged with only some minor wound care.  You know what?  He ended up sending the police away!  Decided not to press charges.  

Goes to show ya, not all domestic abuse is a dude beating a chick. . .

Wednesday, March 20, 2013

Ok, Not Just ONE Word. . .

A word about Press-Ganey Scores.

For those of you who don't know, these scores are how hospitals are rated, based on patient satisfaction with the facility, patient care, the nurses, physicians, and other staff.  You know what the problem with rating a hospital, especially Emergency Rooms, based on patient satisfaction is?

Patient satisfaction often has nothing to do with the quality of care that patient received!

Patient drives himself in with chronic back pain.  There is no acute injury to this patient.  Patient gets some Toradol (non-narcotic pain med), and get's discharged.  Patient, during stay, tries to go outside to smoke a cigarette.  Staff says no smoking on hospital grounds and that if he leaves, it's going to be AMA and he's going to have to start all over again.  Patient is pissed off that A) He didn't get narcotics [since, after all, he's really just a drug seeker], B) Nobody lets him outside to go smoke, and C) He had to wait a while because most of the nurses and doctors were in the middle of trying to bring somebody back to life (you know, as in a code)!
Patient, after receiving Press-Ganey survey, rates everything at the hospital as poor or very poor because he didn't get what he wants.  
Those of you who don't work in a hospital, and especially an ER, would be shocked to hear how often this happens.  Forget that this patient got some pain control (ERs are not obligated to treat chronic pain).  Forget that this guy was going to drive himself home after receiving narcotic.  Forget that the hospital is trying to promote health and wellness by not allowing smoking.  Forget that other patients at the hospital have asthma that can be set off by cigarette smell.  Forget the fact that somebody else was dying two rooms over.  What matters is that this guy wasn't allowed to contaminate his body with unnecessary narcotics and carcinogens, and that he had to wait a little longer than he would have liked.

So, now our scores go down.  People go to the other hospital down the road.  We lose money.  Wanna see how Press-Ganey scores negatively affect health care?  Read this article:
Press-Ganey Sucks
Also, here's a blog post from another ER blogger about the issue:
Customer Service 
Ok, I'm off my rant now. . .

How Does It Last So Long?!?!

Ok, how the hell do you manage to have such poor hygiene as to make a room continue to be un-enterable for hours after you leave?

Even after scrubbing the room down with Sani-Wipes (waaaay more powerful than mere Clorox Wipes), changing the linens, emptying the trash, and spraying air deodorizer, the room still smells like an ashtray that's been sitting around full for months, body odor, leaky [adult] diaper, feet, dirty laundry, wet dog, and halitosis!

I know the room smelled just fine before you walked in there.  I cleaned it.  It was fine.  But, for some reason, since you left, every person who walks in there loses three layers of skin just by walking in!  You, my friend, need much more than an emergency room. . .

Now THAT'S Rough!


*Guy walks in holding bloody wash cloth over left shoulder

NurseHubba:  What happened to your shoulder?

Bloody Shoulder Dude (looking rather sheepish):  I got stabbed. . .

NurseHubba:  Okay, let me see.

*Dude's got four stab wounds in his shoulder, each about 1/2" long.  Bleeding is controlled.  Doesn't look too severe.

NurseHubba:  So, what happened?

Dude (still looking sheepish):  My girlfriend stabbed me with a short little knife. . .

*NurseHubba asking more questions and getting more details about the knife, etc.

Dude (even more sheepish than before):  Well, we like to have rough sex, and. . .

Knife wounds from rough sex?!?!  WTF???

ANOTHER Ridiculous Phone Call

*PHONE RINGS*  9pm any day of the week has us running around like we're preparing for the apocalypse. . . In other words, it's really busy.

NurseHubba:  Emergency Room, this is NurseHubba.

9PM Caller:  Ummm, hi, I have a question. . . (when I hear this statement, I know it's gonna be blog-worthy)

NurseHubba:  Okaaaay. . .

9PM Caller:  So, I just took my blood pressure medication. . . (pauses)

NurseHubba:  Okaaaay. . .

9PM Caller:  Well, then I pooped.  (stated matter of factly)

NurseHubba:  Okaaaay. . .

9PM Caller:  Do I have to retake my medication?

NurseHubba:  WHAT?!?!

9PM Caller:  Well, I'm afraid I took my medication, then just pooped it out!  Do I need to retake it?!?!

NurseHubba:  No. . . No, you don't.

***Are people really this stupid????!!!!!!?????!!!!!

What A Solution!

HERE is a blog post from one of my favorite ER bloggers about how to get someone in the waiting room to shut the hell up.

Unfortunately, the only rooms in our ER that don't have a door are the Fast Track rooms, of which there are only 5.  So, I suppose we could use the same little trick.  Either way, this is pretty creative and probably effective.  Can't wait to try it!

Emergency Patient Groupie

So, there's this one guy who is in the ER constantly.  Ok, there are lots of guys (and gals) who are in the ER constantly, but this one guy is never a patient.  He's always here with somebody.  And that somebody is never the same person.  And that person is always a woman.

So, you say, he's kind of a "playa," right?  Always with a different lady?  Hmmmm.  I guess so.  But this isn't like the kind of playa (I'm way too white to use that word) who is going club to club, scoring nightly and moving on.  This guy is like an ER patient groupie.

This is more attractive than
that guy
At least once a week, he's in there with some other lady, holding her hand, and telling her, "It'll be ok, baby.  I love you.  You're beautiful."  Now, I'm as straight a guy as they come, but I still know a non-handsome man when I see one.  And this guy is definitely not a good looking fella.  Calling him "pear-shaped" would actually be a compliment.  And he's certainly not funny, charming, or wealthy.  I really don't know what all these women see in him.  Although, to be fair, the women he brings in aren't exactly winners themselves.  Often frequent flyers, they have black, rotting teeth (meth mouth), reek of cigarettes and alcohol, and seem to be ten to fifteen years behind where they should be on the maturity scale.  So, maybe he's just preying on the weak?

The lady he's with is always there for one of two reasons.  A) "Severe" abdominal pain, causing her to writhe, scream, holler, shout, cuss out nurses, try to pull out her IV, and just make a mockery of herself in general, or B) She's threatening to kill herself or is "unresponsive" when he finds her at home.

Does this guy have Munchausen by Proxy?  I don't know, but he sure loves women who end up in the ER.

Tuesday, March 19, 2013

A Stoppable Force Meets Immovable Object

I'm amazed every night at all the people who come in because they get angry.

They're not just angry, though.  They are angry and did something stupid because of that anger.  Here are a few. . .

1)  After lifting the ice pack off the top of the guy's hand, I see a bump sticking up about an inch that's around two inches in diameter.  Turns out, the teenage young man had punched a BRICK WALL full force and broken the shit out of his hand because his mother wouldn't let him play his video games that night.  Brick walls are always gonna win that fight.
2)  Sixty-something year old man takes off loosely tied shoe to reveal a dark purple, swollen to size of a kiwi (literally), and blood oozing big toe.  His wifey hadn't done something he was expecting, so, rather than hurting his wife (because he's clearly such a great guy), he kicked a giant OAK CHAIR barefoot and his big toe took the brunt of the force.  That was one extremely broken toe.
3)  Youngish dude in twenties was told he would have to work the weekend.  He pulled out his pocket knife and threw it with blade open towards a fence post about six feet away.  The knife actually hit the post, but then bounced back toward the dude and sliced a four inch long by 3/4 inch deep gash through his calf.  (This was witnessed by co-workers who were with him in the room and laughing at him the whole time)
4)  Young teenage boy in room crying with mom bedside.  Pulled a stack of gauze off his hand to reveal a gash from his knuckles all the way back to just past his wrist.  That was kinda cool because you could see the tendons moving in his hand when I asked him to wiggle his fingers.  The kid had punched a tropical aquarium because his single mom was making him clean his room.
All of these people decided to do stupid-ass shit because they got pissed off at something stupid.  Now, I have a theory that most guys have, at some point in their lives, gotten angry and punched a wall.  However, I would posit that many of those people were "smart" enough to either not go at that wall full force or at least choose a wall to punch that was made out of drywall so their hand would at least go through it.

Hands, feet, and heads (yes, I've had people who bashed their head into something out of anger too) are always going to be a stoppable force when compared to chairs, bricks, and knives.  What the hell is wrong with people?

First Day, Many Posts

Ok, I know this is the first day of the blog, but I just kept thinking of stuff to write.  I got tons more too, so stay tuned!

Not Sick Enough???

*Walking in to room to meet new patient, who happens to be a little girl with her parents and little sister.  After introducing myself:

NurseHubba:  So, what brings y'all in today?

Clueless Dad:  What do you mean?


NurseHubba:  Why are you here today in the emergency room?

Clueless Dad:  Oh. . . Ummm. . .

*Dad goes on about sniffles and a "little bit of a cough" for the last week.

NurseHubba:  Ok, have you taken her to see her pediatrician?

Clueless Dad:  What do you mean?


NurseHubba (getting very impatient, but hiding it as best as I can):  Her doctor.  Have you taken her to see the doctor?

Clueless Mom:  Oh, no, she's just congested.

NurseHubba:  So, why did you come to the EMERGENCY room?

Clueless Mom:  Well, she's sick, but we didn't think she was sick enough for the pediatrician, so we brought her here instead.


Night Shift Woes And Triumphs

I'm not sure the the hell is with this picture, but it sort of fits
Since I work night shift, my sleep schedule is pretty jacked up.

I work from 7am to 7pm, then drive a little over an hour home.  I get about six hours of sleep, then I wake up and leave way earlier than I need to for work.  Why do I leave way early for work, you ask?  Well, because I'm anal.  I fear being late for anything.  Everywhere I go, I leave too early.  I'm pretty sure it drives my wife crazy.  Also, traffic is unpredictable in my city, so I never know whether it's going to be an easy hour long drive, or a horrifying two hour drive.

The six hours of sleep is fine.  I certainly have no complaints there.  But, I switch between night schedule for work days and day schedule for days I'm off.  I like hanging out with my wife and, besides, that's when everyone else is awake, including grocery stores and other places that I might need to go.

Anyway, I usually do pretty ok switching between schedules.  I have a pretty erratic sleep background anyway, having spent time in the military, so I do ok switching around.  But, for some reason, lately, I've had trouble during my off work days.  I'll wake up at 1:30 or 2am and just lay there, completely friggin' wide awake, tossing and turning, trying to shut my brain off so I can just get some damn sleep.  Luckily, my tossing doesn't wake up my wife.  It just annoys the snot out of me.  I usually fall back asleep around 6:15am or so, then my wife's alarm goes off about 6:45.  Being the fuckin' awesome husband that I am, I get up with her and help make her lunch and breakfast.  After she leaves, my plans are always to fix, repair, build something that needs fixing, repairing, or building.  Unfortunately, I soon find myself on the couch with the dogs licking my face at 3pm, another whole day having gone by without getting any of the shit done that I had planned to do.  Pain in my ass. . . I don't know what my problem is.

Night shift isn't all bad, though.  I would never trade it.  I am in the really fortunate position of working with an awesome team of nurses, techs, clerks, and doctors (well, most of the docs, anyway).  The day shift peeps are cool too, but they're just too serious. . . or something.  I can't really put my finger on it.  Night shift folks are more fun, and I think we have a really cohesive team.  Plus, everyone enjoys making fun of the PITAs (Pains In The Ass) as much as I do.

Oh, and the night time pay is way better too.

As much havoc as it plays in my sleep schedule and my ability to get shit done, I'm not switching from night shift.  I like it here. . .

Ummm. . . Sorry?

*DING* goes the call bell for room 4. . .

Every time I hear a call bell, I get an impending sense of dread.  Is it one of my patients?  No?  Ok, good.  Oh, but that person's nurse isn't ready available?  Ok, let's do this.

*Enters room*

NurseHubba:  Yes, sir?  What can I do for you?

Grumpy Guy With Complaint Unknown To Me:  I have the hiccups!

NurseHubba:  Ummm. . . okaaay?

Grumpy:  Well?!?!

NurseHubba:  I'm sorry, sir.  Unfortunately, modern medicine hasn't found the cure for that one yet.

Grumpy:  This is bullshit!

*Hears nurses outside of room giggle*

And Away We Go. . .

Hi.  I'm NurseHubba.

I'm an Emergency Room Nurse.  I'm also a dude.  I am not a "male nurse."  I'm a nurse.  And no, I'm not gay.  Not all "nurses who happen to be dudes" are gay.

This is my first foray into the blogging world, so go easy on me.  I've been reading some of the other ER blogs out there, and I have been really enjoying them, so I thought I'd give it a go too.

The title of my humble little blog is "This Is An EMERGENCY Room!"  If you have read any of the other ER blogs out there, you probably already know why I chose this title.  Before I got into emergency nursing, I had no idea how many people showed up to the ER for ridiculous problems that could easily be handled by either A) Taking a simple OTC medication and going to bed, or B) Going to see their primary care doc (and sometimes dentist) in the morning.  Now, I know. . . and GI Joe fans of the 80s know that "knowing is half the battle."

The other half of the battle dealing with the silliness, ridiculousness, drug-seekingness, and general tom-foolery that uses the ER on a daily basis.  Now, let me just say, there are plenty of people who end up in our ER that have true emergencies (infections, respiratory arrest or distress, serious cardiac problems, real traumas, etc), but there are enough of the others that make it worth titling an entire blog after them.

Lastly, for this opening day post (disclaimer time), please understand that the stories you read here are not from real patients.  They are exaggerations and embellishments in order to illustrate points that I deem necessary to illustrate (it's my blog after all).  Any similarity between any of these stories and you or someone you know are purely coincidental, and have no basis in actual reality.

That being said, enjoy, comment, and have fun!