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Thursday, May 30, 2013

This Sets The Tone For The Night

Ok, many of you know that I work night shift.  So, I come on around 7pm and work until 7am.

This particular night, I was working triage.  In our ER, we have a "pull 'til full" system where patients are brought to a room immediately until we are full up.  Then, we begin the normal triage system where people end up sitting in the waiting room.  If we aren't full, then the EMS patients coming in are triaged by the triage nurse when they come in.  If full, the primary nurse or the charge nurse nurse gets in there to do it.

This night, I came in to a very nice looking board with only a handful of patients on it.  This, in itself, is a miracle at 7 in the evening.  Right when I came on, the outgoing triage nurse told me that everything was caught up and that we just had one ambulance out.

Sweet.  This is an excellent situation to come in to.  I've had some seriously shitty shift changes leading up to this, so I'm excited to have a good one.

EMS arrives with the patient on a stretcher.  She's kind of just looking around, wide-eyed.  She's surrounded by six EMTs of various levels, including the shift leader.  Hmmmmm, that doesn't seem like a great sign.  I start to walk towards them and the shift leader says, "Hey, NurseHubba.  Whatcha got tonight?"  I reply that I'm triaging, and he kind of giggles.  Then he says, "Come here, bro.  I gotta talk to you about this one."  He pulls me off to a corner of the ER and gives me the run down:
"Dude, this chick is seriously jacked up.  42 year old female.  Found her in a hotel parking lot with no clothes on.  She's got no ID.  No nothing.  We don't know where she came from.  Asked around at the hotel lobby, restaurant next door, and the gas station across the street.  Nobody has any idea.  But, bro. . . she's batshit crazy.  She agreed to come in, but I don't know what the vital signs are because she wouldn't let me take them.  Won't let me assess or anything.  You're probably gonna need a sitter and maybe even some restraints.  Sometimes, she decides to 'go off' and you have to get her back down.  Sorry, man.  Good luck."
After hearing this report, I was sure glad that I was triaging and not having to take care of this patient all night.  Immediately, she tried to get up and get the hell out.  Remember, she's nude.  The sheet she was covered with dropped to the floor and she tried to bolt in all her glory.  I got an order for physical restraints from the doc, but not chemical (drugs).   Ok, this made it a little easier, but it was hard to get a good physical assessment done.  Ok, fine.  Vital signs, which I was able to get, were pretty normal, though.  The lady was a useless historian, unable to tell me anything.  I couldn't find any obvious injury or trauma.

Ok, so she's restrained.  She's screaming (sort of) in this weird, raspy, exorcist sounding voice, that she wants water.  Nurse Shaggy (who started at the hospital at the same time as me and has LOTS of hair) is a really nice dude.  He decides to let her out for a few, give her some water, then re-restrain her.

Of course, she tries to bolt.  We all get her back in bed and restrained again.  Two hours later, an hour and a half after an initial dose of Geodon and Ativan, we are completely full with too many ambulances out and too many people in the waiting room.  So, I'm in "the box."  This is what we call the triage area.

Suddenly, I hear multiple voices screaming, "SECURITY!!!  GET SECURITY!!!  SHE'S LOOSE!!!"  I look out the little window that faces into the waiting room and see a very large, very naked woman sprinting through the waiting room with three nurses and our security dude chasing her out the front door to the ER and into the night.

The patient that I am triaging at the moment is there just to have a ring cut off, which I was in the middle of when the commotion happened.  She looked up at me with the most horrified, scared look I have ever seen.

I looked at her, shrugged, and said, "Meh.  Just another night in the ER."

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