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20 Out Of 10



Musings of an Emergency Room Nurse



Updated: 2018-03-06T01:51:07.085-08:00

 



Blog Funeral

2011-08-20T11:03:46.459-07:00

I have been in denial about the life left in my blog for a long long time. I keep thinking, "soon, I'll get back into it and start updating it again," but soon never materializes. This week I started a new job at a regional call center as an advice nurse, and thus it seems a bit silly to continue an ER blog.

I could just change the blog and share my adventures in cubicleville with everybody, but: 1. it would probably be a bit boring. 2. I would be fooling myself to think that I am actually going to maintain a blog with three kids and a busy life.

With all that said, a eulogy:

It was a good blog, but it bit it.

Thank you to everyone who participated over the years and for all the great comments and support. It was fun.



Long Time, No See

2011-02-20T15:43:04.317-08:00

Just a quick note here. It has been over a year since my last post, and for a long time I've been wondering if it is just time to pull the plug on this blog. After thinking a lot about it, I'm not going to do that just yet. With three kids 3 and under, life has not been quite so free as it was when I started the blog, but I hope that as the kids get older and less time-intensive, it will give me more time to work on updating the blog, so if you are still subscribed to this feed, don't bother deleting me just yet. I'll try to post a little more often, though probably not regularly.

I am deleting my 20outof10 gmail address, though, because I get a lot of junk mail there from people saying "how much we love your blog, and oh, by the way, would you post this article and link to my blog?" when it is obvious they haven't even looked at my blog.

If you really need to get in touch with me, just leave a comment on any post, as I get email notifications of comments.

Thanks.



Feces

2010-02-04T12:03:08.689-08:00

WhiteCoat's got a great post up on his blog.  I'll give you a sneak preview:

...I don’t know any adults who have developed post traumatic stress disorder from taking a dump...

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I'm Sorry, Sir, I Don't Remember How To Do My Job

2010-01-16T10:06:31.721-08:00

When you stop to think about it, it is rather interesting to consider that an emergency nurse is one of the few specialists in the medical field that rarely gets to really practice their specialty.  That is because very little of what actually comes through the doors of the emergency room really qualifies as an emergency.  So I spend most of my day pushing Dilaudid and Zofran, and very rarely do I actually perform emergency procedures.  To the point that I'm very nervous to get a true emergency - not just because somebody's life is in the balance (a good reason to be nervous) - but because I haven't set up a vigileo monitor or titrated nitroprusside or helped with a cutdown or identified a pneumothorax in a long time.  And please don't come to me with your premature baby coming out.  Yes, I have an NRP certificate, but that's all theory with plastic babies.  Hand me a real one and I may panic.

And that is why I take on each true emergency with nervous excitement.  I'm here, after all, to save a life, but after all those ankle sprains and reflux pains and migraines, I'm just a little bit rusty on my A's, B's, and C's, so give me a minute before you stop breathing completely.

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A Paramedic Gets it Right

2009-12-25T16:37:00.017-08:00

I have great respect for paramedics.  Having to be on the frontline and running into situations without knowing what to expect in order to help others is among the highest levels of bravery.  I really love, though, when I hear stories like this one, taken without permission from a blog of one of our family friends:

Let me paraphrase the backstory: This man (one of the greatest men I've ever known, incidentally) fell off of his roof last month and broke several ribs along with a collarbone and some other injuries, leaving him in the hospital for three days and off work for a month.  Fortunately, he is doing better now, but here is the story he tells of a great blessing he got (with names removed):

About 10 days after the fall, and after a big wind storm which left our yard strewn with branches, [my wife] was again outside working by herself. A firetruck pulled to the front of the yard and 5 firemen got out - they told [her] that they were responding to a false-alarm fire nearby, when one of the 5 (a paramedic who had assited me to the hospital) noticecd [her] working outside and knowing the situation, suggested they take 20 minutes and help out. What a blessing they were to her - the whole yard was cleaned up in those 20 minutes - it would have taken [her] several hours. We've been truly blessed!
Finding that kind of love and service anymore is so rare, and I give huge props to these firemen for giving of their time when they could easily have just gone back to the fire station to rest and get ready for their next call.  What a great story to embody the spirit of Christmas.

Merry Christmas, everyone!




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Nashville Pulse, But Not For Long

2009-12-21T22:19:49.565-08:00

It's late, and I'm too tired to figure out exactly what dysrhythmia Nashville Pulse is using for their logo (came across it in the app store), but I think it is some kind of heart block.  Among the many problems with this heart rhythm, I'm a little concerned about the length of the pause immediately before this dying blip.  Also, this patient appears to have a U wave and an S-and-a-half wave, and is it just me or is that atrium not getting much loving?

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Z-Coil Shoes

2009-12-02T20:46:47.590-08:00

I have always laughed at that those shoes that are becoming more and more popular with nurses with a giant spring on the back.  They look goofy.
(image)
And yet as my plantar fasciitis continues and I go home from work in pain every day, I've become a little desperate.  Tonight, I stopped by my local uniform store and tried out some Z-Coil shoes.  I was a little bit dismayed at how comfortable they were, because I didn't really want to talk myself into getting silly looking shoes.  I was also a little bit dismayed at how much they cost.

That said, I think I am going to pull the trigger and get them anyway; unless someone who has worn them can talk me out of it.  That's where you come in.  Go ahead.  Do your worst.

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I Think I Know This Patient

2009-11-26T10:25:26.114-08:00

but then again, I think we all know this patient.

Definitely worth three minutes of your lives.

Unless you happen to be an all-too-typical ER patient.  Then you will find this offensive.

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The One That Got Away

2009-11-23T07:12:03.676-08:00

This one was from several years ago, and I may have mentioned it already in a post, but it invaded my dreams last night, so what better dream therapy than to bore you all with it.

I was an ER tech at the time, so I don't know all of the details, (as an aside, it is interesting to see life from both sides of the ER bubble.  I thought that I was so involved in patient care as a tech, and now that I am an RN, I realize that I really didn't know anything about what truly goes on in the ER.  I'm sure it would be a similar jump to go from nurse to doctor.) but I remember this guy was a really nice guy.  He was probably about 50 years old with a great sense of humor and he and his brother were joking back and forth every time I went in the room to do anything.  He had come in for sudden onset of debilitating leg pain.

A few hours later, I was working in another area of the ER, so a different tech was to take him down to radiology for an imaging study.  Somehow along the way, he coded and was rushed back to the ER.  One code was already in progress (I was tied up in that one - another devastating and unexpected code), but whoever was free went to help save this guy.  In all, they tried for an hour and a half but had to call the code.

As I think back on it, I have to think that the most logical explanation for this guy's code was a PE, but that seems too simple and I had the impression that the nurses and docs were confused and had no explanation.  And the poor brother was devastated.  One minute he goes in to the ER with his brother to get some pain pills for a leg injury, and the next minute, he is signing the mortician's paperwork.  And as if he needed the case compounded, nobody on staff was assigned to be with him and explain what was happening, so he stood outside the door to the room watching CPR go on and on and on, not knowing what to expect or how to take what he saw.

As you will hear from anybody who has been involved in codes, they are very stressful for the team working to save someone's life, and often, in some kind of attempt to maintain sanity, and cope with the situation, a few jokes will get cracked.  Such was the case here, and because nobody ws with the brother and he couldn't hear what was happening, he just assumed that nobody cared about his brother and perhaps even that they were making fun of him.

All in all, it was a very sad night and a hard one for the entire staff.  By the time all was said and done, three codes had been run simultaneously, with the only survivor being the 88 year old with dementia and a laundry list of health problems, while the two younger, generally healthy patients both getting the wrong kind of discharge.  What I will always take away from that night, however, was the vision of the brother of the patient I described and the 16 year old daughter of the other patient, both of whom were standing outside the door in shock, trying to find a way to cope with what they were seeing.  I did what I could to try to comfort the daughter and explain what was happening, but I was young and new at this and didn't know what to do.

When they teach you the ABCDEFGHI mnemonic in your TNCC and ENPC classes, please don't gloss over the F is for Family part.

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Today's "Reason For Your Visit"

2009-11-20T06:23:26.717-08:00

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.


So let's get to today's Reason For Your Visit:

hurt ankle rolled ankle

Unfortunately, I got the triage done before the whole poem could be written.  I later found it laying on the floor, scribbled on the back of a tongue depressor:

Inside, outside, upside down
I walk a lot to get around.
Oh, no! twisted, bent, and pulled
My foot moved how it never should!
hurt ankle rolled ankle, ouchie ow!
Let's get to the ER now!
Nurse, oh nurse, you little elf,
Dilaudid won't inject itself!
Get me back or I'mma holla,
Fix me now on your tax dolla!
Thank you, thank you. Happy clam
I really like green percs and ham!

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How to Get Seen Faster

2009-11-20T06:09:17.536-08:00

ERP has a post up about how not to get seen faster over on his blog.  Read that (hint: how it should be done), then consider this:

A month ago, I was told to leave my four other patients to triage a boisterous lobby patient.  "Just check her out and see how she is doing," the manager told me, as she escorted her into an empty room in the ER.  I dutifully triaged her and went through the litany of ridiculous questions forced upon us by Jay, Co.(TM), and at the end of that marathon of pointless questions, I pulled out the thermometer to get her temp.  As I was so doing, the doc walked in, asked her why she thought she would get seen any sooner by making a fuss in the lobby and told her that she was going to wait her turn, then walked out.  As soon as she found out that she was to go back to the lobby, she started screaming and kicked over out vital signs stand and broke it.

Her reward: getting chased into the parking lot by the nurse manager as she stormed out, and getting escorted back to an ER room so that the doctor (who she yelled at for being "unfriendly") could see her, because as we all know, we can't have an unsatisfied customer.

And the 5000 dollar paperweight on the floor?  Written up as a loss.  To this day it still hasn't been replaced.

And that, among many similar stories, is why I quit that job and am about to start at a better hospital.

And that, among many other reasons, is why I have been very sparse in my blogging of late.  Thanks for sticking with me.  I haven't given up the ghost yet.

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Mercy Mercy Mercy Me

2009-10-02T23:43:05.685-07:00

Oh Mercy, what a load of crap this show is.

I don't expect medical perfection from the shows I watch, but can we please get a writer or two who have actually seen a hospital before? Please?

A particularly egregious example: old man on a respirator (on a med surg floor...) with the tubes right next to him but nothing going into his airway. The nurse goes over and turns off the monitor (not the respirator) and the man instantly flatlines (as indicated by the beeping from the machine that she just turned off) and another nurse calls out the time of death. I hope they have very good malpractice coverage.

Or another example would be the time that the med-surg nurse barges in to the ER with an ambulance patient and shouts orders only to be turned down by the ER doc who spends the rest of the two episodes as an internist.

Or the urine drug screen that told the doctor exactly how much oxycontin was in a patient's system. A urine drug screen only indicates the presence of drugs, not amount, nevermind that it isn't even specific to oxycontin. In reality, the only thing the doc would have known is that the patient had taken a percocet in the last 48 hours.

Or the guy who gets compartment syndrome which makes him spontaneously get dizzy and pass out. He wakes up after having had an emergency bka surgery, except he is in the same bed (what, they can't afford a recovery room in this hospital?) with no monitoring equipment.

Here's a great one: the master's level nurse who has never set foot on a nursing unit before.  I want to attend that university that requires no clinical or preceptorship up through a master's degree.

I also enjoyed how the nurses seemed to float wantonly between med-surg, ICU, ER, and oncology units.

Along those lines, did anybody else notice that the woman who was found unconscious in a donut shop bathroom and whose lung function was deteriorating to the point of death, was:
A) on a med-surg floor
B) with no IV
C) with no respirator
D) with no resuscitation attempt despite not having any POA or living will.  Let me tell you, if you make it your hospital policy to make unconscious people DNRs, then you are just begging for some mondo lawsuits.

Oh, and don't get me started on the needle decompression.

So why did I sit through two hours of this drivel?  Chloe.  She's cute.

Don't tell my wife.




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Typo of the Day

2009-09-26T11:21:08.373-07:00

A nurse using our computerized medication charting system couldn't find a simple heart medication.  I found out the reason:  He was searching for asspirin.

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Epi Strikes Again

2009-08-11T22:06:09.188-07:00

When Epijunky really gets into the prose, you just can't stop reading, especially with a climax as good as this one.

I really connected with this line:

As much as I wanted to strangle Elle for calling us for the fourth time in seven days, I treated her as I’d treat a family member.

And that is the true art of healthcare - stepping away from how disgusted we may personally be with patients and still treating them as well as we know how medically.  It can be pretty hard sometimes, and every once in a while (as was the case here) treating them like family means giving them a nice hearty slice of reality.



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Office of the National Nurse

2009-08-02T10:48:25.190-07:00

Can somebody explain to me what the draw of having an "Office of the National Nurse" would do besides put several more salaried positions onto an already burdened tax system?  I know that the default answer is "give nurses representation," but I want something more concrete.  Besides being a puppet, what would this position actually accomplish?

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What Works on the Floor, Doesn't Necessarily Work in the ER

2009-07-31T21:09:09.072-07:00

Good idea on the floor: 4:1 nurse ratios.  It helps keep the nurses from being overworked.  Result for the ER: management wont even consider the much safer 3:1 ER ratio because "we are just following the law".

Good idea on the floor: printing rhythm strips on monitored patients.  It proves that someone is paying attention.  Result for the ER: Despite the patient's heart rhythm clearly documented on the EKG we just got and their telemetry reading being displayed 2 feet from the doctor's head, I still have to take the time to go print a rhythm strip and sign it.

Good idea on the floor: hourly rounding.  It gets the nurses up out of the piles of mandated paperwork and into the patient rooms.  Result for the ER: I have to leave my crashing patient in 5 to go fluff the pillow of the ingrown toenail pain in 6 to prove that I'm "customer service oriented"

Good idea for the floor: treatment goal posted on the whiteboard.  It gives everybody an idea of what, specifically, that patient is hoping to achieve.  Result for the ER: with patients rotating in and out every hour or two, there is no way to keep up with individual goals.  The end-product: everybody's white board says "goal: to feel better."  Yeah, that's a nice one to have up on the board at the end of a failed code.

Do you have any others?

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Centers for Medicare Stupidity

2009-07-21T21:57:38.335-07:00

Kevin says it so well.




Schwarzenegger Replaces Most of Nursing Board

2009-07-13T23:22:33.546-07:00

This alarms me a little, as I think that based on my experience, most allegations against nurses (at least the ones that I've heard about) are false, or at least overblown.  I am a firm believer in cause and effect, and nurses who are defacing the profession deserve what they get.  I like the idea of cleaning house and getting a fresh start, and I agree that years to investigate wrongdoings is far too long, but I fear that a new nursing board that is put
in place solely because the last board wasn't swift enough to punish
nurses may go overboard (no pun intended)


What do you think?



Today's "Reason For Your Visit"

2009-07-11T12:45:27.857-07:00

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.


So let's get to today's Reason For Your Visit:

Dissness

I think everybody has been there before, but the answer to being dissed isn't an ER visit, it is a night out on the town with good friends.  Then again, to some of our patients, we are their good friends, and what better way to forget your sorrows than in a good Dilaudid cocktail?




Today's "Reason For Your Visit"

2009-07-08T22:55:12.335-07:00

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.


So let's get to today's Reason For Your Visit:

sic

[sic]




Your Long-Overdue Update

2009-06-23T19:37:40.511-07:00

Hello to all my faithful blogees.  I know it has been quite a while since my last post, but hopefully you will understand what with the move and all.  We are finally getting settled in our new home and are loving the improvement in weather from Washington State.  I started at my new hospital over the weekend, and I feel a little like a new grad again, because nearly all the equipment is different, many of the meds are different (I had never even heard of Norco before) and so many of the policies and procedures are different that there is a huge learning curve.  That said, I love my coworkers so far and I can't argue with the pay raise (more than 1.5 times my previous salary with only a modest cost of living change).

Perhaps the biggest change is going from a 3:1 patient ratio to a 4:1 ratio.  I thought that I had to run before, now I have to fly.  One of my coworkers told me about her old ER out east where they would work 6 or even 7 patients per nurse.  I'm the kind of nurse that really enjoys taking the time talking with my patients and learning who they are and what they need.  So far in this new place, I feel like I only have time to run from task to task and then I'm getting a new ambulance.  I'm confident that I will adapt and everything will go okay, but it is still a big change and makes me feel just a little overwhelmed so far.

I'll try to get back to doing more regular blog updating, but bear with me as we finish getting everything settled and getting to know our new area... and lounging by the pool soaking up the sun.  I have a tan for the first time in years.  It's very nice.





Is It Just Me...

2009-06-04T12:47:00.617-07:00

Or is there something refreshingly appropriate about scheduling the Obama White House Spectacular right after "I'm a Celebrity, Get Me Out of Here"?

Just saying.



The Walmart Shooting

2009-06-04T00:22:22.653-07:00

I live less than half a mile from the Walmart in Lakewood, Washington where a security guard was executed yesterday as he walked out of the store carrying a bag with some money in it.  The shooters, the getaway driver, and the Walmart employee who was the girlfriend of one of the accomplices and apparently was feeding inside information to them have all been arrested and are behind bars.Needless to say, this has shaken things up in the community a little.  I first became aware of it as I was trying to drive home about 20 minutes after the shooting when a fat topless man with a bad farmers tan was detouring traffic off my street.  "That's odd," I thought as I begrudgingly detoured.  When, a minute later, I realized that although I was about 2000 feet from home, it would probably be half an hour or more given the state of traffic, I decided to call the local police office (everyone should have their local police office number in their cell phone) and told them, "you probably know this already, given the 5 helicopters flying around overhead, but something is going on out here as traffic is at a near stand-still and some random guy without a shirt is directing traffic off of 75th street."  The lady's response: "oh, that is because there is a stalled vehicle over there... and also another incident."Something wasn't adding up, and I've lived here long enough to know that there aren't usually several helicopters floating around overhead, so I called my wife and told her to close and lock the doors, because something strange was going on.  As I was about to turn back onto my street, two police motorcycles came roaring up with lights flashing and started directing traffic, and guess who's car was the second in line and would now be forced to make a big u turn and go around the back way to get home.  If you guessed Barack Obama, you have a very poor grasp of current events.  By the time I got back to where my house was, I decided that with two little girls at home and no idea why police were rerouting traffic and helicopters were making what looked like slow searching patterns overhead, that I should make sure I didn't need to go home and get my family and leave for a while.  I parked a little off the street and walked up to the corner where an officer was directing traffic.  After a few minutes he looked over and saw myself and another man standing there and asked what we wanted.  I said, "I just live right over there and I want to make sure that everything is safe with whatever is going on here."  His response: "Are you kidding?  There are more cops here than at a police convention.  This is the safest place around."So I went home, told the neighbor who was cutting wood in her garage to close the door and lock the house and went in to try to find out what was going on.  As the story has been coming in, it seems like a carefully planned robbery involving an employee who had been timing the coming and going of the security guards, a getaway driver, and the two perpetrators who waited for the moment to kill the armored truck employee and run off with the money.  I had been in the store just a couple hours earlier and my wife later told me that she had been planning on sending me back on my way home to pick up some diapers.  My brother's mother in law was actually in the store at the time of the shooting, though she was in the back of the store and she said that she heard a loud sound and thought, "hmm, that sounds like a guns[...]



...And In The "Threatened By A Fortune Cookie" Department

2009-06-02T19:56:00.901-07:00

How about opening up a fortune cookie and finding this one:

"Only put off until tomorrow what you are willing to die having left undone."

So is the "fortune" telling me I'm dying tonight?  Maybe that really wasn't chicken after all.

And along those lines:

(image)

This is the fortune cookie that I opened a couple weeks ago while eating at a Mongolian Grill.  If you have a hard time seeing the picture, it says, "Next time order the shrimp."

Nice to see a sense of humor in these guys.



Today's "Reason For Your Visit"

2009-06-02T17:57:58.751-07:00

When a patient checks in at our ER, they are asked to fill out a half-sheet of paper with name, phone, SSN, birth date, and "reason for your visit".

Whenever I work triage, I write down the interesting ones and have been building up a list.  Some are funny, some embarrassing, and some just tickle my warped sense of humor.  I try to give the benefit of the doubt.  I know that these people are hurting and just want to be seen, and if I were the patient, whatever I wrote down may just end up on a list like this as well, but it still makes me shake my head to see some of the things that patients can come up with.

Thus, my regular (as in whenever I feel like it) series, "Reason For Your Visit."  Please keep in mind that spelling, punctuation, and capitalization are copied directly from the original paper.


So let's get to today's Reason For Your Visit:

THROWT HURT / CANT EAT SWALLOW

Is that an African or a European swallow?