Saturday's Stupidity Snipits

Saturdays are almost always good for the intoxicated members of society to stop off and visit the local ER.  Now sometimes there is a traumatic event that leads to them landing themselves on a stretcher and other times it's their recreational usage that catches up with them, and often it is their the fear of death, that prompts them seeking treatment.  Last night had its share of both.

First there was the very drunk guy who fell off of "something" leading to two enormous lacerations one on his scalp and on his the side of his forehead.  I have a bit of sympathy for this poor fool because not only is he going to wake up with a hell of a hangover he is going to have the pain from that fall to contend with after the alcohol wears off.

The second of my drunks was an odd little man who was rushed into the ER from triage with a description of epigastric and midsternal pain.  His blood pressure was 158/117.  I started a line sent off labs and got an EKG.  He had some peaked T waves.  His labs came back the trop was negative and his K+ was fine.  His AST and ALT well that was a different story.  Neither of which should ever be 1145 and 770.
This little odd man denied drinking for 3 days to 4 different staff members.  After the results of his chemistry and blood alcohol (345) he was approached by the provider for a chat.  And yet he continued to deny drinking... except for a sip...  That must have been a hell of a sip. 
                                                                                                                                                                                                                                                                                                                

Dear Resident Your Mother Should Have Named You Richard!

There is nothing worse than a cocky almost 3rd year resident.  Oh how I can't wait until he goes across town to do trauma rotations, I'm going to give my sisters a heads up.  Besides the trauma nurses like chewing up and spitting out residents from other programs! 

Prime example why this Resident's mommy should have named him Richard...

Young man with a history of Chron's disease and a new port a cath comes in with a heart rate of 160, a temp of 101.7 and c/o vomiting and pain for 2 days.  The patient is well known to the peds er, and is now an adult patient.

So I ask the Resident, let's change his name and call him DICK,  at 645 am, "...can I get a round of Dilaudid for him, he's in a lot of pain and it's been a few hours.  He's still tachy after 3 liters but improved and he no longer has a fever. 

Dick's response "No, why would we do that.  It's just perfect timing that he now has pain right on time, I'm not convinced he's in that much pain".



I look over at the two attendings and then ask the attending assigned,  "Dilaudid 2mg IV and benadryl 25 mg IV, please."

The attending responds, "whatever you think he needs.  Thank you for taking care of him."

At the end of night shift both attendings apologize for Richard's antics and tell me that they too have had enough of his BS!  

You don't want to go in there!

The yells and screams from the trauma bed were too much for my own curiousness.  I was heading in there anyway looking for some 2.0 silk and a miller blade.  I was outside the curtain and in harmony two paramedics shook their heads and said "You don't want to go in there".  Two other medic teams had tears in their eyes from laughing so hard.  So I had to go in at this point.

And there it was.  A rotund woman wearing only a towel an a foot cast that she had attempted to saw off with a hand saw.

Now I thought the 70 year old who wound up being hauled in for an altered mental status after smoking crack was the  "that's dumb" winner, but nope, she beat him!  Had she sawed a little more and hit an artery she could have won a Darwin Award.

We Know What Drugs You Did! Do You Know What Drugs You Did?

And the survey says:   You haven't smoked pot every day for the last month as you claimed, you were smokin' crack.

Come on now lady.  When you come in the ER high as a kite, tachycardic, difficulty breathing, and you can't sit still please don't tell me you were smoking straight up weed... I knew there was something wrong when I offered you a Twinkie and you said no thanks!  What pot head could forgo a Twinkie! 

Oh that's right your UDS was positive for cocaine. 

"Should I Stay Or Should I Go"

Did you ever hear that Clash song "Should I stay or should I go"....
apparently some patients in the emergency room live by this.

They call 911 for an ambulance for something that has been bothering them for years.  They don't agree that triage is an appropriate way to manage care, it should be whoever comes in the ambulance goes to the head of the line.  When they are seen they aren't happy that the narcotics prescribed don't quite meet up with the narcotics they use from the street, so they opt to elope.  An hour after leaving without signing out they call 911 again get a free ride to the ER...  PS sucker you are now going back to the waiting room and have to be triaged again!

Xanax Aerosol Stat For The Charge Nurse

There are days when I wish they would come up with Xanan in an aerosol form!  Sure this would be a great delivery source for the crazy ER patients, but I think it would better serve at least one or two of the charge nurses I work with.

In my experience the volume really doesn't change much we are generally always busy, but as a staff nurse my number one concern is.. "is the patient safe".  Now I have had the honor or working with some amazing charge nurses.  They see the full picture and they too put the patient's safety first.  They know that giving any nurse 3 untriaged patients back to back could be dangerous for the patient and puts even the most experienced nurse in a position where he or she cannot meet the patients needs, but if the cards are dealt that three ambulances pull up to your door and you have nowhere else to put the patients you put them wherever it is most appropriate and hope for the best---  and a good charge nurse gets the triage going, line and labs them, in the spirit of working together to best ensure that the patients needs are met.   But unfortunately there are charge nurses out there who spaz out when asked to help and say "that's not my job".  And for those charge nurses we should have aerosol form Xanax!  A little spay to slow down their mania!  Because clearing out the waiting room with patients who are not critical in record time, while compromising the care of sick patients really isn't what nursing is all about!