Dude, Lets go get some free candy!

So I am sitting out at triage talking to my supervisor about the impending JCO bogeymen lurking just around the corner for our annual surprise accreditation visit. We both glance up and see two young women in their 20's and what appears to be their father walking into the waiting room. 

They all sit down in a triage booth...........

22 yo female disheveled, pin point pupils, lots of old bruises on her face neck and arms. Her CC: H/A s/p fall on ice. "I am allergic to anything without opiates in it."  Are you with these other two people that you walked in with? No

Next

21 yo female disheveled, pin point pupils, Swollen right mandible, lots of fresh cuts and bruises and a nice menage of old bruises all over. Her CC: s/p Assault. "I really need something for the pain." No other info given! Do you know the girl in both next to you? No

Next

56 yo male disheveled, smells incontinent with a touch of GPC menthol smoke. His CC: I want a body scan for cancer! O.k. Sir, Do you know the two girls you walked in here with? Hah hah I wish! Seriously docta I needa body scan!

As the Nurse finishes registering the last of the trio they wander off to different parts of the waiting room. Gradually over the next three hours they slowly move back together until they are all sitting together assuming that we have forgotten the shitty cover stories and why they are here.

In the end Pop and s/p assault get copious amounts of percs and codeine. Fall on ice loses her cool and AMA's before she gets her share of the narcotic plunder. Later she reappears to demand a doctors note stating that she was in our ED all day. I decide to inform her just for shits and giggles that had she waited five minutes she was about to be d/c 'ed with a script for 20 percs. Oops now she wants to check back in!

Triage; means to sort

Still fighting Darwinism

I know it's been way too long since I last posted. I don;t really have to worry about a fan base to piss off. Anyway I am still here living the dream in big city emergency department. 

I will now continue along with my theme of the completely unbelievable moments of terror and comedy that are part of life in the Emergency Department.

9 shifts out of 10 I am usually working triage. 

Working in a teaching hospital when your not a student

.......sucks at times but is good at other times.  July 01 is soon upon us where the Department will be flooded with new interns, med students and, PGY01's 

I'll never forget the first year I was working in the department I noticed some of the senior nurses in the break room wisely planning vacations and switches for the first two weeks of July. It was like watching a high stakes poker game. 

I found out soon enough what the nervous excitement was all about. I came into work one hot and humid early summer evening and was inundated with desperate pleas from young faces in scrubs bristling in arsenals of shiny new must haves for emergency medicine like trauma shears, pen lights and drug calculation cheat books.  

We all need to start somewhere!

You can't make this shit up............

It's just after midnight on a weekday and I am sitting at the triage desk staring out into the empty waiting room. I look out into the parking lot and see some one stumbling out of a cab. A 19 YO male stumble into the WR with lips and face severely swollen holding a can of planters party mix.

"Dude, We got a problem!" he blurts out. 

"Right this way buddy." I reply

"I got wicked baked and thought I was eating cashews." he continues on.

We get him inside HR in the 170's. IV started, meds pushed, PT stabilized and held for OBS until the AM. 

Two hours later I am again staring off into the void of our dirty WR. A delivery driver pulls up and comes inside.

"I have delivery for Mr. Jeffery" he states in broken English.

"Where you from?" I ask

"Thai Dragon" he replies

"We don't have a Jeffery that works in this department right now.' Are you sure they are in the emergency room?" I ask

The driver turns away from me and pulls out his cell phone. He makes a quick call speaking very softly and quickly into his phone.

He hangs up and turns back to me.

"I have delivery for Room 3"

Are you fucking kidding me!!!!

"Lets Go!" I motion for the guy to follow me.

I stampede into the PTs room where the resident is checking his VS after the med intervention.

"Did you order food????" I ask dumbfounded

"Yeah dude, chicken wings I am starvin!" Eyes lighting up

"Do you realize that everything is cooked with peanuts in a Thai kitchen you dip shit?"

"Do you have change for a twenty Doc?" he mumbles...................

Welcome to The Workplace Part 2

I had heard the rumours.......

I had seen from a distance Nurse GiGi in action......

And Today, I finally had to work a painful 12 hour shift with her train wreck of an ass.

I walked into the breakroom for huddle and saw i was in the psych zone. 

Fuck Me! Must have been for banging out a few Sundays before. I strolled into the zone and ran right into the tornado of Nurse GiGi. She looked up from the pile of notes, charts, seculusion forms and, section paper work-

"Oh thank god! Are you the tech over here??"

"Yup, Do you need something right away?" I asked.

"Oh yeah can you get an ECG in room 3 and labs while your in there, I am drowning here. I can't get ahead of all this work."

Fair enough I thought. After all there were 29 in the WR. I logged into the computer to dig up an old ECG for Daisheiki in room 3. Thats when I noticed there were only two beds occupied in our 7 bed psych zone. 

WTF over!

Even worse only one of them was a psych peep. The other in room 3 was an overweight alcoholic with pancreatitis who couldn't lay still for a ECG for her 15 out of 10 chest pain. The labs were their own nightmare. I ended up chasing a small vein all over her left hand until I anchored it strecthing it like a rubber band. 

I spent about 45 minutes in the room total. I walked out feeling like I was in there for hours. I walked over to the tube station passing GiGi on the way.

"Where were you???" she implied.

" In 3 drawing blood. Good luck with that IV." I snapped back.

"Oh the resident just ordered some zofran for her. Do you mind starting an IV for me? Oh an after that 2 needs vitals and something to eat."

Your kidding me right. We have two patients, one has already been here for six hours.

"Ok GiGi, I'll start the IV and you can take care the other guy." I reply

"I can't right now I need to catch up on his chart. The triage nurse won't leave me alone, i told her no more until I catch up." She blurts out.

I am used to seeing up to 11 PTs in Psych zone. Usually they are mostly ETOH and a few true psych players (see my pink zone post). There are 3 sitters, 1 nurse, 1 tech and, 1 security guard.

So I'm busting my ass, Nurse trainwreck is trying to print everything in the same color ink and, everyone else is sitting by the nurse station speaking loudly in jamican and playing dominos. Execept for Security, he is watching march madness on the internet eyes glazed over having already been on duty for 16 hours with another 4 to go. 

As I walk towards the room with my IV set up in a kidney basin I see the resource nurse pushing a stretcher with PT, monitor, lifepack, nitro drip and 2 cards residents moving fast towards me.

"Brown, Get this guy up to the cath lab! He is a code STEMI Don't stop for shit! I gotta go help out on the code that just came in. Thanks Love ya!" 

She hands off the pathway paper work and the stretcher to me in about three seconds in passing.

I come screaming around the corner in psych zone on our way to the elavator. I aim for the domino game and clear it out fast!

" Hey Watch werr ya goin Mon!" 

Nurse GiGi looks up from her chart. " Brown your supposed to be putting that IV in for me. Where do you think your going??" 

I laugh out loud and reply as I fly by "Just out for a cigarette, they are joining me from the cath lab."

We rush upstairs and I help slide the PT onto the table and make my departure back to the ED.  When I get back downstairs I notice there is a different nurse in the psych zone. I ask where Nurse Trainwreck went off to. I am told she had to leave for a personal emergency.

More Truama For Your Mamma

Another Monday Night from hell.

The triage clinic was open for business. Our 7 bed trauma zone was chock full of ICH, Code Strokes, MVA, more code strokes and, the usual gaggle of negelected ST and cough/ general bullshit hallway players hangin out for the show.

The theme of the evening was head bleed. Everyone got to hone their skills. The residents with there ryobi drills to relieve the pressure, the nurses navigating mountains of documentation and meds, me trying to figure out CVA leads and confusing lab specimen paperwork.

PT #1

BIBEMS sudden onset of acute HA and N/V still mumbling on arrival wearing a coat of regurgated chinease food. Dutiful EMT's bagging her anyway. Tubed, foley, central line, ekg, labs and fluff and buff done in less than 10 minutes or your money back. Oh yeah and she weighs about 320 lbs. Four of us go down to CT to help slide her onto the table. 

Family= piss poor historians "She ain't never done this before! Momma never had no medical problems."

MR= Positive history of ICH, diabiates, AAA

CT says= Large global infarction 1% chance of cheating a body bag.

Next Victim- 

PT 2- 19 YO male s/p assault BIBEMS ETOH on board. T00 bad he wasn't on a board. LOC for 5 min, kicked in the head. the word LUGZ clearly imprinted across his cheek. Throwing up blood and teeth.

EMS: Useless "He got the Shit kicked out of him! Oh yeah he is from quebec or something. Hah hah have a good night."

PT: "I only speak french. However I know plenty of dirty words in english."

CT says= early stages of pneumothorax. 

Sometime around 0300 the onslaught stops. 

Beds mysteriously appear throughout the hospital. We are down to 6 stoic peeps left in the WR. The call in fax machine spits out a travel agency ad for tickets to the bahamas $449 round trip. Someone overheads "Dunkin rounds at the board." 

I smoke a cigarette outside in the Ambulance bay with one of the janitors. He tells me a story about being a waiter in lisbon in the 70's. Then we head inside I give him a hand cleaning the medical waste strewn trauma zone, preparing it for the next show.

Inza Inza Influenza

It feels like an epidemic. We are getting hit hard in the Northeast. Acuity is up, Bed availibilty is down. For about a month now the department has seen an increase in ES  1-2's. Mostly respitory distress and failure hidden amongst a sea of "Flu-Like Symptons" in the WR. 

Of course the emails and memos don't stop coming about Norwall virus pathways and documentation. One by one staff started dropping like flys out for days from this killer strain. I got nailed by it about two weeks ago and was in bed for four days. When I returned to work the next week about ten pounds lighter there was a CF of float nurses and travelers running amuck. The Nurse manager even made a point to have a meeting to verbally harass all those who had banged out sick over the past month.