Hello!!!! You are working in an EMERGENCY ROOM, DAMMIT!

I walked past a co-workers room today and noticed that her patient was blue. Probably because he was not breathing well as evidenced by the oxygen saturation of 57% and snoring respirations. I went in the room and tried to stimulate him to wake up and breathe without any success. I yelled for help and started to open the ambu bag - which was difficult because there wasn't one. One of the other nurses grabbed one off the crash cart in the hall. I opened the airway box on the wall to get an airway only to find it was empty, I ran into the next room to find that box only had pediatric sized airways in it, I finally found an airway in the third room - the patient was bagged until the MD could intubate him and everything turned out OK, luckily.

I have no patience with laziness. If you are working in an ER then you damned well need to be ready for an emergency. If your patient decides to stop breathing that is NOT the time to start looking for an airway or an ambu bag. Your suction always needs to be put together and ready to go. Check your rooms at the beginning of your shift and make sure all the equipment is there.

If you can't do that maybe you should go work at a nursing home.

Old Fart, welcome back! Glad you're alive and getting better everyday.

A Taste of Things to Come

Our ER clerk had a family emergency so I was filling in running the desk. The ER doc was seeing a patient from the Bay Area who was in our area visiting some family and had developed an infection in their surgical incision. The patient belonged to Kaiser which is the biggest HMO in California.

The doctor brought out a card that the patient had given him with the name of the surgeon and a number to call 'in case of problems.' The doctor asked that I try to reach the surgeon. It was 11:17 am.

I called the number on the card and got a phone tree. The first thing I heard was to push 1 to continue in English. (Warning: I am going to be politically incorrect. I live in America and this is an English speaking country. If you choose to move to this country - learn to speak the language! If you want to speak Spanish, Hmong, French or whatever, go back where you came from. I would not move to Cambodia, Mexico or whatever and expect the whole country to work around me.) Gritting my teeth I pushed 1 and got a recording telling me that I had reached the appointment line and to please enter my medical record number to proceed. It was 11:28. I entered the patient's Kaiser medical record number and was placed on hold.

I was on hold for 14 minutes. In the meantime the phones are ringing off the hook, the doctors are giving me charts with orders to process and people are asking for pages to be made. At 11:32 a human answered and I explained that I was trying to reach a patients surgeon for the ER doctor. The human told me they couldn't help me with that and transferred me to another number that hung up on me.

I looked up the Kaiser facility on the Internet and found another number to try. I called it and got a phone tree that asked me to push 1 to continue in English. I gritted my teeth a little harder and stabbed the number 1 button and was placed on hold again. It was now 11:43. I was on hold for 8 minutes before a human answered. I explained who I was trying to reach and why and was transferred to the wrong clinic. I called back the number, pushed the fucking 1 button and spent another 7 minutes on hold before another human answered. By now I was extremely annoyed and told her so in no uncertain terms, for God's sake - I am calling from a health care facility and can't get a doctor, what hope does some poor patient have? This human did manage to transfer me to the correct clinic which was closed for lunch. I got a recording that instructed me to leave a message and "someone will return your call." I left a message, and it didn't even have any four letter words! It was now 11:58.

I spent 41 minutes trying to reach a doctor that never did call back. Kaiser patients boy do I feel bad for you.

This is a taste of what we might get with free health care. As horrible as Kaiser is it can't hold a candle to the VA. We all know how the government can make a complete bollocks out of the simplest thing and we want them to take over health care? I think not.

Be careful what you ask for, you just might get it. Free does not equal more and it certainly does not mean better.

The Zombification of America.

In the past, parent's knew how to be parents and there was no such thing as 'oppositional defiance disorder' if a kid misbehaved he was considered to be a 'brat' and got disciplined. Parents weren't concerned about a child's self-esteem, their only concern was to raise a responsible adult. Parents weren't afraid to discipline even if it mean the occasional application of a hand to a child's bottom. Kid's learned to behave because they knew, without a doubt, that there would be consequences. And they grew up to be responsible adults.

Now, parent's are either afraid to discipline or they are too lazy and self-absorbed to be bothered. 'Experts' preach to parents that they must nurture the self-esteem at all costs and children must never be punished lest it harm their fragile psyche. So, as a consequence, we have a nation where we have an increasing incidence of drug abuse, teen sex and pregnancy, crime, school shootings etc. because kids are growing up with no morals - no sense of right and wrong.

More than half the children we see in the ER are on some form of psychiatric med, Ritalin, Abilify, Depakote, Risperdal and so on. Let's drug them all into little zombies, they'll sit quietly in class so the class sizes can be larger, and the state will save money. Let's drug them all into little zombies so they won't bug mom and dad. Who cares what the long term consequences are. Who cares what the long term effects are on their developing brains. As long as they sit still and behave now without and adult having to be bothered to interact with them it's all good, right.

Please Don't Kill Yourself This Winter

Poison Control Centers Warn of Cold Weather Dangers

from Carbon Monoxide Poisoning

(Alexandria, VA): The onset of cold weather greatly increases the chances for exposure to poisonous carbon monoxide (CO) gas as consumers increase their use of appliances such as space heaters and portable generators, warns the American Association of Poison Control Centers (AAPCC). Every year, hundreds of deaths and many thousands of illnesses result from exposure to CO.

Among the numerous potential sources of CO are furnaces, water heaters, stoves, ovens, space heaters, wood and gas fireplaces, wood-burning stoves, portable generators and automobile engines.

“All fuel powered engines produce CO gas,” explains AAPCC Board Member Edward P. Krenzelok, PharmD, director of the Pittsburgh Poison Center. “Although such devices are safe if used correctly, a malfunction or improper ventilation can make these common household appliances deadly.”

Carbon monoxide gas is lethal, even though it is colorless, odorless, and tasteless. It may kill quickly or slowly, and the warning signs specific to carbon monoxide are also common to the flu and food poisoning. Even when it is not fatal, carbon monoxide can cause permanent damage to the brain and other parts of the nervous system. Symptoms include aches, dizziness, headache, confusion, and other symptoms also found with flu and typical cold-weather viruses.

AAPCC suggest taking some simple steps to prevent carbon monoxide poisoning:

· Have all of your combustion appliances and especially your furnace inspected and adjusted before every heating season.

· Have your chimney, fireplace, and wood stoves, and flues inspected before every heating season.

· Have chimneys and flues repaired as needed.

· Do not use charcoal grills indoors for cooking or heating.

· Do not use your oven for heating your home.

· Do not leave your car’s engine running in an enclosed or attached garage, even if the door is open.

· Install a carbon monoxide alarm outside of every sleeping area in your home.

Poison control centers around the country are prepared to respond with information and treatment advice about CO poisoning. To reach a local poison center call 1-800-222-1222. More information about CO poisoning may be found on the AAPCC’s Website at http://www.aapcc.org.

This is Why ER Nurses Get Burn Out

I had a patient recently that we see about three or four times a month for migraines. She's a drug seeker and everyone knows it. She's been fired from several doctors in town, even Dr. Feelgood - and if you get fired from him you know it's bad.

I was feeling irritated already because her husband had been out to the desk several times in the 14 minutes she had been in the room wanting to know when she was going to get pain meds. I mean, c'mon you have had 37 ER visits this year alone, you know the drill - you have to be seen by the Dr. first. After the doctor saw her he ordered a shot of Dilaudid and Vistaril. I went in to give it and she informed me she didn't want a shot, she had told the Dr. that it only works if she get's it IV. Instead of wasting time going round and round with her I left and told the Dr. to go hash it out with her, if he is going to order narcotics for a patient who has had multiple documentations of drug-seeking behavior then I refuse to do his dirty work for him. To his credit he told her one pain shot, no IV and then out the door and that was all he was giving her and if she didn't want that he would discharge her home right now. She decided to get the pain shot so I went in to give it to her and when I got in the room she was telling her husband to go to administration and complain so she could get a free visit "like last time."

I SWEAR I THOUGHT MY HEAD WAS GOING TO EXPLODE.

WTF!!!!!!!!!!!! We have a known drug seeker who has been fired from multiple practices for violating her pain contracts who has been documented to be a frequent visitor to all the ER's in town who went crying to administration for not being given her narcotic fix and instead of the spineless assholes telling her to never darken the doors of our hospital again they GAVE HER A FREE VISIT!!!!!!!!

Thank You