3/31/11

Loud Urogenital Symptoms

Here's another entry from a nurse who emailed us at ernurseyblog @ gmail and won gift certificate for a free set of scrubs.


20 year old male and his female companion come to the er. They are c/o of urogenital symptoms. (Translation: had unprotected, dirty sex and are now paying the price)

They get their workup and appropriate antibiotics are prescribed. However, they will not leave without pain medication!

It is explained to them multiple times by multiple staff that they are not getting their requested lortabs for an STD. Take tylenol, motrin, antibiotic as directed. (A bar of soap was also provided :>) Increase your fluids, bath, use a condom and you'll be fine.

Male is getting agitated (did I mention his UDS was positive also?) and is now standing in the middle of the ER corridor screaming "You don't understand...I have a really small pee hole and it f...ing hurts to urinate!"

The elderly gentleman in the next room started cracking up..as did staff! We replied (as we called security)
the size of your penis is a personal problem that cannot be resolved in the ER, please leave now!

3/23/11

A nurse submitted article, part two of a two part series that started here....


.....I went back to my alcove to start charting around 2100. I felt good about that at least. I had already assessed both of my patients and had given nighttime medications. Did I mention this was my 3rd shift on the floor as a new travel nurse, and my 1st shift on my own? The charting system was new to me, so I was glad I had a chunk of time to devote to navigating the charting system.

As I was in the midst of checking boxes and tabbing along, the alarm went off for my patient’s arterial line for a low reading. I looked at the tracing and wondered why it had dampened, when it was brand new that day. My patient still had an EKG tracing, but I went in to check on her to make sure she was okay.

I should also note that my patient was in droplet isolation. I gowned up, put on my gloves and mask and started in to see that my patient was not the responsive, bright eyed, smiling patient that I had come into that shift. I tried to rouse her several times, and then proceeded to check a pulse and did not find one. I called out to call a Code Blue. She had pulseless electrical activity (PEA), which progressed to asystole. I started compressions almost immediately, her frail body surrendering to beneath me. Must. Pump. Hard. It’s an indescribable sensation to feel someone’s ribs moving under your hands, as you try to do the work the heart cannot do itself.

My coworkers ran to assist me, the Code team arrived, someone else took over compressions, someone else gave ACLS medications, and there I was watching (and also providing what I could remember about the patient’s condition and history).

They let her go with just enough effort and called the code at 2133, which was about 15 minutes after I discovered the change. Coming from an open-heart surgery background, I was astonished by the short duration of the code, but also felt at peace
with it. I’ve watched a code go on for over an hour, thinking, when are we just going to give up? There are only so many medications you can give before the body rebels. I’m sure many of you have had this same thought, just know you are not alone.

What I’ve taken away from this experience:

That it can happen to anyone, anywhere.
That nurses are great team players when there is a code.
That my nursing skills transmit to a variety of environments.
And that my gut is never wrong.


If you get the feeling that something is not quite right with your patient, but you can’t put your finger on it, you’re probably right......

3/18/11

Nursing Instinct is Never Wrong

ER Nurse J sent in this story. BTW, all of the details have been changed, in fact, this is a mere anecdote of what could happen in the ER :D.

It started with a feeling. You know, that gut feeling that nurses get when something is about to go wrong. They call it “nursing instinct”, but no matter the name, it’s never wrong.

My first assessment was nothing out of the ordinary. My patient was on the ventilator for recurrent sepsis, and looking to improve. She responded to my questions appropriately, nodding her head yes when I asked if she felt warm, which correlated to her above 100 degree F temperature. I offered her a cool, wet washcloth for her forehead and a fan, for which she smiled. I asked if she had pain, to which she shook her head no. I continued on, listening to her chest and abdomen, checking her pulses, looking over her IVs, and finished by asking her if she was okay, to which she nodded yes. I informed her I would be right outside her room and would be in periodically to check on her. She smiled, but something still did not feel right.

I sat in an alcove between her room and another patient’s, which allowed me to both see my patient, as well as her monitor. In report I had asked about the patient’s ongoing sinus tachycardia, to which the off-going nurse replied, “The doctors know about it. They’re not concerned, and just want us to keep an eye on it.” How many have heard the “keep an eye on it” warning? That set off an internal alarm, when I continued to watch her heart clipping along in the 130’s. Had it been that high all day? As I looked back in the telemetry monitor records, it seemed it had. I knew her heart couldn’t stand much more after all she had been through.

But I was optimistic. Here she was, on the ventilator, no sedation, no pain, completely appropriate with talks of weaning in the morning. But then, her fever went up. It went up a whole degree in the course of an hour. I went back in to check on her, offered her some Tylenol, to which she eagerly nodded, and administered it via her OG tube. I thought, that the fever could be part of her tachycardia, that hopefully the Tylenol would help, which in turn would help decrease her heart rate. I wanted to believe that things were going okay for my patient, but that internal nudge wouldn’t stop telling me the contrary...... part two next week.x

3/12/11

Free Ambulance Ride With Every Broken Nail

This blog post was submitted by a nurse who won a free gift card for her contribution.

Working in the ER one of the funniest things that I remember is the day we received a call that the ambulance was bringing in an accident victim with more to follow on arrival. That usually means they are so busy working on the patient they are unable to call report.

We set up our trauma bay and then got everything set up for any major trauma so those tools were close at hand. As the patient rolls in, Ginger, she's sitting up on the stretcher wailing holding a hand wrapped in what looks to be several towels applying pressure. Several of us enter the room while the ambulance crew asked to speak with the triage nurse outside.

Ginger is crying hysterically and we are trying to calm her down and remove the towels to see what damage has been done. She continues to cry “my hand, my hand” as we get down to the last layer still no blood as we are trying to figure out what is wrong, We hear a laugh outside the curtain as we get the last towel off to see no injury that I can see. I ask the patient what happened. Still crying she replied,
“Can’t you see? You must be blind. I ripped off my nail. I need the rest of it off.
” I look at the nail in question which is artificial and excuse myself from the room. She called an ambulance to bring her in because she ripped part of her nail off did not have the money for gas or to get it repaired and wanted us to fix it for her.

I forgot to mention, I work in a military facility where if you’re a dependent all your care, medicine and ambulance rides are paid by the government. I see so many things that just blow my mind working in the ER. My government dollars at work for things you just can’t make up.

3/9/11

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