It was a four pen day

Busy Beavers

The ER has been busy this morning.  My first break into my 12 hour shift has occurred at precisely 6.5 hours into the shift.  Haven't sat down until now.  Not to bad actually.  We shall see what the rest of the day holds when I walk back out the doors into the mayhem.  

Paranoid Much?

My CNO followed me around on and off for a few hours today. Listened to me talking to patients, watched my technique on quite a few things.

Wonder what the stars hold for me now.

Key Music.....................

I always feel like
Somebody's watchin' me....

Oh! To Be Restrained!

Remember when you were in high school and some group came in and put on one of those classes about car wrecks and tried to scare you into submission regarding wearing your seatbelt and following traffic laws to keep you safe? Yeah?

Well, that's me now.

I do a class every quarter for our local court system called Trauma Nurses Talk Tough. It was originally founded and developed by a group of nurses at my former workplace - Legacy Emanuel Hospital in Portland, Oregon. It's an amazing program. The studies/analysis/review on it have shown that it truly does make an impact on some of the kiddos that go through it. There are different programs designed for each age group of kids ranging from Kindergarten through Senior Year. It also has specifically arranged classes for high risk drivers, seatbelt violaters, etc.

One of the main points I hit on in the older age groups is wearing your seatbelt properly. So many people do not know how to properly wear a seatbelt. They think if you just have it clicked and somewhat arranged over the front of your body, then all is well.

You people are wrong!

A guy I took care of in the ER once told me he never wears a seatbelt because "Dude, they cause more harm than they prevent. My buddy broke his back wearing a seatbelt and now I don't wear one. I don't want my damn back broken."

Let us discuss.......

Improperly worn seatbelts cause injuries. Improperly worn.........dude.

Officer Smith also talks about this on a recent blog post of his. It is not OK to put the shoulder portion of the belt under your arm or behind your back. It's not fun for a person to deal with the effects of broken ribs, a pneumothorax, lacerated liver, lacerated spleen, ruptured bowel, broken back, etc. These are just a few of the injuries you can receive from wearing your seatbelt improperly.

Another important point: Do not sleep with your head against the seatbelt and do not recline your seat and sleep in a car. Reclining seats are stupid. Shall I repeat this for my hard of hearing readers? Reclining your seat in a car is STUPID! I don't know why car manufacturers even give us the ability to recline. If you are reclining in your seat and have your seatbelt on, you can slip UNDER the seat belt in a crash and have horrible injuries from this (or even dun, dun, dun.......die). You can also get your head caught up in the seat belt in this position (and also when you are sleeping, laying your head against the seatbelt) and have a neck fracture resulting in paralysis.

This my friends, is not fun.

If the lap belt is not properly positioned you can also have major injuries. Many people like to wear it up over their belly. This is a big No No! Abdominal injuries, paralysis, and groin lacerations - oh my! The lap belt should be properly positioned across your hips. If you are pregnant, then under your belly and across your hips/pelvis area.

They have also found that kids raised in a rural environment are more likely to fall asleep at the wheel when they hit driving age. Why, you ask? Funny you should ask that, because I happen to have the answer. Amazing how life works, isn't it?

Rural families often drive long distances to get anywhere. Ask me how I know this......Our town is 2 hours from anywhere. So back to the topic......Rural families often drive foreeeeeeeever to get to their next destination. Mom and Pop encourage the kiddos to "take a little nap" during the drive. Thus, kids learn at a young age to sleep in a car and become accustomed to that. They think this leads to the body being more apt to fall asleep at the wheel because it is not trained to maintain alertness when driving. Kinda weird how things work, huh?

So sit upright, make sure you are alert, seatbelt properly across your shoulder, lap belt properly across your hips and you have a much better chance of not receiving injuries in a crash.

Oh and one more thing! 10 and 2 o'clock hand position no longer applies. Try 9 and 3 o'clock. The former position is shown to have more injuries now related from the expelling of the gas with airbags. Burns and fractures of hands/wrists. Reeducate yourselves to the 9 and 3 position to decrease those injuries.

OK Class.......Lecture over. There will be pop quiz on this. Get out your papers and pens.

Oh Pish Posh Applesauce

What a whiner! I re-read my last post and even I thought I was a big ole' crybaby. Buck up Julie! Toughen up and quit crying in your beer. I get irritated with people at work when they verbalize shit like that, and look at me - I did the same.

Well bend me over and whack my fanny with a wet noodle.

Wait, maybe I should save that one for my man. It could be fun.......right? NOT THAT I'M COMPARING YOUR WILLY TO A WET NOODLE DAVID! Seriously. Truly. I'm not. Um hmm. Nope, not at all.

I was slammed in the ER on Saturday. Lot's of little things, nothing really big or eventful which is surprising for a holiday weekend. Didn't even have a wreck until this evening. Weird, isn't it? Is the moon traveling out on a different track or something? Spinning a bit off course? Who knows. But apparently the man in the moon isn't talkin'.

My man is gone for the weekend, water skiing without me. Can you believe the gall of that man? He leaves me behind and goes and has fun in the water without me?!? Pashaw I say. Pashaw.

Of course, it COULDN'T have had anything to do with the fact that I had to work all weekend. Nah...... couldn't be that.

Ramblings....

I worked on Mother's Day and we were busy as hell. Truly though, is hell busy? Are they all down there slaving away and constantly busy? Or is it just sluggish monotonous work? Hopefully I won't find out, though I'm heading down a path that will probably take me there.

12:23 PM the firestorm started, and it never stopped. When I left they were still filing through the door, limping with their broken limbs or clutching their chests. We were 2 nurses short and one of the nurses that was there felt it was her job to sit on her ass doing nothing. Now THAT's always a good time right there.

We're losing a couple of our nurses over the next few months but our manager doesn't know it yet. It will be interesting to see how our staffing shapes up by September. These are good nurses too and they will be sorely missed.

We're receiving email after email telling us that we need to change this or that, changing policies, implementing new QI measurements, etc. It would be great to have one week - just one week - with zero changes and zero emails telling us we suck. It would be great to hear "WAY TO GO GUYS!" every so often. I wonder what other careers there are where you get to go to work everyday and get beaten down? Hmmmm....... Anyone?

I still love my job though. I love working in the ER and I love taking care of patients. It is such a rewarding field in that aspect. I love learning about people and finding out where they come from related to life lessons.
Maybe I just need a vacation. Sign me up!

I am a blogging loser

Yes I know.


You don't have to say it.





Sigh..............................

Simple Thoughts From A Simple Mind

If you are a veterinarian, do not tell me you are a medical doctor when your son is a patient in my ER.

Dude.

Seriously.

I'm not stupid and I WILL figure it out. Rather quickly too.


(Nothing against veterinarians here. Don't get your panties in a twist.)



NEXT!


If you have admittedly stolen funds from your place of employment and then you are magically promoted............. you gotta be blowin' somebody.

Just sayin'.

The Boys in Blue

I found a new blog when I was surfing around tonight. Actually, I found a few new ones. I'm having a lot of fun reading the police blogs and looking at things from their point of view (which is often shared by little ol' me).

One of the blog posts caught my eye. The officer at Cop 'n Attitude wrote about Ticketing Doctors and Nurses. I must say that I am thoroughly embarrassed to be associated with the people in this story. They were complete and total assholes.

That being said, I must admit my downfall. I am a speeder. Oh how I love to push that gas pedal down to the floor. 50 in a35? Not a problem for me. It is a problem for the local boys in blue though. I constantly get appropriate lectures from them when they are in the ER (and they are the BEST smart asses in the world, better than me which is a near impossible feat). I've been pulled over by a few of them, getting put through the verbal wringer, and they are right - every time. I'm trying to do better, I truly am. It's a hard habit to break though.

But I must say with 100% conviction, I have NEVER used my position to get out of a ticket. Never. My father is an officer (the Chief in fact), my ex was an officer, one of my best friends is an officer. I know the shit they have to deal with. I know how people can be complete and total jerks. I also know that being nice and respectable goes a long way.

Honestly though, many of us medical professionals do get a "PASS" from Law Enforcement. Living in a small town we get it more often. Do we deserve it? Not really......... but we're all a team. Is that an excuse? No. It just is what it is. We all see each other quite often carrying out the duties of our jobs and that develops into a relationship that is truly unique.

We see them bringing in an out of control schizophrenic who has been threatening people on the street. We see them helping us restrain someone who is trying to harm themselves or others. We see them with broken hands, broken ankles, or God-forbid - Gunshot wounds. They see us dripping with sweat trying to resuscitate the 10 year old who was ejected from the car during the rollover. They see us telling wives that their husbands didn't survive the wreck even though we did everything we could. They see us helping out their buddies when they've been injured.

We all see that we share the same sense of humor to deal with the horrors and stress of our jobs.
And they take the doughnut jokes really well, too.

Seriously, Dude......Don't

For all of you out there who want to know when you should go to the ER, let me help you out.

You should go to the ER when................






You are dying.



Or close to it.










DO NOT, I repeat, DO NOT come to the ER for the following (or the nurse and the physician will not only think you are an idiot, but also bitch about how it is single handedly your fault that the medical system is in the shambles it is in):

1. Runny nose that just started this morning.
2. Fever that just started this morning.
3. Cough that just started this morning.
4. In fact, any cold symptoms at all - just wait it out. Seriously. We're not going to help you.
5. The flu - stay away. You're going to contaminate everyone else and there is nothing we can do for you.
   
6. A tiny little scratch on your finger
7. A tiny little cut on your finger (ever heard of applying pressure? And by pressure I mean actually pressing down on the area for more than 10 seconds)
8. Back pain you've been having for a few weeks. GO TO YOUR CLINIC DOCTOR.
9. A cough you've had for a few weeks.
10. Anything that has lasted for a few weeks - GO TO YOUR CLINIC DOCTOR. It is obviously NOT an emergency since you've lived through it for the last 21 days.
11. Your 2 year old that is pulling on his ear on a Wednesday night. Wait until the morning and go to your clinic doctor. Tylenol - it's a good thing.
12. Your 2 year old with a rash which he's had for a few days. Or even a rash he's had for a few hours. It......can.....wait.
13. Ankle pain after falling off a porch and twisting the darn thing. If you can walk in, you don't need to be seen.

I know there are plenty more, that's just a few from my last day at work. I constantly shake my head in wonder at the very idea that people think they need to come to the ER for these things.

And before all you people start jumping on me about the .0000005% rare instances of some wild and crazy disease or near fatal instance of your child/niece/nephew/brother/sister/husband/mother/
father/dog/cat/parokeet in the above scenarios - just know this............ we're not gonna catch those either. And if we do, it's plainly a miracle from God.

Scrubalicious

So the powers that be finally decided we can have a little variety in our scrubs at work. By variety, I mean same color - but different companies. So even though that may not seem like much of a choice, it's all the freedom in the world to those of us who have been stuck in a repressive sea of green for 5 years.

I think I'll shop HERE. Scrubs Gallery dot com. New sponsor and some pretty good prices to boot.

Now off to find some more green scrubs.

Life as a Groupie

Meandered my way to Portland for a concert this past weekend.   Saving Abel, Papa Roach, Buckcherry, and Avenged Sevenfold.  I do believe the man and I were the oldest ones there.  Grandma and Grandpa in the house.  LOL.  It's sad when you're old in your mid 30's.  

It was a great night though.  3 young 'uns carried out on stretchers.  Such is the life of over-chemicalized children.  One of the situations made me laugh (call me a bitch, call me evil, call me to dinner - whatever suits your fancy).  Picture the scene - loud rock music, screaming fans, one young girl laying on the ground........her friends franticly trying to administer CPR. 

She was drunk.  

And awake.

But apparently CPR was called for.  Who knew?

Hey - at least they knew to check her airway.

The concert was actually pretty good.  Saving Abel was impressive.  Personable.  

Papa Roach - gained a new fan here.  What great entertainers.  Never really listened to them before this but I immediately became a fan.  Good crowd interaction, great energy.

Buckcherry - sadly a bit disappointing.  This group is why I went to the concert.  I love Buckcherry.  But apparently, I don't love them live.  They were......okay......but reserved.  Minimal crowd interaction and they seemed rushed.

Avenged Sevenfold - ack.  Had to leave.  It was all screaming.  Minimal entertainment (besides the second girl who was carried out of the pit by her friends).  Even the 4 or 5 Coors Light couldn't keep me interested.  Ah well, I suppose I am getting old.   I do love the song "Dear God."  Stayed for that then took the back door back to the hotel.  

It was a good mini-vacation for this old haggard woman.  Snort.  God, being surrounded by high school kids makes you feel old really fast.   I need to get my ass to the spa for a seaweed wrap and a mud bath.  Maybe that'll strip a few years off this aging body.  Aw screw it.  I think a few shots of Crown and a six pack of Coors Light will cure what ails me.

Busy day at work today.  Rollovers, cardiacs, abdominal pains, and foreign objects unintentionally inserted into orifices.   Seriously people - if it doesn't have a handle, don't stick it in there.

And with that I'm done.  

Liar Liar Pants On Fire

If you come to the ER weighing 82 pounds at the age of 48, skin the color of freshly bloomed daffodils, vomiting blood, have a heart rate of 140, a blood pressure of 138/79, and have tremors so bad that you can't hold a cup without dropping it - I will not believe you when you tell me you do not drink alcohol on a regular basis. I will prove you wrong when the labs come back and your ETOH level is .280.

Don't go there.

Truth - it's a good thing.

Foul Language

I got a comment on another post basically saying that I cuss too much. So I read back through my posts from the beginning and I will have to say she was right. The question remains though - will I change?

Probably not. I work in an environment where cussing is a native language. I don't know a single one of my co-worker who has not uttered a foul word, even the "good girls." We are faced with people cussing us out almost on a daily basis because we won't give in to their demands for pain pills, work excuses, or other things. We get cussed out by people who have no medical training telling us that we are doing our job wrong. We get called bitches, fuckers, and the Queen of the mean - c.u.n.t. Why? Because we care.

We come to work ready to save lives, dress wounds, set broken bones, run our butts off all for the sake of getting called names when one person is unhappy because their morphine shot had to wait until we were done with CPR in the next room.

Are these valid excuses? Not really. But I tell you one thing. You will never catch me cussing at a patient or their family members. Never. I may cuss all day long on my little blog-a-roo here, but I will be respectful and professional with you if you are seeing me as a patient. I will probably continue my use of shit and such here, but I suppose that will expose you (my 12 readers) to the world I work in every day that I put those scrubs on my butt.

Welcome to the ER....... it's the place to be.

Linkylooloo

This post over at Emergiblog got me all fascinated and such. She makes some great points about ideas for health care for our new President.

I love it when someone can speak my mind better than I can.


Loved this one also. It is an amazing play by play of a trauma death.



And THIS video over at Mel's blog made me tear up. It's an amazing testament to the strength of women and their friendships.

Yeah, Sorry.

I suck.

At Blogging anyway.

The past 2 months have been extremely difficult at work. Actually the last 4 or 5 months have been. Too many changes, too many cooks stirring the soup. Getting emotionally punched in the face every few days by someone you used to be very close with but who now feels the urge to "take you down" takes it's toll. A new job is sounding better and better.

Enough of my useless prattle. Onward and upward they say! I just don't say it with them today.

16 year old drug into the ER by her parents. She is visibily shaking in Triage. I can see her heart pounding through her chest. Heart rate about 160, respiratory rate about 40. Glassy eyed, scared shitless.

"Emily says she took something but she won't tell us what," Mom says.

After an extensive workup we found............................. nothing. Nothing popped positive on the drug screen. No weird labs. Just crazy vital signs. Was she just nervous? Did she take something else that we can't test for? Salvia came to mind.

"Can I have some ice cream on my toes for my trip to Maine?" Emily asked.

Um....................... huh?

"I need some tiles for my eyes on Canada."

What the hell? She is as confused as Grandma Mabel - who thinks it's 1812 and that she's a man fighting in the war.

Little Emily gets admitted for a few nights stay at our overpriced hotel. I came back a few days later to check on her and they finally figured out what she took.

Hold on - are you ready?







Dramamine.

Yep, you heard me right. Who knew? I've never had anyone come in that took Dramamine to try to get high. Holy crap. These kids will take anything. Do they not understand that almost anything can kill you if you take enough of it? I think they finally figured out that she took about 7 or 8 tablets.


***********************************************************

I've been taking practice tests for my CEN (certified emergency nurse) exam. Apparently they were designed to make you feel like the dumbest nurse on earth. The other night our crew sat down and did them all together, reading the questions out loud and discussing them. We argued with the book many times on the correct answer. Is that a sign that we might not be right in the head?

"Oh bullshit! That is not the first thing you would do for that patient."

"What a load of crap. Who wrote these questions?"

"Close the book and let's go get chocolate!"

Yeah, I like the last one.

***********************************************************


I've found my nursing soul mate. One of our night shift nurses moved to day shift and I'm finding that we work wonderfully together. I can read her like a book. We argue like sisters about practically everything, but when it comes down to the knitty gritty, we don't even have to speak. We get it all done for the code/trauma with little fussing and only relevant communication. We can briskly shout commands to each other without getting offended, which is the absolute frosting on the cake. I lubs her and she's my favorite team member now.


OK, I'll try to jump back on the blogging bandwagon, but I can't make any promises. My internet time lately has been limited to hours on Facebook and shaking my head at some of the responses on AllNurses.com. We'll see how it goes.

The Mother Letters

Someone linked me to this great project called The Mother Letter Project

I think I might write a letter and submit it. Mine will be to a mother who wants to bring her child to the emergency room.

How honest shall I be?

Running Commentary of a Random Day

My first patient of the day was a STEMI (heart attack). Busy beaver this AM. 37 years old. Yes, you heard me right. 37. No risk factors. NONE. No family history, not a smoker or drinker, eats well, exercises daily. Therefore, I shall use this as my excuse to never exercise, eat like shit, and drink to my heart's content.


THEN:

A gallbladder and 2 ear infections.

Do you ever find it weird that we refer to patients by their diagnosis and not their name? Even though I do it online for privacy reasons, we still do it in real life.

"Hey Lucy - can you medicate my gallbladder in Exam 2 please?"


NEXT:

Migraine (my own).

Trauma Chart Reviews for an hour.


TIME FOR LUNCH.

Another chest pain after lunch, another Migraine, a Peeing blood, and abdominal pain, and a r/o labor.

Then I got transferred to OB with my r/o labor and finished my shift there.

Rural Medicine is great.

You're Kidding Me, Right?

You have to be. You absolutely have to be, because no one in their God given right mind would think that you insert a chest tube into someone's SPLEEN - FOR SHITS SAKE!

Phew...... got that one off my chest. Chest. Huh, funny. That's where that damn tube belonged.

Dr Morris even said it! "5th intercostal space, mid-axillary line." That means 5 rib spaces down from your collar bone and along an invisible line that comes straight down from your armpit.

Um, yeah. Maybe the technical advisers should have listened to the dialog (that doesn't look right - shouldn't it be dialogue? Nope guess not. Spell check says I'm stupid as hell apparently. So anyway........). As Morris is telling Chaz where the tube belongs, he meanders south about 5 inches and puts it in his abdomen. Loser. It's not like they couldn't have faked him putting it in the right spot - they didn't need to pretend the abdomen was the lungs. Sheesh.

Oh! And! (How do you like that rule breaking sentence structure?) When the "blood" was pouring out of the chest tube area - it looked like red tinted water coming straight out of a faucet on high pressure. Whatever. Special effects on a tight budget all of a sudden? Blood does not spray out continuously like a water faucet. I know they can do this right as we've seen it before. Apparently, the special effects peeps have either forgotten the basics of blood spurting or have become so incredibly lazy they figure the general public will believe blood sprays out just like when you're running yourself a nice, cozy, hot bath with bubbles. Maybe they should supply us all with a glass of Chardonnay and a good book to read too.

Now let's talk about the MRI incident. Can I just call a bullshit on that one? Granted, it was funny as hell to see a patient screaming for morphine get their due, but honestly.... the MRI techs would have NEVER let that happen since in the REAL WORLD the techs do the scans and not the doctors/interns/med students.

Moving on to Sam and Gates. Sam gets an A+ for wanting to secure their patient's airway first. A-B-C's. Learn 'em. Know 'em. Follow 'em. Dr. Gates obviously is dyslexic since he follows algorithms backwards. "Naw, we don't need to worry about no stinkin' airway - let's scan his head first! Off to the scanner troops! Move out!" Oopsy-daisy...... airway needed.

And I will give a nickel to anyone who can tell me how exactly a 1% Non-Rebreather is supposed to work. Anyone? Anyone? Bueller? Mrs Bitchtastic, superheadchief of the ER, apparently has invented a new way of providing oxygen to a patient. For all my non medical peeps out there, a NRB (non-rebreather) is usually run on 10 to 15 Liters of oxygen. Therefore you will receive an order to "place the patient on an NRB at 15L." Ah well - dramatic license and all, eh?

Whatever will I do when this show is over? Thursday nights will be so dull and boring. No one yelling at the TV in my house. No one cussing about portrayals of medical care on TV. Maybe I'll just have to get drunk.

Paging Dr Greene.....Paging Dr Greene - STAT!

So, my prediction for the return of Dr Greene shall be as follows (and y'all know mine will be a hell of a lot more entertaining than anything they have planned anyway):


Dr Greene will come back as an evil twin of the original Dr Greene, who will carry out his evil plans to become a serial killer by offing ER patients via injections of a mysteriously blue colored substance or smothering them by holding the tip of his finger over the end of the ET tube. And then good Dr Carter will come back to save the day, all the while screwing some hot nurse in the janitor's closet. But then (oh no! dun dun dun.....) Dr Carter will be trapped in the dungeon of the hospital by Evil Dr Greene who will inject him with some new bio terrorism substance that will turn Dr Carter into a Stepford Wife. The Carter Stepford wife will then become the Evil Dr Greene's new partner between the sheets.

Suddenly - Sam will show up and kick the shit out of both of them before jumping out of the 5th story window and becoming a patient herself. But alas, the Evil Dr Greene will be able to sneak into her hospital room and will pull out the mysterious blue syringe. Just as he starts to inject the substance Neela will run in, throw her arms around Dr. Greene and say "I knew we could do it my love. I knew we could!!!"

Ack! It's all so shocking!