Obligatory Resolutions

I hate January.

The month of "I-must-change-my-life-and-become-a-better-person-right-this-instant-but-will-probably-fail-within-2-weeks-when-I-rip-ass-on-the-gas-station-attendant-for-spilling-unleaded-down-my-car." Seriously. Personal improvement? Bettering of our lives? Pashaw I say. It's a bunch of crap.

You TOTALLY know (now I sound like my 12 year old) you will be back to your old self within 18 days, so why bother?

Alas, I've been told it is a requirement of living in our great United States of America that I must make a list of resolutions for the New Year. Who knew? Therefore, in the spirit of rebellion that flows throughout the veins of my soul, I shall make resolutions that I know I can keep, rather than professing that I'm changing my life and becoming the perfect example of a modern day Mother Mary. I prefer to make goals that fit nicely into my life and require very little work. Why not feel some bit of success, eh?

So without further ado........

#1 - I will wake up every day (Whaaat? You don't know how that is a challenge for me sometimes. I like to avoid the world, pull the covers back over my head, and dream of running my own country. I have admirers there - and servants. And they allllllll adore me).

#2 - I will go to sleep every night (Ok, so this one isn't so hard for me - see above. I like to visit my country).

#3 - I'll probably laugh a few times, cry at least once (maybe twice - depends on what my dear lovely manfriend does to piss me off), and yell at my poor innocent children frequently (don't worry - they're used to it. They've learned to tune me out).

#4 - I shall engage in arguing with my haters. Now that is always a fun time. Pushing buttons - it's a great thing!

#5 - I will find a few new blogs and love them for about 2 months. Then never go back to read them, until I find them again 8 months later and think they're new ones I've never seen before.

#6 - I will tell a story to Yolie and lose topic in mid-sentence, diverting to what we're going to do Saturday night instead.

#7 - I will read approximately 102 books, some of them twice - again, not remembering that I read them the first time.

#8 - I will tell someone I love them. Probably 5 or 6 someones. 2 of which will be my children, 1 my dog, 1 my cat, 1 my man, and 1 is saved for a wild card later. Might get a bird or something.

#9 - I will not laugh like a hysterical maniac inside my head every time I see an Oregon Ducks fan make a big O with their hands that totally looks like a big asshole. Sigh......I might have trouble with this one. In fact, I've already broken it 186 times today watching the Rose Bowl. I am already a failure.

#10 - I will forgive myself for not succeeding at resolution #9 and I will pretend it never existed.

I think that about covers it. That's all the success I can handle without my head exploding and becoming so enamored with myself that y'all look like the pathetic losers you are. So for the sake of your sanity and self esteem maintenance I will go no further with my Resolutions (cuz I'm gonna keep all those bitches!).

Surfing for Porn - AKA reading other ER blogs

I seriously Laughed My Ass Off reading THIS blog.  No seriously.  It slid down the back of my thighs, did a ski jump off my muscular calves, and landed with a greasy sounding PLOP! on the floor behind me.

Seriously.

OK, it really just slid off my backside like the blob it is and settled into the canyon between the couch cushions.  I'm still trying to find a way to reattach it.  Cuz I need my ass.  I truly do.

So props to Candice  and her amazingly funny blog.

(Plus - she uses the word fuck a lot and how can I resist a fellow trash mouth?  Huh?  How can I?)

Come to think of it, I haven't cussed much lately on my blogs.  Maybe that preachy woman actually did get to me.  Must remedy.  Pronto.

Sanctimonious Assholes.

I feel better already.  Sigh.........

Medical Screening Exams

At our facility, the RN's perform the Medical Screening Exam (MSE for short).  An MSE is the initial exam you receive in the ER to determine if your need is emergent or non emergent.  This must be done before any financial information is requested from the patient (such as insurance info).  Basically, it's a quick assessment and any testing that may be needed (such as a quick lab draw or xray) to determine if you truly need to be seen and use up ER resources.  An MSE is required by our government so that we don't dump you on some other hospital or refuse to treat your emergency if you don't have insurance.

Let us discuss......

Please.

Because some things drive me to drink and this is one of them.  

#1 - This does not, I repeat, NOT mean that you are entitled to a free ER visit.  We DO get to charge you.  We just cannot ask for financial info until after the MSE.  Some hospitals happen to not charge for MSE's that are not seen by a physician, but every facility is different and can choose what they charge for.

#2 - An MSE is NOT an ER visit.  It is a screening to determine if your situation is emergent or not.  Emergent means life or limb threatening, or acute pain.  Example:  A stroke is emergent.  A sprained ankle is not.

#3 - If we deem your visit as non emergent, we do have the right to tell you so.  We also may tell you (but not always) that there is NO need for you to be seen in the ER and that you should follow up with your primary provider.  Follow ups can even wait until Monday.  Yes - they can.  If you are seen in the ER anyway (either because you insist on it or because the facility allows it), you will probably have a tremendously long wait (think 6-8 hrs) because the emergent patients come first.  You come last.  Sorry, that's just the way it is. 

#4 - If you do not have a primary provider - get one.  If you do not have insurance to see a primary provider, what makes you think that going to an ER will be any cheaper?  We are usually 4 or 5 times the cost of going to a doctor's office.  Example:  office visit for sprained ankle approx $100.  ER visit for sprained ankle approx $600.  Most physician's offices will work with you to arrange payment options.  Yes, even those that ask for money up front.

Side vent - for those who say they cannot get in to see a physician because they have not established previously with the practice, take the time to do so on a day you have some free time.  That makes it so much easier for you to get that appointment for a sore throat when you call the doctor's office.  If they already have seen you and you've established care, they can put you into the open slots they save for daily immediate care cases.   

#5 - We'll ask for money too.  We just won't ask until the MSE is complete.  That means we may tell you that you need to pay your $100 copay (average ER copay) up front before being seen any further.  Yes, we are an ER but we are also a business.  

#6 - If your visit is deemed Emergent, then you will be seen regardless of insurance, ability to pay, or any other defined item.  You will be taken care of.  Period.  But...... it is our decision to make.  Not yours.  

#7 - Even if a physician performs your MSE, these same rules apply.

Now let's move on to the nurses, because we have some stuff to learn too.

SHHH - don't tell anyone I said that out loud.

#1 - Not every person needs to be seen in the ER.  It is OKAY to MSE them and discharge them out of the ER for follow up with their primary provider.  

#2 - YES - even if they have no insurance to be seen at a clinic.  Do you think that means we'll ever get paid?  We do not (yet) get government reimbursement for non emergent visits. 

#3 - Standing Orders may be used for MSE's.  As long as your policy says so, then do so.  Think of it this way - if you have a Chest Pain come in, do you wait for the MD to come up from the cafeteria and give you an order for an EKG before you do one?  Didn't think so.  I bet you use your cardiac standing order sets (or some such name). 

#4 - And for you overachievers out there....... when in doubt, have them seen by the ER doc.  We are not allowed to diagnose a patient.  Remember your scope of practice.  

#5 - Last but not least, an MSE is a whole different monster than Triage.  Triage determines who should be seen in what order.  An MSE determines if they should be seen at all.  

Of note for all you medical peeps out there:  Our state has determined that it is within the Scope of Practice for an RN to perform Medical Screening Exams as long as a proper orientation and monitoring program is set up and followed.  

And apparently I am supposed to remind you that this is my OPINION and not a teaching tool for MSE's.  If you'd like a teaching tool, you may contact me via email and I will share our MSE orientation packet and monitoring program.  It's not big, nor is it impressive.  Just warning you now. 

Alrighty then, I am off to pour a glass of vino because just typing this out made my head hurt.

Photo Blog

Just a quick note to post a link to a new photo blog.  There are some pretty neat pictures at Eastern Oregon Photos. 

I'll Just Get Right On That Suzy Q

If you are diagnosed with a fracture and the ER doc tells you to follow up with an ortho doc, it is NOT our job to arrange that referral for you.  We are busy.  Go to your primary care doc within 1 to 2 days and have their office staff arrange for the referral.

I do not have time (nor the ability on a weekend) to call your insurance, obtain approval, and then arrange an appointment with the ortho center.

I'm too busy doing CPR on this 21 year old who overdosed on sleeping pills.

And if you continue to be snippy with me, I will curse you in my prayers.

Just sayin'................  

Time Machine and the Flu

2 years ago these same symptoms would have been called "A Virus" and everyone would have been told to go home and let it run it's course.  Now all of a sudden everyone has "the flu" and is getting rx'd for Tamiflu or hospitalized, sometimes unnecessarily.

I brought this up to Dr Q the other day at work.  

"I know," he responded.

Love how the media has determined how we treat patients this year.  

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

Reciprocity

My new friend Richard, AKA Rich apparently, left me a comment asking I link to his post about iPhone apps for EMS personnel.

Hmmmm.... I thought.  Ah-ight.  Can do.

So HERE YOU GO.  

Alas, in my little Burg one cannot use an iPhone.  Piss poor service and reception I hear.  Our 4 bars of Verizon equals 0.25 bars for iPhone.  

But for the betterment of humanity, I shall overcome this little setback and post the linkyloo for those of you who can use it.  My selflessness is of benefit to you.  Yes, Yes.  I know.  

I deserve the Nobel Peace Prize too damn it.  

Update From The Burg

Well craptastic - it's been a while eh?  I guess my life in the ER has not been interesting enough to provide you all with a story or 2.  Either that or I'm just a lazy piece of work that hasn't had the inclination to log into my blog and share.  I'm going for the second excuse.  

Flu season has hit my little burg.  Not only at work, but at home.  I have 2 sickies home today skipping school.  I heard that 50% of my oldest kiddos class is out of school sick with flu like symptoms.  We also have about 15% of our staff out related to their own or their child's illnesses.  Oh boy - the joys of winter!

I've been spending a lot of time on the internet looking at non medical things - like facebook.  Sometimes you need a break from anything medicine related.  Right now is my Sometime.  

I had someone ask me a while back, "Do you think this is a trauma?" for a patient who was pitched over a motorcycle, into a barbed wire fence, and had 2 long bone fractures, a positive LOC (loss of consciousness for my non medical peeps), and a probable flail chest.   

Um..........

Yeah.

Idiot.

Some people are dumber than a box of rocks. 

It's Not A Tumah! It's Not!

"OH MY GOD !  MY WIFE IS HAVING A SEIZURE IN THE CAR!  HELP ME!"  He screams as he runs through the ER doors.

Up we jump, 'cuz we're like Les Schwab Employees.........always running to greet you.

Lucy and I hop up out of the chairs at Nurse's Station, leaving our Peanut M&M's behind.  Sigh.....I had just opened that damn bag.  Now I won't get to finish it.

We walk out the double doors and into the drive up.  A blue '78 Caddy is idling with the front door open.  A large, no very large, lady is sitting in the front seat applying lipstick.  

"Is this your wife?" I ask.

"Yes ma'am," he replies.

"She's not having a seizure," Lucy says.  She's a smart one, that Lucy.  

"Well she was!"  he insists.  "She had a seizure at home so I threw her in the car and drove her up here!  It scared me!"

You threw her in the car? I was thinking.  How on God's green Earth did you do that alone? 

Finally his wife pipes up, "Oh yes, I had a seizure.  I'm so lethargic now.  I just can barely stand up honey.  You'll have to help me out of the car."

Um....... I call a bullshit. 

"No ma'am.  You'll have to get into this chair on your own.  I've got a bad back."

Up she pops and flops down into the chair.

"OK dear, you better hurry and get me in there because I feel another seizure coming on."

Oh Dear God.

Lucy and I escort her back to Exam 2 and get her onto a stretcher.  She pulls out her cell phone and calls her daughter as I'm trying to obtain her history.

"Sarah?  Sarah?  You better come up to the ER.  It's your mommy honey.  I can feel a seizure coming on and they have me in the ER.  Hurry baby, hurry!"

Oh for Christ's Sake.  Insert eye roll here.

I hooked her up to the monitor and got her vitals.  I finished her history and went out to talk to Dr. Q.  It was right about this time that her daughter showed up.  She walked into her mother's room and within 10 seconds was out in the hallway screaming "MY MOTHER IS HAVING A SEIZURE!  HELP ME!"

So Lucy and I leisurely make our way to her room.  By leisurely I mean we finished our bag of Peanut M&M's and downed the rest of our Diet Cokes.  We then scratched our butts and walked over there.

Now before you give me the whole uneducated attitude of "GASP!  What a shitty nurse.  Why would you not RUN?  Run, Forest Run!  That poor lady is having a seizure.", let me explain something to you........

This lady was having a seizure like I was winning the lottery.....

Not happening.

I did not for one second ever think this woman truly had a seizure.  Not once did she act post-ictal.  

Anyway - back to Exam 2.

Lucy and I walked in to the room and observed her "seizure."  And let me tell you, that's a loose word to describe this event.  I like to think that "Idiotic fake ass 3 year old fit thrower faker" would be more suitable.

Our patient's husband and daughter were standing beside her stretcher wringing their poor little hands while our patient was babbling and cooing like a baby.

I shit you not.

She was shaking her head back and forth and saying "wah wah wah bah bah bah momma momma dadda dadda wah wah wah bah bah" over and over.  And over.   Then she started kicking her legs.   And asking for her "ba-ba".

Oh Good Lord in Heaven above.  Help me please.

Right about that time, Dr. Q runs in to save the day.  "CT Scan STAT!"

"Dr Q - please observe the patient's seizure first."

He takes one look at her and orders a psych consult, then turns around and walks out the door.

Daddy and Sarah were not too happy with us.  "She doesn't need a psychiatrist!  She needs a doctor!  There's something wrong with her!  She probably has a tumor."

"It's not a tumah" I said in my best Arnold accent (points for throwing in the Terminator here).

"It's highly unlikely your mother has a tumor," Lucy replied.  "She is not having a seizure, she is having some type of mental event."

All of a sudden Mommie Dearest popped up and said "I am too having a seizure!"

Ho Boy.  We've got ourselves a winner here Bob Barker!

The end result of this visit was a psych consult, a discharge, and a family complaint that we did not offer her a CT Scan for her Tumah.    Two days later I was eating at our local greasy spoon when her daughter came on shift as our waitress.  Oh joy.  I got to hear her tell the guy next to us how the Hospital didn't take care of her mother and she wouldn't even take her dog there.  Well goody for you.  We don't want your dog there either.  

Dear Mr Resident: way to smack down the haughty x ray tech. I'm very proud of you.

At class. I'm cracking up listening to the med students sitting beside me discussing how much they know. I'm also getting an ear full about how much nurses suck. they obviously don't know as much as they think they do or they'd know nurses will save their asses through med school and fix their mistakes. Oh preach on dear med students. Preach on.

This is my Tom Tom. Cell phone on my shoulder, pen in hand, writing as i drive. I'm gonna end up one of my own patients. Stupid stupid nurse.

On my way to ATCN

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..............................