Seventy Four

Line of the day made by yours truly.....

"It puts the leads on the skin or it gets the hose again"

Said to a nurse who was vapor locked while we were working a particularly sick patient.

Now back in October I said I'd post once a month...I lied. Life tends to jump in the way of 'ol Crusty ER Tech and things got away from me for a bit. End of semester worries, vehicle break downs, the holidays and other things conspired against me.

New year, same ol' Crusty ER Tech.

I'll be on the job a bit more now with a break from school to get some funds saved and ty to get my head around more advanced math. In the mean time you all will benefit from fresh stories and (hopefully) some words of wisdom.

Most of all dear readers take care of yourselves and each other. Keep in mind we are often the ones folks rely on in times of great need on the worst day of their life.

Now go out there and stamp out pestilence and disease.

Seventy three

It's October and I try to at least to make a post once a month. Last post was about folks getting shot in the genitals. Let's face it it's very cringe worthy esp if you're male. It's notable and dare I say educational.

Let's keep in mind that Crusty ER Tech ususally blogs once a month with a drink or two aboard.

Aside from a gory story or bitching about asinine nurses ( or docs, midlevels etc) much of what I say goes into the void. Being an ER tech is very much a transitional or dead end job.  So why stay why do the job still for piffile?

One reason is it's better than the ambu. seriously.

You're (that's right buzzed I still know the difference between your and you're) warm and dry in the winter and cool (and dry) in the summer.

I can only say I love the job. Sure I get the occasional horrific code brown and deal with ignorant medical or nursing staff. Often I get looked down upon and people are surprised by my knowledge and experience. Smart charge nurses let me do my thing and ask for specific tasks occasionally. I see and experience a lot more. More is better.

I don't work in your common ER I work in a a large urban area level 1 trauma center which affords me a great deal of latitude. Some days it can be maddening and others it can be uplifting. it's a tough job in a tough place and no I am not blowing smoke up your ass.

For those aspiring EMT types out there. There is more you just gotta push yourself but for those of us who cannot get past the math based courses in college there is no shame in the blue collar ethic of EMS or the ER tech. Keep training, keep pushing no matter what.

Seventy Two

It's becoming a "thing"

Crusty (that would be me) has noticed a trend in penetrating trauma as of late. Penetrating trauma in the sense of the GSW. This trend is far from empirical and purely anecdotal on my part. It comes from what I have been told about and seen over the last several weeks.

This new "thing" in GSW is male pts being shot in the genitals. I can think of 4 off the top of my head in the last several weeks. Now before you readers start saying "Well Crusty obviously a very angry female must have shot this guy in his cock and balls." I will tell you in these cases that you are very wrong. This particular subset of penetrating trauma is not because of some angry female but due to gang violence.

I have been told by people in the know that certain high ranking gang members are wearing Kevlar vests now, that people who want to be the high roller say they wear a vest even if they don't wear one. So because for whatever reason one gang member gets angry with another and they assume the other is wearing a kevlar vest they aim for the genitals.

Smart yet VERY mean spirited.

Yes I know getting shot is in itself mean spirited but jeez to get shot in the genitals intentionally is just harsh. These bullet wounds despite the caliber can be rather damaging because of the soft tissue involved. Also if you are male and see this injury it does as a part of male nature makes you cringe.

I was also told that this is a way to avoid a bigger charge if the shooter gets caught. Makes sense but really I'm no lawyer so I cannot speak to it directly. Seems to me if you point a weapon at a person and pull the trigger no matter where they get hit at that it's gonna be an attempt murder charge from the get go.

Also those of us who work in this business and have the most basic knowledge of A&P know that here are some real important vessels in that region that if they are damaged that the entire volume of blood in the body can be lost very quickly unless there is serious diesel bolus from EMS followed by bright lights and cold steel therapy by a trauma surgeon.

Just some thoughts on the GSWs I've seen or talked about as of late.

Seventy one

PT assault

Lets keep in mind Crusty ER Tech has now had several shots of liquor and decided to post. With that said ....


Recently again I have been attacked by a patient. this time they actually connected giving me a black eye among other scratches and bruises associated with fighting with a pt in a dynamic urban hospital environment.

I encourage you all to ALWAYS press charges against pts of people that attack you. The other is to get trained on how to defend yourself. Often you will get put in a position where you will be attacked, do all you can to defend yourself. Know your protocols, know which drugs work best for chemical restraints and above all know how to handle yourself if and when the system breaks down.  

Reassurance does nothing stay on your toes.

Seventy

The Willfully ignorant Nurse Bass

As promised this next entry is about for the 3rd or 4th time the willfully ignorant Nurse Bass and I have had a run in. In the recent past Crusty ER Tech had yet ANOTHER run in with her. Crusty has tired of this and decided once and for all to slap his cards onto the table and in the most figurative sense slap some sense into her.

Other techs have approached me about her she has said some real hum dingers one of which I will include here:

"Honey we want you here but we don't NEED you here."

this comes from an experienced charge nurse in a large urban ER. Nurse Bass is of the opinion that staff that is certified like EMT, Paramedics and others are not necessary to running an ER. That the nurses, docs and midlevels can do effective patient care with out us.

Let's put it straight the ER tech does a lot of the scut work that is needed to make the ER run effectively. I ain't talking about code browns either. ER techs stock the rooms run paients to the floor and to various places in the hospitals. Meet the ambulances in the ambulance bay. Dispatch ambulances, answer the EMS calls into the ER and direct them (at least in two of the ERs I have worked) Go get oxygen tanks, find anything you need in the ER. In many places the ER tech is taking over the ward clerk job because the paper push is no more. You just need a dedicated person to field and make phone calls and help direct patients ER techs can be cross trained to do that. Need a suture set up ER tech can run down everything the doc needs. Warmers and linens need to be stocked, ER tech has got you. Need scrubs because you are covered in some sort of human goo, ER tech can find you another set of clean scrubs. Need a pelvic set up ER tech has it all on hand. That way the nurses, docs and midlevels can do their jobs and frankly not sweat and worry over menial stuff. All of this is just stuff off the top of my head. So if the ER tech is needed to do the smaller things that help make the ER run smoother.

I think I have proven my point.

Nurse Bass decided to yell (yes yell) at me in front of patients in the waiting room when I was doing something that our bosses boss told me to do. The details are not important but needless to say her tone was condescending as usual and I was in a foul enough mood not to let it pass. Knowing that trying to reasonably resolve things with her proved futile in the past (Which included her calling me a liar and denying the incident took place) I had no other option except sit down and bring in manglement.

I don't really like bringing in manglement because it can turn into a mess and things get put on a back burner. Lately though I have done somethings for manglement that shows the true effectiveness of the ER tech and shows how we are valuable assets to the dept. Plus I have tried to back channel this problem to manglement and still this problem persists.

We got called into the office and there I took off the gloves and dismantled her verbally. At one point I called her an ignoramus. Now it helps that I've been working with manglement a bit more lately and it helps that this particular manager REALLY likes me and is keenly aware of how Nurse Bass is and has been privy to some of Bass's back stabbing attempts to me. As one unit clerk told me recently "Crusty ER Tech you're a sneaky fucker."

Indeed I am.

I won't go into the details of the entire nearly hour session but at one point Nurse Bass tells me:

No shit full stop. I laughed at this. At this point the manager face palmed and shook her head. This among other just as condescending things she laid out. I was not kind to Nurse Bass and my assessments of her interpersonal relations with staff. At the end of the session the manager asked me did I need to say anything else. To which I said "I do believe Nurse Bass has said enough for both of us" Nurse Bass chose to stay behind and talk to the manager for another 20 minutes after I left the office. Bass realized that she had royally inserted her foot into her own ass and mouth.

Since then I have worked with Nurse Bass once and she was rather pleasant. Will this hold? I have no clue I honestly don't know. For now it's good enough for me. I had to expend some political capital in the department which is fine if it makes my day to day in the ER more tolerable.

Lessons learned:

Over the years I have had numerous run ins with nurses of this ilk. Rarely has it turned out for the positive for me. In actuality in rare cases are ER Techs respected. There is a lot of ignorance surrounding what we do and what we are capable of.  Many nurses are really do not know and a few like Bass are willfully ignorant and only see us as gophers who need to shut up and do what we're told. With that said me spending now a few years in this urban ER and knowing manglement as well as I do got me a bit of favor with them. I am by no means an ass kisser but I have shown my worth to the department time and again. This got me a nod and because I followed guidelines, because Bass did not know when to shut up got me a favorable nod. Write shit down and if you're being treated like shit don't blow up esp after trying to calmly resolve an issue just keep plugging way eventually you'll be heard.

Now hopefully Bass will go work in some clinic in the suburbs some place.

Sixty Nine

I was going to sit down and write about how quite recently a nurse told me that it was not in my scope of practice to assess bleeding. Then I realized it was entry number sixty nine and well the number conjures up thoughts of genital injuries.

Genital injuries and the insertion of various objects into the rectum are great fodder for ER and EMS types. In fact the subject of objects inserted rectally has it's own book:

Never read the book, I'm sure you all get the point though. This entry will not be about this because frankly there are shit ton (pun intended) of these stories and when we all gather around the nurses station or after shift for drinks there is a tendency to one up each other concerning inserted objects.

This dear readers is about genital injuries. Now I won't talk about genital injuries sustained during a sexual assault. Those are a sensitive subject and Crusty takes those rather seriously. Male genital injuries are more common because hey let's face it our anatomy hangs out. Again, this is easy fodder for those of us in the business. Less common are the female genital injuries that are not related to sexual assault.

I was trying to remember a real rare genital injury and then I remembered the home bar stool accident.

Way back when I was a new ER Tech I assisted a doc with a woman with lacerations to her vaginal wall secondary to sitting on a home bar stool.

Pt was a mid-50's female. Nice woman. Her husband a few years prior made their basement a home bar with taps televisions pool table and such things that normal bars have including bar stools. The bars tools they had were of the four legged padded top types the ones that you can find in discount furniture stores all across our great nation. The stools got wobbly over the years and the husband said soon they would buy newer better ones. The wife being "thrifty"(cheap) decided to fix the stools herself when the husband was off at work, she got home early and wanted to surprise him with the repairs.

She grabs his portable drill and what screws she can find which if I remember right would have been 2 or 3  inch drywall screws. She screws the legs into the top of the seated portion of the stools which takes the wobble out. She's proud of herself pours up a beer turns on the TV behind the bar and sits onto one of the newly "repaired" stools and it collapses once she puts her full weight on it. She was not a hefty woman, she was weight to size appropriate.

Naturally this hurt then the woman discovered she was bleeding from what she thought was her behind. She thought the screws came up and poked her in the ass. Which honestly I would have thought the same thing. Problem is that she's bleeding a lot. She goes into the bathroom drops her pants and looks in the mirror no holes in her ass besides the ones she already had.

Then she notices that there is blood running down her leg from her vagina. No she was not preggers and lost the baby. She feels inside her vagina and feels the laceration in her vaginal wall. She runs out of the bathroom wraps a sheet around her waist and calls the ambulance. Which of course brings the police and fire too. What can I say it was a slow day in this particular suburb.

Husband pulls up as they are wheeling her out and asks what's going on all he hears is that his wife's genitals are injured and sees the police. The cops assure him that there was a strange accidnet and his wife will explain.  Which she does once they get to the hospital.

Ended up that she had a couple of decent lacs to her vaginal wall secondary to a lot of embarrassment. I had to assist the doc in the lac repair. The couple had some humor about it but the wife was clearly mortified.

The husband and wife decided that night to use the stools for fire wood and buy nice top of the line stools instead for future use. Thus endeth the story.

Next the willfully ignorant Nurse Bass.

Sixty eight

 Ol' crusty got a question here recently:

Crusty (ER TECH), any thoughts on combative patients and ER staff being hesitant to help out to restrain them?

I apologize for the late reply. Every situation is different. Sometimes with enough patience you can talk them down which if possible should be the first thing you do. I highly recommend "Verbal Judo" by George Thompson. Pick up the book and give it a good read and try to re-read it once a year. When I worked the ambu for a major west of the Mississippi river urban agency they sent us all through the training, it changed how I dealt with difficult and violent patients.

You can't always talk them down though and sometimes no matter what you say the pt is altered via a substance of their choice or mental illness (or both) and it'll be go time.

I gotta buddy who works in a left coast state who told me they have an overhead page for a violent page where all males in the area show up to help restrain the violent pt. and there is a standing order for chemical restraints in that situation.

 Where I work at we have a crack security staff who get in there and really do the job.

One really shitty I worked at we had terrible security that just patrolled the parking lots and if a pt really got out of hand the charge nurse would call the cops which may take forever.

Along the way I have learned a series of wrist locks and holds that help control a violent patient. If you wanna go that way I recommend getting trained. People are reluctant to get involved because let's face it's a hospital and we're there to heal not wrastle with pts. Besides that staff often is not trained on how to deal with this type of situation hence the hesitation.

If it is a huge concern organize some fellow staff members and propose a solution to manglement. Then once you propose something dig in and don't let up til they resolve the problem. Never tell someone about a problem unless there is a solution.

Bruh, if ya got more questions about this drop me an email and I'll give ya some more idears.

Above all dude stay safe. Never go in to restrain a pt with less than 5 people (one for each limb one for the head) We prefer 7 one for each limb one for the head one to apply restraints and one to supervise, talk to pt calmly and to medicate. remember I currently work in a very large urban hospital with a shit ton of resources. Other places are not so fortunate

I cannot stress that enough BE SAFE BE SAFE BE SAFE.

Ol' Crusty has got a shift today soas the kids say" I'm outtie". Take care out there.

hopefully that helped you out and some others