Fifty seven

57

"Motherfucker wait for us to get clear, goddammit!"

Working a code/code blue/cor-0 awhile back (about a year ago) It's going smoothly enough. The pt is a young (under 40) female who all of the sudden went into v-fib in her room. No history of cardiac problems just had a sense of malaise for the week prior to her visit to the ER. One minute she is talking the next she ain't.

We pull her into the big room with all the fancy equipment that goes "bing" etc. A new nurse is insisting on being on the defibrillator, they say they've never done it before. We are in a slight rush so no one argues, the assumption is made that since this nurse has ACLS that they know to "clear" the patient before shocking. We've all been new once.

Pads are attached (not paddles have not seen paddles used since circa 2004) and a quick rhythym check as per the doc. Vfib...yay..SHOCK.

Unlike TV we make sure everyone is totally clear of the patient before shocking because well you can at the very least give a co-worker a nice electrical shock at the most kill a co-worker if they are not clear (touching the patient). I have not had it yet but I would NEVER want to work two codes because some ass hat did not make sure that everyone is clear when the pt is getting a shock.

so vfib...yay....shock patient....charging....clear patient...

This is when everyone in the room says "CLEAR" and steps away from the patient, the person doing the shocking looks over everything and delivers a shock to the patient. It always works that way until it does not.   

So is the case here. Defib nurse is concentrating on the machine (back turned to all of us including pt) and not making sure the pt is clear, I'm grabbing people on my side of the patient to make sure they are clear of the patient and without not even a "clear patient" a shock is delivered.

The RT and airway resident are nearly shocked. The attending scolds the nurse and says be more careful if we need to shock again. CPR continues and the next round of ACLS drugs are given. We are digging in the pt is a young female so with no history and we've gotten a shockable rhythm already. It looks good.

We stop for a pulse and rhythm check no pulse but vfib again...Doc says shock. Again the nurse turns his back on the patient and everyone else and "BOOOOOOOOOPPPPP" charges the machine then with no warning shocks the patient.

Fortunately we are all paying attention from the last close call and we are all clear. Someone in the room (not me) yells "Motherfucker, pay attention goddammit you nearly shocked the entire code team" (I think it was the attending) It's not my turn to do compressions and turn to plead with my eyes to the nurse beside nurse itchy trigger finger to change places with him. She does not see my pleading eyes. I just don't wanna die today from someone not paying attention.

Again another round of compressions and drugs and two minutes are up  we all look to the monitor and thank the heavens the pt is NSR (a good thing) at around 70 bpm. At this point various drips are set up and the call to the ICU is made.

I pick up a roll of 2 inch cloth tape and throw it at nurse itchy trigger finger's head. He barely ducks in time and asks why I did not warn him I was throwing tape at him. To which I reply, why did you not warn us you were shocking first. The nurse is later taken aside by the charge nurse and "counseled" on how to administer a shock to a patient in a shockable rhythm. It was the closest I ever came to punching a co-worker ever because of their gross negligence.

Pt lived and made it up to ICU. Nurse itchy trigger finger is still on staff and is watched very closely during codes now especially if he gets near the defibrillator.

Take care and Happy new year!

Fifty six

In the ear.

Working a code (code blue/cor-0) and doing my thing which is taking turns doing chest compressions. I am working with a not so confident senior resident running the code and a even less confident and obviously nervous junior resident at the head of the bed in charge of the airway.

There is an unusual amount of chatter during the resuscitation because the senior resident is not really leading he's just following what everyone else says. The attending is standing in the corner of the room with his face all screwed up arms folded and pissed. We are late into the residents rotation year so they should have the hang of a simple code. Instead there is flailing and chatter things are getting done just not in a crisp manner that most of us are use to.

They are having trouble getting a peripheral line on the patient, there is a big honking EJ though. I'm looking down at it salivating over such a big juicy vein. The junior resident looks at me looking at the vein while I'm doing compressions. He asks "Do you think I should do it?" Unnecessary chatter. You know they are having probs with a line and you got this huge EJ don't ask doctor do it. I don't answer I just roll my eyes and he gets the picture.

I look down to concentrate on doing compressions we are getting close to the pulse check so I'm getting weaker and have to pound out the compressions. Then all of the sudden I feel some thing cold and wet right inside my right ear. Like a splash of water. I look over and the junior resident has a half empty 10 cc saline flush in hand and he has gotten anxious after trying the EJ he wanted to get the air out of the flush first and instead of turning away from everyone (mostly me) he has squirted the saline right into my ear. He looks at me I look at him. I then give him a "What the fuck?!" look.

Pulse check.

I snatch some paper towels while I'm switching out with another tech on compressions. The junior resident has missed the EJ somehow.  The code ends and the patient lives after multiple rounds of drugs and defibrillation. 

My scrub top and neck are still wet from the 5 cc or so of saline. In fact for the rest of the day I feel like my neck is wet. I never get an apology from the junior resident.

So it goes in the dynamic emergency room environment.

Double Nickels

Fifty Five

Well shit I missed posting in November sorry 'bout that folks. To make up for it I'll tell my most recent Thanksgiving story.

Just after getting my assignment I head out to triage to do my thing which is do vital signs and stat EKGs. It's a quiet Thanksgiving morning. Night shift tells us that it really cleared out about midnight so much in fact that the waiting room is totally empty. This gave the housekeeping floor crew to come through and work on the beat up floors. The empty waiting room gave the regular housekeeping staff an opportunity to properly clean the area and really dig in and clean the bathrooms in the waiting room after maintenance unclogged the toilet for the 3rd or 4th time in the last 24 hrs. The waiting room is empty and sparkling clean a rarity for the inner city trauma center.

One of the nurses walks up after running late and says:

"Wow it smells great up here"

 I never notice the smell which is bad and ask her what triage usually smells like to her and she replies:

"Like a dumpster"

A few minutes later up walks an appox 50 year old male looking disheveled and much like our typical homeless type. It's unusual to see homeless on the tgiving holiday because only a couple of miles from our doors is a big holiday feed the homeless event. They que up early there and stay until the police runs them off.

He registers and I wave him over then ask him to take off his jacket so I can take his BP. He does and then tries to hand me the jacket. I tell him "oh no..no you keep your jacket it's suppose to get real cold tonight." Then he proceeds to unbutton his well worn flannel shirt. I say he really does not have to go through the trouble and hey please keep your shirt on. He just stares at me blankly unbuttons the last button and opens his shirt revealing a bare chest to his nipples. He then points to his nipples and says:

"You want to suck them?"

I reply no flatly and tell him that all I wanna do is get his BP. He then says:

"I have a chemical imbalance"

I tell him flatly that I believe him. The triage nurse on the other side of the curtain is chuckling away.
I direct him over to the triage nurse for her to deal with him. No surprises here, he's off his meds. Back to psych he goes the rest of the day is uneventful.

Naturally we had a grand tgiving potluck which Crusty actually got to before all the food was inhaled eaten by everyone else other than the ER staff (maintenance, housekeeping, radiology and security) in the past I have been lucky to eat the dressing no one liked and that fucked up disgusting Frito pie. This year I even got a decent lunch and pie. Crusty was happy.

More stories from the dynamic work space we call the emergency room. Happy Holidays!