Fifty

Well Crusty ER tech made it to 50 posts. Man well I gotta continue until I get out of this business. Tonight, I'll strike nostalgic and say that I miss the old ER whiteboards.



This lame picture that I found in a 5 second google search does not do the proud white board justice. When I first came to big inner city trauma center I was excited to see that they still used white boards (and paper charts...oy vey!) They got phased out in a couple of years with a more advanced tracking system and virtual tracking boards on pc's that roll around the area.

A true grand white board hung at the front of the emergency room tells a story of a bad night in a city. It's all there the results of the human drama that occurs in a twelve hour period. In my early days as a baby ER tech I vividly remember the wall phone beside the white board with what seemed a 20 foot long cord. the phone seemingly attached to the charge nurses ear. if you could decode the medical jargon you knew EXACTLY what was going on with every patient in that department within seconds. Never was the phrase uttered "wait a second let me pull up the board" Tell a doc something and they'd glance at the board and in a second they knew what was going on with a pt.

If you stood in front of a board for too long you'd get some object thrown at you and something said to you along the lines of "move your ass I can't see the fucking board"

One color name would mean one thing and another color circle would mean another. In fact although the old white board was pretty ubiquitous in every ER there are subtle differences from hospital to hospital. It was ALWAYS the best way to communicate with co-workers. Because EVERYONE from housekeeping to the CNO and CEO of the hospital could see the board. Everyone looked at the board. I know I said a million times "WTF?! don't you read the damn board?!" It's all there no ands if's or buts and not putting a status change or a admit on the board was inexcusable.

Some charge nurses were crazy about the boards. One I worked with would line by line at the beginning of the shift, would change all the writing to her own which always got me to change random letters in her writing during the shift. We'd play the BAC game during night shifts on weekend nights or rookie nights where when we'd find out a pts. BAC we'd put it on the unused portion of the board add the totals up at the end of shift and whoever guessed the cumulative total  would either win the pool or we'd all chip in and buy breakfeast for them the next morning.

Other games played one was a personal fave was trying to land a white board marker onto the holder at the bottom of the whiteboard. It's a lot harder than it seems. During lulls in action the staff (and docs) could spend a few minutes throwing a marker or two up there for soda money or until the charge nurse got up set and ran us off.

Sometimes when the charge nurse was not around I'd make up patients with bizarre complaints based off of TV. Which got the charge nurse looking into the (rare) empty room asking "Where the hell is the pt with the (crazy complaint) at?"

Then there were the never ending abbreviations specific to a certain hospital:
CLB: crying little bitch (usually the tough guy with a tummy ache)
WADAO: Weak and dizzy all over (a personal fave)
BS or BGL: get a blood glucose level
HBD/SBD; He or She be drunk
+ S/S: positive Samsonite signs meaning pt has a shit ton of luggage with them
That's just a few I remember off the top of my head and of course we'd use the local ten codes for EMS for other things. 

The whiteboard knew all and rarely no matter where I have worked was it totally empty. Alas things have changed. With the advent of tracking boards on PC systems there is no real central system for everyone to gather and discuss department strategy or a place where you know if you hung out long enough you could find most anyone in the department or at least leave a note to tell them something. Now things are tracked in real time in a computer system so we know numbers and it makes us more efficient. It does to a degree, all these fancy whiz bang systems you can find pt info in a flash gone is the lo-fi system that gave true character to any ER. I liken it to the diffrence between mp3 and the old vinyl records. Both do the same job it's just vinyl records has more of a "feel" to it, same for the old white board.

At big inner city trauma hospital we've lost the whiteboard and the paper charts a few years ago (thank heavens we don't have paper charts anymore!) The old gigantic white boards are still there for general info but not like the old days. The old white boards stay primarily now for "down times" which either scheduled or unscheduled is when all of us old hands do a little dance and happily scribble on the white board and strike nostalgic. The younger docs nurses and techs get frustrated by the whiteboard and often don't understand the joy of such a simple device. The old whiteboard in many ways was the equivalent to the water cooler in cubical land. Yet vastly different.

I miss the whiteboard, at times I look at them and wonder if in a small way if the whiteboards don't miss us too.

Forty Nine

One thing that I find funny and others find disturbing is that Crusty talks in the third person a lot in this blog. I also find that most english degree holders and majors cringe at my switch in narratives between first second and third person. Which is my purpose and I find funny because anyone who talks in the third person is a mixture of funny and crazy.

Here are three triage quick patient encounters that stuck in my head:

1) I'm in triage getting vitals on a patient when another person busts into the area we are in. The patient I'm getting vitals on and this other person don't know each other so both of us look at this person like they're crazy and then I say "Hello there, how may I help you?" thinking that there very well could be a penetrating trauma in a car at the turn out or another preggers woman delivering a baby there as well, possibly both at the same time *shudders* I never want that to happen. Anywho...

The busting in person says with shirt pulled over their face "I NEED A MASK I DON'T WANT EBAUMMA!!!"

At this point I face palm and hand over a mask just to placate the person while the triage nurse snorts on the other side of the curtain. The pt I am getting vitals from says "Some peoples is so ignorant." I could not help but to agree.

2) Oddly enough during black history month I was helping a EMS crew pull a patient out of their ambulance who was having a bit of a mental break down. While this patient is being triaged he screams "I'm just like Martian Luther King" over and over again. This is obviously getting on several peoples nerves. I get his attention and tell this very delusional patient "Sir, I beg to differ you are nothing like MLK...you're not black." which got whoops of laughter and a smattering of applause from patients and co-workers. At this point the patients starts screaming "I'M JUST LIKE GANDHI...I'M JUST LIKE GANDHI...I'M JUST LIKE GANDHI..."

3) Last and certainly not least I'm talking with a patient who is in obvious pain and rubbing their elbow I ask what happened and the reply I get is "I fell on my bone marrow."

Yup just a few moments in the dynamic environment of the inner city urban ER.

Forty Eight

I must apologize for not writing sooner. I've been laid up with an arm injury and school. Stay tuned and rest assured the Ol' Crusty ER Tech maybe down but not out just yet. Stay safe and take care be back soonish.

Forty seven

Not that I pay much attention to it I just noticed that the old crusty ER tech has gotten over 5000 hits on this here blog. Well shit everyone, thanks. Now compared to what any social media star gets in their corner of the internet 5k is nothing. For CRT 5k is a nice round number and it might mean that some people out there get what it's like or at least want to know what it's like working in a dynamic environment such as an ER.

I will say that not all my tales come from the same ER or even in the same region of the country. One thing that I have learned is that when it comes to an ER much everything is the same. Yeah..yeah there ARE slight variations here and there commonality is the thread that holds it all together whether it is in a urban inner city hospital or a 3 bed rural ER. At now 47 entries and over a measly 5000 hits have I run out of things to say?

Hardly.

I have attempted to show what kind of personalities work in and come to an emergency room. I've said many times that there is often a very fine line between care givers and patients in ANY emergency room.  Sometimes the line can be blurred. One thing that I have learned in all the regions and ERs that I have worked in is that a truly great ER has fantastic team work.

For all my grumbling (trust me there is a ton of it) about my current job at Inner City Trauma Center we have great team work day in and day out. We have to or we'll get crushed. Sure those clip board nurses often get in the way we still manage though despite the tsunami of humanity we see in any 24 hour period. When I worked at a hospital out west (or was it back east...hell I forget) I worked in a ER where there was a bunch of glory seekers. People who would not get out of their chair for a cup of ice or pillow for a patient, hold on though when a code/cor-0 or hot trauma/trauma-cor came in through the doors then they would fly off that chair like they had a rocket strapped to their asses. It could have been great there it was not because of a culture of indifference.

I do not mean to paint a bleak picture of our healthcare system. My purpose is now to paint a landscape of what it is to work in such a place like an ER. To that end I endeavor with each key stroke.

For all of you who have read this so far thanks, I appreciate it. Frankly I'd write here whether or not anyone read it. Keep checking it out I still got more to come.

Forty six

Beats the hell outta me.

I pulled this patient out of a mini van curbside outside the main entrance of the ER. His chief complaint was bilateral lower leg pain secondary to falling off a ledge 10-15 feet in height. This patient landed on both feet and does not complain of pain anywhere else. Pt denies striking head on ground and has negative LOC. Pt cannot stand on his own feet and cannot ambulate so naturally I load him onto a stretcher.

I'm thinking that this pt has a good story and wheel him back to the triage nurse. The triage nurse is non-plussed and insists that I put this patient in a wheelchair and put him into a waiting room. I ask the nurse to at least order xrays on his lower extremities, hell I even say please. The nurse becomes upset with me and tells me to "just go". I would have ordered xrays but as a Tech in this hospital I don't have access to ordering diagnostic tests or anything else for that matter.

I'm not taking no for an answer and grab another more level headed nurse on the way out to the waiting room and ask her to order xrays bilat lower extremities on this patient who is in obvious distress. This nurse says "Absolutely no problem" and I wheel the patient on over to radiology.

Lo' and behold this patient has multiple lower extremity fractures which include but not limited to broken calcaneus, multiple fractures of tibia and fibula bilat and a nice small fracture of one of his femurs. Needless to say this patient is a candidate for trauma. After a call to the charge nurse to tell her what I got I grab yet another stretcher and put the patient on it and we wheel on over to the trauma bays. Naturally while I am going over to trauma I run across the triage nurse who ordered me to put the pt in a wheel chair and put him into a waiting room.

She throws a minor shit fit in front of the patient and several other folks. I get told that she's the nurse and I'm just a tech and I better follow her orders without question, now put this pt in a wheelchair and put him in the waiting room at once! She also tells me to expect a write up by the end of the day. Once she's done I tell her to go ahead and write me up because this patient has a laundry list of leg fractures and the trauma attending and the charge nurse wants this particular patient in trauma now. The discussion ends there.

The triage nurse walks off without another word and the pt and I head on over to the trauma bays. This being a dynamic urban environment the patient who has been very stoic to this point says "Fuck that bitch, thanks bruh."

The BIG 45

You MIGHT be a red neck if you walk out on a cardiac cath to go watch a NASCAR race on local cable. this patient has had an extensive cardiac history with open heart surgery with 5 count 'em FIVE STENTS ! This patient is quite adamant about leaving to watch this race. Pt signs out and leaves AMA despite a cardiac attending and fellow BEGGING him to stay.

It can be only assumed that said pt watched the NASCAR race soon afterwards. Seeing this first hand I have to say that this little scene was UNREAL!!!

Pt Left hospital AMA never saw this person again!

Fourty Four

Pt who is a mid-30's male is found unresponsive at local recreation center. Bystanders call 911 while others begin chest compressions. While waiting on ambulance arrive by standers attach AED to this unresponsive seemingly healthy male. The AED orders "NO SHOCK" no shock is given and  bystanders continue chest compressions.

Ambulance crew arrives (along with a fire engine a supervisor and a few police officers) pt is scooped up and placed into ambulance. Then the pt is assessed further by EMS crew. Pt is found to have a pulse with a GCS of 3 as reported by crew pt is breathing on his own. this patient is transported to us at BCH.

When the ambulance gets to the hospital (a very short trip from said rec center) the pt now has a GCS of 10. As pt comes into the critical care area of the ER the patient becomes more and more alert to the point of by the time we get him on the monitor we find out that the patient is deaf. When he does not want to talk to us any more he has another "syncopal" episode.

No one knows ASL in the ER. BCH has many many resources so in rolls a computer on wheels with a web cam on it. We dial up the ASL interpreter who pops right up on the screen and sees a room full of people around a patient who is now "unresponsive" the ASL interpreter is unaware her mike is on and the volume is on full blast on our end and she says:

"HOLY CRAP"

The room erupts in laughter.

The pt. arouses on his own again and begins signing with the interpreter. It begins a very circular conversation which frustrated the hell out of everyone. The patient was a poor historian. The only real complaint we get is the patient is having chest pain. Which figures because bystanders were doing chest compressions on him for a few minutes before the EMS response. Trust me if the AED did not stop the bystanders from shocking him he woulda gotten a 360 joules wake up call.

The patient was rapidly moved out of the critical care area into a regular room.  Never did find out why he passed out and was unresponsive. With intermittent episodes of responsiveness and unresponsiveness who knows what was going on. The patient of course got the million dollar work up. What can you do with these situations?

At least the system worked seemingly flawlessly and kudos to the bystanders:



Soon more mysteries of modern ER care in the dynamic urban environment will be revealed. I am just an old Crusty ER Tech trying to make it to the end of shift.