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!
Thursday, December 31, 2015
Tuesday, December 29, 2015
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.
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.
Monday, December 21, 2015
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 wasinhaled 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!
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
More stories from the dynamic work space we call the emergency room. Happy Holidays!
Friday, October 23, 2015
Fifty Four
CT techs (CAT Scan) can be a pain in the ass sometimes. Mostly though they do their work with the utmost professionalism despite the nutty personalities that sit or stand in their work space.
BTDT CT Tech:
I met this tech and worked with her for nearly a year before her "all knowingness" became obnoxious. She had made her bones in a large inner city Level 1 doing XR then eventually CT. She was competent and did her job well mostly. On occasion she'd get pissy and say shit 'Well at the level 1 I used to work at..." Just a little note to folks here don't say that shit, if you do at least phrase it with out a large dose of conceit.
By the time I made it to this Level 3 hospital I had already worked for a long time in a Level 1 also AND worked on a busy urban ambulance service. I knew a thing or two as well. Naturally working in a dynamic environment such as a ER people butt heads. It was only a matter of time before BTDT CT tech and I had a conflict.
An 18y/o male is driven in by his sister after a skateboarding accident. The was hitting a rail fell off his board backwards landing on his right flank. He had made it past the triage nurse who put him at a low level of acuity. I roomed the kid and his sister and thought his story was pretty good. He was complaining of urinating blood and constant right flank pain. His HR and pressure were fine. I did the usual thing. I started an IV and waited for the nurse of the room to pick him up and do an assessment.
Well it was one of THOSE days where one critical patient was coming in after another and the nurses were being pulled every which way. I checked with the charge nurse and made sure it was cool if I ordered a CT on this kid because my spidey senses were tingling. Now several minutes later his hr was rising and his BP dropping just a little he was getting a little pale. It had been a few hours since his fall, his sister talked him into coming to our little Level 3.
Charge says it's cool and since most of her nurses are busy with medical patients that I should take this minor trauma on over to the scanner and get him scanned. Which was what I wanted all along. I pop back in on the kid and his HR is over 110 and BP is low 100's systolic. The kid is in a fair amount of pain. I have fluids wide open on him and bring another bag of NS on him just in case, along with a monitor.
I call CT and BTDT is all cranky. No one is on her table with no scans ordered except mine. I'm thinking I can come right over. Nope, she wants to go smoke first. I'm telling her this kid has a good story and I'm on my way. I'm there in like 2 minutes because man, my little oh shit voice is really whispering in my ear.
We get to the room and I get a ear beating in front of the patient by BTDT CT tech. I tell her to scan him he's a trauma and if she's got a problem call the charge nurse. BTDT CT tech tells me she's seen serious trauma before and he ain't one. The CT tech really rakes me over the coals.
Ah, pride before the fall.
I put the kid on the table and run his VS again more tachy more hypotensive. She scans him and lo and behold he has a nice tear in his renal artery with free fluid in the space. Fuck, he's bleeding internally. Now usually we have to wait for the radiologist to read it but this time since the scanner ain't got shit going on the rad calls right up and says get on the fucking stick it's time for bright lights and cold steel for this kid.
Remember this is a level 3 they ain't use to seeing this kinda thing. I'm immediately on the phone to the charge nurse telling her what the rad is saying. The charge says "Fuck, I'm sending a nurse over now and the lab will pull uncrossed O blood..." I over hear her saying to the ward clerk "Get the on call surgeon and the OR we have a good trauma in CT." The other lines start ringing off the hook in the CT scanner because the rad is calling everyone and everyone is calling CT to get a report. It was a cluster fuck for a second there.
The CT tech is burning a hole through my forehead while I'm on the phone with the charge nurse. The nurse is over in no time at all with the kid's older sister then we rush on over to the OR where they give the kid blood and prep him for surgery. Fortunately the on call surgeon was in the hospital doing rounds.
The kid lived and came back to thank us for saving his life a month or so later. Really his sister saved him by insisting he come to the hospital.
After we drop off the kid to OR I make it a point to go back to the CT tech to hear her out. Basically it boiled down to "Well he did not LOOK like a serious trauma" I was not too gentle about it and told her frankly that she has a lot of experience scanning patients and hardly any with patient care. That when medical staff brings a patient to her she is to do her job and not buck on us because she wants to go smoke. I told her I had a good case to get her ass in a lot of trouble but I was not going to bother because we all have off days, if I hear of it happening again then I'll do all I can to see things through. No one worth a shit is going to tell her how to scan patients so just drop the know it all act.
Keep in mind I'm just a dumb ass ER tech with no real juice. Needless to say as far as I heard such a thing never happened again. In fact she was always very pleasant to me every time I saw her afterwards. If she was being a hemorrhoid to someone and I over heard I'd just get on the phone and say hello then the gates would open. Wah La. I can tell you no one likes the taste of humble pie (myself included) because it tastes a lot like how I would imagine how shit tastes. You never forget it or who serves it up to you.
So goes the job in the dynamic ER environment.
I have more CT tech stories as well as doc stories, nurse stories, cop stories, psych stories and dumb ass ER tech stories as well. More in Movember.https://us.movember.com/
BTDT CT Tech:
I met this tech and worked with her for nearly a year before her "all knowingness" became obnoxious. She had made her bones in a large inner city Level 1 doing XR then eventually CT. She was competent and did her job well mostly. On occasion she'd get pissy and say shit 'Well at the level 1 I used to work at..." Just a little note to folks here don't say that shit, if you do at least phrase it with out a large dose of conceit.
By the time I made it to this Level 3 hospital I had already worked for a long time in a Level 1 also AND worked on a busy urban ambulance service. I knew a thing or two as well. Naturally working in a dynamic environment such as a ER people butt heads. It was only a matter of time before BTDT CT tech and I had a conflict.
An 18y/o male is driven in by his sister after a skateboarding accident. The was hitting a rail fell off his board backwards landing on his right flank. He had made it past the triage nurse who put him at a low level of acuity. I roomed the kid and his sister and thought his story was pretty good. He was complaining of urinating blood and constant right flank pain. His HR and pressure were fine. I did the usual thing. I started an IV and waited for the nurse of the room to pick him up and do an assessment.
Well it was one of THOSE days where one critical patient was coming in after another and the nurses were being pulled every which way. I checked with the charge nurse and made sure it was cool if I ordered a CT on this kid because my spidey senses were tingling. Now several minutes later his hr was rising and his BP dropping just a little he was getting a little pale. It had been a few hours since his fall, his sister talked him into coming to our little Level 3.
Charge says it's cool and since most of her nurses are busy with medical patients that I should take this minor trauma on over to the scanner and get him scanned. Which was what I wanted all along. I pop back in on the kid and his HR is over 110 and BP is low 100's systolic. The kid is in a fair amount of pain. I have fluids wide open on him and bring another bag of NS on him just in case, along with a monitor.
I call CT and BTDT is all cranky. No one is on her table with no scans ordered except mine. I'm thinking I can come right over. Nope, she wants to go smoke first. I'm telling her this kid has a good story and I'm on my way. I'm there in like 2 minutes because man, my little oh shit voice is really whispering in my ear.
We get to the room and I get a ear beating in front of the patient by BTDT CT tech. I tell her to scan him he's a trauma and if she's got a problem call the charge nurse. BTDT CT tech tells me she's seen serious trauma before and he ain't one. The CT tech really rakes me over the coals.
Ah, pride before the fall.
I put the kid on the table and run his VS again more tachy more hypotensive. She scans him and lo and behold he has a nice tear in his renal artery with free fluid in the space. Fuck, he's bleeding internally. Now usually we have to wait for the radiologist to read it but this time since the scanner ain't got shit going on the rad calls right up and says get on the fucking stick it's time for bright lights and cold steel for this kid.
Remember this is a level 3 they ain't use to seeing this kinda thing. I'm immediately on the phone to the charge nurse telling her what the rad is saying. The charge says "Fuck, I'm sending a nurse over now and the lab will pull uncrossed O blood..." I over hear her saying to the ward clerk "Get the on call surgeon and the OR we have a good trauma in CT." The other lines start ringing off the hook in the CT scanner because the rad is calling everyone and everyone is calling CT to get a report. It was a cluster fuck for a second there.
The CT tech is burning a hole through my forehead while I'm on the phone with the charge nurse. The nurse is over in no time at all with the kid's older sister then we rush on over to the OR where they give the kid blood and prep him for surgery. Fortunately the on call surgeon was in the hospital doing rounds.
The kid lived and came back to thank us for saving his life a month or so later. Really his sister saved him by insisting he come to the hospital.
After we drop off the kid to OR I make it a point to go back to the CT tech to hear her out. Basically it boiled down to "Well he did not LOOK like a serious trauma" I was not too gentle about it and told her frankly that she has a lot of experience scanning patients and hardly any with patient care. That when medical staff brings a patient to her she is to do her job and not buck on us because she wants to go smoke. I told her I had a good case to get her ass in a lot of trouble but I was not going to bother because we all have off days, if I hear of it happening again then I'll do all I can to see things through. No one worth a shit is going to tell her how to scan patients so just drop the know it all act.
Keep in mind I'm just a dumb ass ER tech with no real juice. Needless to say as far as I heard such a thing never happened again. In fact she was always very pleasant to me every time I saw her afterwards. If she was being a hemorrhoid to someone and I over heard I'd just get on the phone and say hello then the gates would open. Wah La. I can tell you no one likes the taste of humble pie (myself included) because it tastes a lot like how I would imagine how shit tastes. You never forget it or who serves it up to you.
So goes the job in the dynamic ER environment.
I have more CT tech stories as well as doc stories, nurse stories, cop stories, psych stories and dumb ass ER tech stories as well. More in Movember.https://us.movember.com/
Monday, October 5, 2015
Fifty Three
It should have never gotten to this point.
This patient should have lived the rest of their life in relative comfort and joy after surviving a grievous GSW a few years ago. Yes, they lost the use of their limbs and has to shit in a bag. They have family who should have cared for them or in the very least if they were incapable, find another way for them to live the rest of their days as a human being instead of a slowly decomposing organism, food for any number of microbes and insects.
Instead they put him in a room, turned off the lights and closed the door.
Words will do an injustice to this person's condition. Horrible is the best word I suppose. If you did not feel outrage over this extreme case of neglect then I would challenge you to feel emotion ever again.
We threw everything we had at this person's illness including the kitchen sink then we tore out the wall and pulled out the plumbing and threw that in as well. A valiant attempt at saving a life. We spent hours in the room hanging meds, cleaning the patient all while trying to keep the maggots out of our clothes and shoes. It did no good.
The tragedy did not end there.
The patient coded then died of massive sepsis in our emergency room. Then if the sadness of this was not enough the ICU attending decided to dress down the ER nurse in a very public manner in front of the patients room. It was damn shameful the deceased patient was not even in a body bag yet.
It was all a bit hard to swallow. I nearly walked out just to get a shower and a drink. I did not leave, I'm a professional and we were of course up to our eyeballs with sick patients. We all swallowed this and carried on. The rest of the shift passed on slowly and as all shifts do ended.
I stopped by the liquor store on the way home and bought a tall bottle of whiskey then went home took a shower until the hot water ran out, drank whiskey until I could not see straight and watched goofy comedies and laughed until my sides hurt.
I'm so tired of seeing pain and suffering. I need to find a new career.
This patient should have lived the rest of their life in relative comfort and joy after surviving a grievous GSW a few years ago. Yes, they lost the use of their limbs and has to shit in a bag. They have family who should have cared for them or in the very least if they were incapable, find another way for them to live the rest of their days as a human being instead of a slowly decomposing organism, food for any number of microbes and insects.
Instead they put him in a room, turned off the lights and closed the door.
Words will do an injustice to this person's condition. Horrible is the best word I suppose. If you did not feel outrage over this extreme case of neglect then I would challenge you to feel emotion ever again.
We threw everything we had at this person's illness including the kitchen sink then we tore out the wall and pulled out the plumbing and threw that in as well. A valiant attempt at saving a life. We spent hours in the room hanging meds, cleaning the patient all while trying to keep the maggots out of our clothes and shoes. It did no good.
The tragedy did not end there.
The patient coded then died of massive sepsis in our emergency room. Then if the sadness of this was not enough the ICU attending decided to dress down the ER nurse in a very public manner in front of the patients room. It was damn shameful the deceased patient was not even in a body bag yet.
It was all a bit hard to swallow. I nearly walked out just to get a shower and a drink. I did not leave, I'm a professional and we were of course up to our eyeballs with sick patients. We all swallowed this and carried on. The rest of the shift passed on slowly and as all shifts do ended.
I stopped by the liquor store on the way home and bought a tall bottle of whiskey then went home took a shower until the hot water ran out, drank whiskey until I could not see straight and watched goofy comedies and laughed until my sides hurt.
I'm so tired of seeing pain and suffering. I need to find a new career.
Wednesday, September 9, 2015
Fifty Two
Five nurses + One ER Tech + 100 patients in waiting room = a severe HA for the tech which is alleviated after shift fine bourbon PRN.
Five nurses who every time I even looked like I wanted to do my job in triage stopped me and asked me to do at least two things at once. Often they interrupted each other while telling me they needed me to do one thing or other and then another then another oh and another. You know "If you aren't busy doing something else." Of course I'm fucking busy doing something else we have at least 100 patients in the waiting room.
Crusty ER Tech is just one person.
Five nurses who every time I even looked like I wanted to do my job in triage stopped me and asked me to do at least two things at once. Often they interrupted each other while telling me they needed me to do one thing or other and then another then another oh and another. You know "If you aren't busy doing something else." Of course I'm fucking busy doing something else we have at least 100 patients in the waiting room.
Crusty ER Tech is just one person.
Saturday, August 29, 2015
Fifty one
Been away for a bit, Crusty ER Tech has been busy picking up extra shifts in the grind of a summer term and now present fall semester. I've had some stories that stick out. One I'd like to relate to you is how some people work hard (and sometimes at the expense of a patient) to make themselves look good.
Nurse Bass is a prime example. Nurse Bass is the typical busy body nurse who is the one arranging baby showers and birthday parties for everyone on staff whether or not they want it. Nurse Bass will make it a point to guilt trip you into putting money into the hat even for people you don't particularly like, which makes for a rub between she and Crusty because his funds are limited and he's not going to pay an ATM fee break a twenty and donate a fiver for a jackass resident who does not know what a sterile field truly is. Nurse Bass once spent a full four hours of a 12 hr shift going around the entire ER (and ambulance bay) getting people to sign a card and donate money for a baby shower she was throwing the next day. Crusty has no problem with these little baby showers and bday parties on shift. he likes the food. Crusty just has a problem with you practically abandoning your assignment and the patients curse him because you're never around. Nurse Bass never ever speaks to the ol' Crusty one unless she wants something. I've even told her so. She does not take me seriously of course because she's a nurse and Crusty he's just an ER tech. Which leads into today's story.
Awhile back Crusty is working Triage. Crusty's job in triage is simple, take vital signs and do what he is told. Naturally, when he sees a sick patient pop up either right in front of him or on the screen he tends to want to take initiative because patients have died in waiting rooms before.
A SOB (Shortness Of Breath) pt pops up on the screen and I jump up to go see if I can find her. For a couple of reasons one because of standing protocols a 12 lead EKG is going to be ordered on the patient, usually the EKG tech is not around so the ER tech is stuck doing this simple procedure. Secondly and MORE IMPORTANTLY the patient might need some oxygen. Due to the demographics of the population that goes to our hospital these patients tend to spend their money on rent and food instead of meds that can keep them alive. Knowing this I go hunting for the patient.
The ER waiting room is crowded. We have terrible lines of sight in the waiting room in fact the main waiting area is a dead end fire trap. I'm going into the main waiting area when Nurse Bass asks me what I am doing. I tell her I'm looking for Pt R. who is on the board as being short of breath. I want to make sure she gets O2 if she needs it and an EKG is going to be ordered according to protocol.
Nurse Bass says to me. "Oh Pt R? she's getting an EKG right now." I ask if she is sure. Nurse Bass gives me a dirty look and responds in the affirmative. Great, I think and return to my station to do vital signs and what I am told.
Not even a minute later Nurse Bass is running up to me telling me she needs a wheel chair. I say sure it's right behind me (The techs in this particular ER are in charge of keeping track of stretchers and wheelchairs) I ask what's up. Nurse Bass informs me that Pt R who was suppose to be getting an EKG is on the floor in the back of the main waiting room and she is "very much short of breath"
I give Nurse Bass the wheel chair and off she trots. We get her into the wheel chair and while I am walking off to get O2 and a non-rebreather mask and a nasal cannula. Nurse Bass tells me "Get her O2 and a nasal cannula stat!" No shit she said stat. I return quickly with both and Nurse Bass has now put the pt in the EKG bay with an EKG tech. I tell Nurse Bass we need to put the pt on O2 now she puts the kibosh on that idea. We can't bother them because they need an accurate EKG.
I was taught Airway trumps everything else, ya know the "A" in ABC (airway, breathing and circulation) I've seen the Pt I know they are gasping for breath right when I start to go into the EKG bay the EKG tech (who was only around because he was delivering coffee to some friends in the dept) says he's done. Nurse Bass because of her sheer size pushes me out of the way and puts the pt in the wheelchair. I figure she is going to put O2 on the pt while at least get a baseline pulse ox and VS because usually the, respiratory therapist, mid-levels, residents and attendings like to know those details.
She snatches the pulse ox probe off the patient puts the patient onto 2 liters nasal cannula and rushes to the back with the patient. About half an hour later one of the attendings is following Nurse Bass back out to the waiting area congratulating her on her great catch of a patient who was severely short of breath. Once that is over I approach Nurse Bass.
"Nurse Bass I just want to make clear that you stopped me from looking for a patient that was SOB, telling me they were in the EKG bay getting an EKG. That you then proceeded to look for and find the same patient I was looking for who you lied about. When I went to put this same patient onto O2 you denied them oxygen because they were getting an EKG and you also kept me from getting baseline pulse ox and VS on a pt before a provider saw her. I just want to make that clear."
Nurse Bass tried to interrupt me while I was saying this and I just held up my hand stopping her momentarily. When I was done, she gave me a dirty look and walked off. Nurse Bass did not talk to me for the rest of the day. I guess I'll never have her throw me an on shift birthday party or baby shower.
Damn.
So went another shift for the old Crusty ER Tech.
Nurse Bass is a prime example. Nurse Bass is the typical busy body nurse who is the one arranging baby showers and birthday parties for everyone on staff whether or not they want it. Nurse Bass will make it a point to guilt trip you into putting money into the hat even for people you don't particularly like, which makes for a rub between she and Crusty because his funds are limited and he's not going to pay an ATM fee break a twenty and donate a fiver for a jackass resident who does not know what a sterile field truly is. Nurse Bass once spent a full four hours of a 12 hr shift going around the entire ER (and ambulance bay) getting people to sign a card and donate money for a baby shower she was throwing the next day. Crusty has no problem with these little baby showers and bday parties on shift. he likes the food. Crusty just has a problem with you practically abandoning your assignment and the patients curse him because you're never around. Nurse Bass never ever speaks to the ol' Crusty one unless she wants something. I've even told her so. She does not take me seriously of course because she's a nurse and Crusty he's just an ER tech. Which leads into today's story.
Awhile back Crusty is working Triage. Crusty's job in triage is simple, take vital signs and do what he is told. Naturally, when he sees a sick patient pop up either right in front of him or on the screen he tends to want to take initiative because patients have died in waiting rooms before.
A SOB (Shortness Of Breath) pt pops up on the screen and I jump up to go see if I can find her. For a couple of reasons one because of standing protocols a 12 lead EKG is going to be ordered on the patient, usually the EKG tech is not around so the ER tech is stuck doing this simple procedure. Secondly and MORE IMPORTANTLY the patient might need some oxygen. Due to the demographics of the population that goes to our hospital these patients tend to spend their money on rent and food instead of meds that can keep them alive. Knowing this I go hunting for the patient.
The ER waiting room is crowded. We have terrible lines of sight in the waiting room in fact the main waiting area is a dead end fire trap. I'm going into the main waiting area when Nurse Bass asks me what I am doing. I tell her I'm looking for Pt R. who is on the board as being short of breath. I want to make sure she gets O2 if she needs it and an EKG is going to be ordered according to protocol.
Nurse Bass says to me. "Oh Pt R? she's getting an EKG right now." I ask if she is sure. Nurse Bass gives me a dirty look and responds in the affirmative. Great, I think and return to my station to do vital signs and what I am told.
Not even a minute later Nurse Bass is running up to me telling me she needs a wheel chair. I say sure it's right behind me (The techs in this particular ER are in charge of keeping track of stretchers and wheelchairs) I ask what's up. Nurse Bass informs me that Pt R who was suppose to be getting an EKG is on the floor in the back of the main waiting room and she is "very much short of breath"
I give Nurse Bass the wheel chair and off she trots. We get her into the wheel chair and while I am walking off to get O2 and a non-rebreather mask and a nasal cannula. Nurse Bass tells me "Get her O2 and a nasal cannula stat!" No shit she said stat. I return quickly with both and Nurse Bass has now put the pt in the EKG bay with an EKG tech. I tell Nurse Bass we need to put the pt on O2 now she puts the kibosh on that idea. We can't bother them because they need an accurate EKG.
I was taught Airway trumps everything else, ya know the "A" in ABC (airway, breathing and circulation) I've seen the Pt I know they are gasping for breath right when I start to go into the EKG bay the EKG tech (who was only around because he was delivering coffee to some friends in the dept) says he's done. Nurse Bass because of her sheer size pushes me out of the way and puts the pt in the wheelchair. I figure she is going to put O2 on the pt while at least get a baseline pulse ox and VS because usually the, respiratory therapist, mid-levels, residents and attendings like to know those details.
She snatches the pulse ox probe off the patient puts the patient onto 2 liters nasal cannula and rushes to the back with the patient. About half an hour later one of the attendings is following Nurse Bass back out to the waiting area congratulating her on her great catch of a patient who was severely short of breath. Once that is over I approach Nurse Bass.
"Nurse Bass I just want to make clear that you stopped me from looking for a patient that was SOB, telling me they were in the EKG bay getting an EKG. That you then proceeded to look for and find the same patient I was looking for who you lied about. When I went to put this same patient onto O2 you denied them oxygen because they were getting an EKG and you also kept me from getting baseline pulse ox and VS on a pt before a provider saw her. I just want to make that clear."
Nurse Bass tried to interrupt me while I was saying this and I just held up my hand stopping her momentarily. When I was done, she gave me a dirty look and walked off. Nurse Bass did not talk to me for the rest of the day. I guess I'll never have her throw me an on shift birthday party or baby shower.
Damn.
So went another shift for the old Crusty ER Tech.
Saturday, June 20, 2015
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.
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.
Monday, May 18, 2015
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.
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.
Wednesday, April 1, 2015
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.
Friday, January 23, 2015
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.
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.
Sunday, January 11, 2015
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."
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."
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