#575 - F is for Frenetic

Momma told me there'd be days like this...

Here's an example of the kind of day I DON'T like to have in the E.D...

My shift started at 0800, there were already 5 patients on the board,

4 of which my colleague signed out to me waiting for lab or xray results.

The patients I saw today:

 - patient who swallowed an entire bottle of herbal supplement after confusing it with a bottle of 5 Hour Energy Drink

 - leg pain for a week, worse today

 - I Didn't Know I was Pregnant show candidate who came in about 7 months pregnant and using meth

- patient with facial lac after a fall out of their wheelchair

- psych patient off their meds who ran out the door twice, and brought back by police once

- patient who passed out while getting out of their trailer

 - strep throat

- skin infection

- patient who passed out while doing chair exercises with their senior group

 - asthma attack

 - migraine headache

- hair coloring on beard gone awry

- dental infection

- alcohol intoxication, passed out in front of the local market

- cough for several months

- chronic headache who could only be treated with demerol which we haven't had in the ED for years

- tick bite brought in because "we didn't get it all out"

- end of life hospice patient

- patient who was second in line to be seen, but left because after waiting 30 minutes they couldn't wait any longer for the CT they knew "they just had to have" for the belly pain that had been going on for several weeks

- appendicitis

- eye irritation

- panic attack

- alcohol intoxication hit in head by spouse with head laceration that then cussed us out and ran out the door

- skin infection

- febrile illness in transplant patient

I left out identifiers like sex... the pregnant person you can figure out.

I left out much of some of the back story because this is a small town

after all, and everyone knows everyone's business as it is...

These all came in within a 12 hours period and kept my ED busy

the entire time...

Let's now even talk about how many charts I have yet to do...

Like Moths to the Flame...

Some days the E.D. is just like this...


I was signed out a patient that was waiting for a simple blood test.  The blood test came back slightly abnormal so I called the patient's private physician, and we made some medication adjustments and the patient was discharged back to their senior living facility.


I spent 20 minutes wrestling with a 4 year old who was bitten in the face by the family dog and needed just one stitch to hold his lip together.  And then, I got several more patients that were "verticals" meaning patients that had simple clinical problems: uti's, colds, etc.  Quick see, write a script, discharge.  Then I got my next patient.


He was convinced that a sexual encounter he had over 30 years ago is still causing multiple medical symptoms that have to be checked out a couple of times a year.  He couldn't answer any of my questions with anything more than a grunt or a yes or no.  For every question about his condition he kept telling me, "It's in your computer somewhere."  Very frustrating.  I ordered some simple things and got him some medications for his symptoms and then discharged him.


No sooner had we cleared out the room, then there was a banging on the triage window.  A patient was having chest pain after an assault.  His face was beaten, he had a cut lip.  He said he felt pressure in his chest after the assault but managed to go to the police station to file a report, and then to the optometrist to get his glasses fixed.  The optometrist told him he didn't look so good and maybe he should go to the E.R.  By the time he got to us, his chest pain was pretty severe, and his EKG confirmed a STEMI.


We went into overdrive to meet our goal of sending this patient to our sister hospital to the get to the cath lab.  At some point in the middle of this flurry of activity, there was a large BOOM!  It was thunder.  Then suddenly, hail the size of ping pong balls started falling.  Within a few minutes, the ground was white.  We all looked at each other thinking, "Oh, &*^%$!"


Sure enough, the tone out signaled an ambulance call to a multi-vehicle accident.  Then a second ambulance was called out to the same accident.  Then another tone out for a another accident.  About this time, my husband texted that one of our new goats had jumped the fence that he had put up in the barn.  And another tone out sounded for the patient we had sent out earlier in the morning.  And another tone out for a frequent flyer who was "lethargic."


While we waited for ambulances to start arriving, I saw another couple of "verticals."  Another patient showed up with a possible ectopic pregnancy, but she signed out AMA because she had to "go pick up my other kid from school."  I explained the risks of everything from worsened pain to bleeding to death, and the patient left.


We got the "lethargic" patient in.  The STEMI got shipped out (did I mention he had his service dog with him? A large German shepherd that went with him in the ambulance).  And then three patients all came in at the same time from the car accident.  While I got them all seen and orders written, we got another couple of "verticals" through the triage window.  I quickly saw them, and we seemed to be on a roll.


Then a mother brought her son in for an evaluation.  He'd fallen on his back and hit his head while playing basketball out in the rain.  She wanted to make sure he was ok since he had "hit his head on the side where his brain was."  I kept a straight face while she said this.  The patient in the other bed on the other side of the curtain giggled somewhat loudly.  I politely explained that the brain filled the whole skull and didn't just sit on one side.  I could still hear giggling as I walked out of the room.


My car crash victims were all discharged and a new round of ambulance patients filled the rooms.  My "lethargic" was transferred to the sister hospital since her cardiologist was there.  I admitted a very sick patient with heart failure.  I sent home an elderly gentleman who kept falling, most likely because he was over-sedated by all the medications his physician had him on.  I signed out an elderly lady with broken ribs from her recent fall and came home.


My hubby reported that the wayward goat jumped every barrier my husband set up, so our barn now looks like Fort Knox.  One of my cats caught a mole and decided to play with it in the kitchen while my husband was having lunch.  At one point, the cat tossed the mole up in the air and it landed in my husband's boot.  So that's how his day went. 


Seriously, you can't make this stuff up.

Full Moon, Saturday Night...

There have actually been medical studies performed to disprove the notion that E.D.'s become more crowded on Full Moons.  However, ask any E.D. physician or nurse, and they will tell you that the crazies do seem to come around more during the full moon.  Add a busy Saturday night, and it's a recipe for complete chaos.... if you're the superstitious sort.  Which I am... I'll let you be the judge.

I came on shift last night to a full board, a child continuously crying, a patient in the corner room yelling out, "Nurse!  Doctor!  I need something for my pain!" and a bevy of police officers.  Looking around,  I put my stuff down in our work area and started picking up charts to see patients.

The Screamer is a regular who comes in demanding narcotics and has a "pain specialist" that prescribes a large quantity of pain medications on a regular basis.  So, I don't quickly rush into that room.  I go see a patient with an injured shoulder.

The crying child got into some of her grandmother's medication and is sitting around waiting to see if she has any lasting effects.  She's screaming because she's been in the E.D. for 2 hours... and has 2 more hours to go.  We'll see if her lungs last that long... or our ears.

A radio call comes out that there's been a rollover accident on the highway 30 miles south of us... three injured.  They'll be at our doors in about an hour.  I haven't even been in the E.D. for an hour.

My colleague who worked the day shift signs out her one patient... who's supposed to go home.  However, the patient's heart decides to go into an irregular rhythm which means more tests and an admission for me on a patient I really don't know a lot about.  But, ok.  I have a patient who shot off part of their finger;  which explains the police presence.  I go see them.

The Screamer starts to yell in a more fevered pitch, and the RN takes a call from the Screamer's Spouse demanding to know why we haven't treated their spouse.  I sigh looking at the still-full board and waiting room and walk into the room.  To say that things did not progress well is an understatement.

The Rollover Trio arrive.  They are supposed to be evaluated for their traumas.  They are all gone within half an hour.  The E.D. staff and the arrival of law enforcement forces them to answer a lot of questions they don't want to.  So they all disappear.  One with what I could guess is a broken arm based on my fleeting vision of them as they made their way out of the E.D.

The Child is still screaming and the Screamer wants more of anything we are willing to give them.  I deal with a tooth abscess on a patient with bad teeth, who's a smoker who has a history of heroin abuse.  Then another abscess on a patient visiting family in the area.  And a child who dropped a rock on their foot and broke a bone.

The Screamer's decided they have had some relief with the non-narcotic cocktail I gave them, and they leave.  I check out the Child and get them going.  The E.D. is emptying out.  I sew together the cheek of a patient who fell while riding their motorbike, and then I finally finish treating the missing finger part.

Around this time I get a child who is very ill and who will tie up most of the rest of my shift.  I see a patient who thinks they got broken ribs from a tight hug, and another who was seen six hours before at our sister hospital who thinks their rash was getting worse.  I spend my last hour dictating the charts from the night, and a few I had left over from my previous shift.

Morning comes, and my relief comes.... I sign out my sick child who is waiting for transport to another hospital and go home.  I think those studies are trumped by anecdotal evidence.