Coughing

One of the emergency departments that I work at is a freestanding facility in a shopping center.  On a normal night I could see anywhere from 2-10 patients with a wide variety of complaints.  The best one of the night belonged to a 30 something woman who came in with her husband at 3am with a chief complaint of " coughing".  During the assessment phase of her visit with us she proceeded to cough everywhere and of course she did not cover her mouth.  No other symptoms reported, just a COUGH.  Please.  I work with kids all the time and unless they are ranging from ages 0-6 or 7 they even cover their mouths when they cough. 

ahhh, the holidays

I have a houseful right now at home.  With my brood and family visiting for the holidays I have at least 12 people in the house.  Makes it quite interesting when I am trying to sleep during the day to get ready for the night shift. 

Last night was a much needed break.  No one came in with an eye rolling complaint.  It was quite nice.

Pet Peeves top 10

So as you might have figured out by now, I don't blog every day.  I just don't have time for it.  I work full time at one ER and  sometimes at another as well as having a brood at home to deal with.  Oh and a dog too.  So I come on here every now and then just to speak my mind to keep the boredom away (sarcasm anyone?). 

Tonight I would like to go over a short list of pet peeves, some related to patient care and some related to home...

1.  Coming in at 0350 with your very awake/alert/hyper 7 year old who had an emergent fever of 99.7 but of course has no other symptoms and of course you didn't giver her anything because you wanted me to see how high the fever is-is not going to receive any sympathy from me.  Oh and it's a fever for her because she usually runs 97.

2.  Pull your pants up when you walk into the hospital.  I know I don't want to see your boxers.

3. Pick up your feet when you are walking to the room.  I can't stand the shuffle noises. 

4.  Waiting until the child is having sternal retractions before you bring them in to be treated.

5.  Being in triage on a standing room only night and having, not one, not two, but multiple people interrupt me from triaging someone who is actually sick to ask me how long their wait is, or to tell me that it is ridiculous that they should have to wait this long.

6.  I noticed that some hospitals in some states are advertising on billboards how long their wait time is in the Emergency Department and I just have to say, for the record, BAD IDEA.  Some places will even allow you to log onto their website and reserve a place for your totally life threatening emergency. 

7.  Not getting enough sleep.  Due to hubby not acknowledging that you work for like 12 freaking hours and are tired when you get home and you have to do it again the next night so he wakes you up at like 1300 or due to the phone ringing and of course no one else is home and the phone is in the room too. 

8.  When you as a nurse know that antibiotics do not cure viruses but your doctor that your working with tonight is going to go ahead and give the family who does not understand the script anyway because they don't want to do any patient education.  My absolute favorite is when the doc will give your crouper with stridor xopenex.

9.  Ambulance report that states "patient is a little short of breath but pulse ox is 98% on NRB. Patient arrives with stridulous respirations and has a GCS less than 8 and you have to emergently intubate them. 

10.  The one EMS personell that insists on us checking tube placement by auscultation before he will allow us to move the pt from his stretcher to ours.  I always wondered if he is willing to extubate if we refused?

Well, I am sure that eventually you will get a lot more of my pet peeves later.

Ped fever

As I have stated before, I absolutely love working pediatrics.  Not so much working with their families though.  I am sure everyone has had the parent who is hysterical because their child has a fever.  I recently had a grandparent who was just on the edge of being ridiculous.  2 month old with fever as the only symptom so of course I had to do the fever workup which includes IV and blood work.  Grandma looks me in the eye and tells me that I got one chance to get the IV and that is it.  She was completely serious and I had the feeling she was gonna go all exorcist on me if I had not succeeded.  Of course I got the stuff done to her satisfaction but I gotta tell you that it is nerve racking to have someone stand over you and tell you how to do your job.  I don't remember her from school...

Clueless caller...

Clueless Caller:  Yeah, I was at home the other day and I noticed that my vision got a little blurry but then went away.  Yesterday I was reading a book and all of a sudden I could not make out any of the words, not from blurry vision, but I just couldn't put them together in my head right.  I take blah,blah,blah, and blah blah blah, metformin but I am not diabetic, and blah, blah blah...Today I woke up and I have been really shaky.  I have not been eating well for the past couple of days because I have IBS that was diagnosed a few days ago so I haven't really had an appetite. (yes, all of this was said before I could ask her what I could help her with.) 

Me:  Why are you on Metformin if your not diabetic?

Clueless Caller:  Oh, well, because I am close but not really a diabetic.

Me: OK, what have your blood sugars been running at home?  Do you check your blood sugar?

Clueless Caller:  Well, no because they are always good.  Should I come in and be seen?

Me:  Well if you are having blurry vision, shakiness and changes in your vision, you should probably have someone else drive you.

Clueless Caller:  Oh no I'll just go ahead and drive myself.


These are the people who are in traffic with you...

chief complaint of the day...

And the Winner Is....

Blood clots in the nose.

Discharge Instructions:  Quit picking your nose...

Killer

Went to a memorial today for a wrestling legend, Killer Karl Kox.  I knew him only a little even though we were family.  What I do remember about him though were his stories that he would tell us of when he was wrestling. I heard a lot of those today from people who used to work with him and from close friends and family.  It was a nice memorial.  He is going to be greatly missed. 

well child exams

I work primarily with pediatric patients and I enjoy it.  I can also work with adults but I prefer not to for many, many reasons that I am sure you will eventually come to understand.  I enjoy working with the pediatric population for a variety of reasons but the number one reason is that they don't bullshit you.  If a child is sick (with the exception of a few) they will show you by their assessment findings or parent history.  If they are not sick, it is determined by the same methods.  That being said...the emergency room doc cannot fix "congestion since birth" in a 6 month old child who is currently cooing and babbling with a fabulous assessment. Don't get me wrong, I work with fantastic emergency room doctors and they are good, just not miracle workers. 

Unanswered Questions

I have decided that I love giving report to other ER nurses and not so much to other nurses.  The biggest difference is that an ER nurse only wants to know a few things like, "Is the patient pink, breathing, oriented?", "What do I need to do for the patient now?"  I don't get the questions like "Which arm is the IV in?", "Why didn't the Dr order (insert completely inappropriate test here)?", and my personal favorite..."Did you fax the report up already because I can't take report until the actual paper is in front of me that tells me the exact same thing that you are going to relay to me word for word over the phone".  Sometimes I get really lucky and give report to a person who works on the med/surg or cardiac floor that is really an ER nurse at heart.  I love that.