What is it like working in the ER??

1. You are assisting a primary nurse with charcoal administration down an orogastric tube. The room measures eight feet by twelve feet. The patient starts to retch before the tube is pulled. Knowing that charcoal can spew out of a tube in a five foot radius (even with a thumb over the opening) and the stretcher is two feet wide, how many feet per second do you have to back up to get less charcoal on you than the primary nurse?

2. Doctor A picks up a chart out of the rack. S/he finds that it is a repeat patient with abdominal pain. Doctor A puts the chart back. Doctor B picks up the chart five minutes later and also returns it to the rack. Doctor A leaves the nurses’ station heading south at three miles per hour. Doctor B leaves the nurses station for the doctors’ lounge at five miles per hour. How long before the patient is at equal distance from Doctor A and Doctor B?

3. You were assigned two large treatment rooms and the gynecologic room. By the end of the day you have cared for ten patients. Four patients were female over the age of 80, all complaining of weakness. Two patients were male, ages 72 and 50. The last four were female, between the ages of 24 and 40, all complaining of abdominal pain. It is 3:00 p.m. and time to restock the rooms. How many bedpans will you need?

4. You are the primary nurse for an elderly patient with congestive heart failure. The IV stick was exceptionally difficult, but you are able to start an 18 gauge catheter on the second attempt. You leave the room to check on another patient. A relative thinks that the IV has stopped dripping and opens the clamp. How much IV fluid will infuse before you return?

5. You are sent for your morning coffee break. You need to use the restroom but can’t find one unoccupied and have to walk down to the lobby. The coffee pot is dry and you have to make more. When you get to the cafeteria, the line extends ten feet into the hallway. You can’t remember exactly when your break began. How much time do you have left?

6. You are the primary nurse taking care of a particularly shy female in the gynecology room. Her private physician arrives to see her, but you can see that he is not in a particularly good mood. After much coaxing, the patient agrees to a pelvic exam. How many people will open the door during the exam?

7. An elderly man arrives in the Emergency Department by rescue squad. Twenty minutes later his wife arrives and registers him. She is shown the entrance to the department and slowly shuffles in. How many rooms will she walk into before she finds him?

8. You are assigned to the EENT room. You have a patient to be checked for a peritonsillar abscess. The ENT physician has been paged and expects to arrive in 45 minutes. Three hours later, he arrives and is at the patient’s side, asking for a flashlight. Lightly jogging at 22 miles per hour, how many rooms will you have to search before you find one?

9. You have been asked to cover a coworker’s rooms during her break. One of her patients is an elderly, confused male with an enlarged prostate. A catheter has been inserted and his physician is coming to see him. Somehow he manages to get off the stretcher. The drainage bag is firmly hooked to the side rail. Knowing that the catheter is 16 inches long and the drainage tubing is three feet long, will he be able to reach the door before pulling out the catheter?

10. A college student named Muffy is brought to the Emergency Department with a sore throat. She has no relatives in the area. Will there be enough chairs in the waiting room for deeply concerned significant others?

I’m not sure where I originally read this, but I thought it was a good indication of the craziness in the ER.  I do love it though.  I love never knowing what is going to walk through the door next.  I love the turn over of patients, 3 or more through each room per shift.

My ER experience

So, I got to make a trip to the ER for the first time in my life last night.  I woke up in pain around 1AM, after walking around for awhile I was able to lay back down and get some sleep.  Then a little before 4AM I woke up and felt like I had an alien growing inside of me.  No matter what I did the pain would not get better.  We’re just covered by Cobra, which is a pain, so I DID NOT want to go to the ER.  But, I knew that I could not handle that pain, I have never felt anything like it.

Brian and I both got up, threw on some shoes, put Maggie in her crate and headed to the hospital.  I debated the entire way out of our subdivision and to the main road to either hospital about where I wanted to go.  To the hospital I work at, or the one in Douglasville, which is closer but smaller.  I really wanted to go to my ER, I think because it is familiar to me.  I knew that Douglasville was smaller and I was scared that they wouldn’t be able to handle anything serious.

Once we got to the main road where I had to make a decision I decided on the closer one, just so I could get some pain meds in me as quickly as possible.  That and I figured their waiting room had a better chance of being empty.  I was praying the entire way for God to ease the pain so it was at least bearable.  By the time we got to the ER it had eased off a little.

Thankfully, my instincts were right, the waiting room was empty and they took me straight back.  The Dr was in my room in less than 10 minutes.  At my hospital I probably would have waited at least an hour, just because they see thousands more patients a month.  The nurse had a hard time getting an IV in me.  I had to get stuck three times.  Then, finally, some relief!  I had never had anything stronger than Tylenol or Advil in my life, so I wasn’t sure what to expect.  When she told me she was pushing Dilaudid I was just like “OK, whatever.”  Then as soon as it went in I freaked a little.  I wanted to know how much I had gotten, because we’ve been having problems at my ER with people coding after getting Dilaudid lately.  Thankfully she only gave me one milligram.  I could feel how it could make you stop breathing.  WOW, that stuff was strong.  *Note to self, try to get patients pain meds even more ASAP than I do now, and be a little more compassionate for patients that I have to poke more than once.*

A few hours went by, and I tried to wait patiently because I knew our nurse had gone home and a new nurse had taken over and was probably trying to get settled.  Finally someone came to take me to an ultrasound that I didn’t know I was going to get.  Once I got there I was like “Um, what are you looking for? They didn’t tell me they had ordered an ultrasound.”  They were looking at my gallbladder.  *Note to self, try to do an even better job keeping my patients informed.*

Not long after they finished my ultrasound the Dr came back in and let me know that I had gallstones and they were waiting for a surgeon to see me.

They ended up letting me leave with some pain and nausea meds and I am seeing a surgeon later this week.  I will probably have my gallbladder taken out sometime next week or so.  I know they want to do it soon because my bilirubin numbers are elevated.  I’ve found out today that both sides of my family have had gallstone problems.  A couple of years ago I went to the Dr because I had been up in the middle of the night every night with stomach pain, but they blew it off as indigestion and gave me some pills to take.  I think that it was my gallbladder, because this was the same time of pain, just 10,000 times worse.

Once I got home I slept really well.  Not getting any sleep all week because of swing shifts at work and two nice doses of pain meds will do that to you.

So, maybe this was God’s way of giving me the perspective of the patient before I get out on my own in the ER.  It is also weird being the patient.  I don’t know whether to play dumb and let them speak to me like I have no medical knowledge.  Or tell them that I’m a nurse so they will give me more detailed information.  Anyway, I will keep you updated on my surgery.

More house pics

I keep getting hounded to post more pics of the house.  We haven’t gotten a whole lot done since I posted last, but here are a few more pics.

Some of my bird feeders.

Brian’s office, still in progress.  It actually looks worse now than it did two days ago.  How is that possible?

The downstairs bath.

The upstairs guest bath.

My office/one of the spare bedrooms.  It’s still a work in progress.  That’s my trundle bed that I slept in when I was young.  We stripped off the brown varnish and painted it black.

Brian mowing the lawn for the first time.

In Need of Prayer

It’s been a rough weekend.  My family has sickness going on along with a lot of stress of who can help take can of my grandparents.  My sister also found out that her fiance got papers to be in Japan a lot sooner than expected.  For those of you who don’ know her fiance is in the Air Force.  This means they are going to have to get married several months sooner than planned.

I also had a really rough night at work.  The nurse that is training me and I were in pod 3, which is where the worst patients are put.  We also had the trauma room, so we had the worst room in the worst pod.  With in 30 minutes we had two deaths in that room.  Both of them came in already receiving CPR in the ambulance.  The first patiens was a cute little old lady from a nursing home, her family came in and handled it well.  They seemed to be at peace about it that she had lived a good life and it was her time.

The next man was in his 50’s, but in very poor health.  He weighed almost 500 pounds with long time lung and heart problems.  About 20 of his family members, including small children showed up and were all hysterical.  It got pretty interesting for awhile.  And please, don’t let small children into the room right after a death.  It’s pretty traumatic and the mom of the children who showed up a little while later was not happy that they were taken into the room by the family.

The next death was the worst, though it wasn’t our patient.   I don’t know the whole story, I just know that a 25 year old female came in with her boyfriend and her 3 day old baby.  I believe she was diagnosed with pneumonia.  Sometime around midnight she started screaming that she couldn’t breath and soon she was entibated, then her heart stopped beating.  The best we could tell she threw a clot.  They worked on her for almost two hours, trying everything anyone could think of.  They even had a cardiologist in the room doing an echo trying to see if there was something wrong with her heart that they could rush her to surgery for.  All of the staff around the ER was silent and teary eyed the whole two hours, just watching the monitor and periodically stepping into the room praying for a miracle.  One of the ER Techs did chest compressions for the entire two hours no matter how many people offered and insisted that he let someone else do compressions for awhile.  I think it was the only way he could feel like he was helping her.

She had no family except for her 19 year old boyfriend, and from what we could gather he didn’t really have any family either.  At least none there supporting him.  I’m just praying that his family will step it up and help him raise that little baby.

I don’t work in the ER again until next Sunday night because I’m in class the rest of this week. Hopefully next Sunday night won’t be so awful.