15 days from my last post...and the only reason I'm able to blog at all right now is because I showed up to clinicals an hour early to go to noon conference (like I normally do)...only it was cancelled, and nobody let me know!
So I made my way to the library and decided I had 2 options: 1.) I could try and squeeze in some homework or the discussion postings for this week, OR 2.) I could check out facebook and my blogs since I haven't done it in, oh FOREVER!!
Guess which one won : ) ???
The lack of blogging(and FB'ing for that matter!) probably has something to do with the insane amounts of homework that my professors have tried to pile in. Make that, "they did pile in!" I'm TRYING to get it all done!!
I officially have 3 papers left...one for each Monday this quarter. Then it's off to an AMAZING Mexican fiesta for 10 days with my family! I CAN'T WAIT!!!!
And then 10 more weeks til I'm officially a Nurse Practitioner!! OK, well at least until I'm a Masters graduate. The NP will come once I pass boards and get credentialed...details schmetails!
Over the last 2 weeks, the E.R. was every bit as exciting as stated in the last 2 posts. I'm still baffled at the lack of "Emergency" there, but it is what it is!
This week, I am going to a Press Ganey conference for 2 days. It will be 16 hours of fun learning about how to improve our patient satisfaction scores. While I know the days will be long, I'm actually excited to go b/c I know that I'll learn some great stuff to take back to my unit, and the hospital as a whole!
My times up, but before I go, I want to leave you with a funny story from work the other day. My patient's mom, who I know very well, came in laughing and so excited to tell me something!! Her husband was in a pretty bad accident and needed to have surgery (that's not the funny part)- he needed bladder surgery. Only, instead of telling people he had bladder surgery, he kept telling people he had uterine surgery!
What's even more funny is she said NONE of their friends even caught on!! They just said "Oh my gosh that must be so painful" and "Wow, I can't believe you had surgery on that!" She had to calmly (I'm sure she was laughing hysterically!) explain, "Honey, you do not have a uterus. Nor do any other men!!"
Ohh, people can be funny!
K, well that's all for my break. Time to make my way to the exciting life of the Emergency Room for the next 10 hours!!! Hope you're doing something just as exciting tonight as well : )
Tuesday, May 17, 2011
Monday, May 2, 2011
Day 2 in the Room of Emergencies (AKA: ER)
I have to believe that at one time the Emergency Room truly fulfilled its name.
Maybe it's because I'm a PICU nurse at heart, and we truly do care for PICU patients. Once they no longer fit that criteria, they go to the general floor.
However, the ER is definitely NOT that way!! Apparently anyone can come in, at anytime of day or night, for any reason.
Your kid chops his finger off? Bring him to the ER!
Your lovely daughter drank your entire bottle of perfume? Take her right to the ER!
Your 2 year old has a cold? Welcome to the ER!
Your four year old is crying too much? Oh yeah, ER!
Stubbed toe? Ringworm? Rash? Definite ER!!
You would think the average person reading the above list would be able to differentiate between the appropriate ER trips, and the not so appropriate ones! But I'm begging to differ!! People bring their child into the ER for the SILLIEST reasons ever!!
Take Ms. Black for example (name totally made up). She decides that her 8 year old son who has autism has been acting "all wrong" for the last 2 weeks...ever since he got bit by an unknown animal in their house. So she brings him to the ER.
When trying to gather all the information about what brought them their, we had to revisit the whole "animal bite" incident for which they were in the ER 2 weeks ago. Apparently some animal in their house (maybe a rat, maybe a possum, maybe a raccoon) bit the kids hand right by the thumb.
Now first of all, before we move on...how many people do you know have possums or racoons routinely in the house...and close enough to biting distance!? Apparently this lady says they come in all the time and she sees their footprints on their walls when they wake up in the mornings.
So now they are wall walking, not supposed to be in the house, animals.
As a side note, she also said that the toys she puts away at night are all over the living room floor int he morning too. Great, now we're dealing with a possum/coon who likes to play with 8 year old toys in the middle of the night.
Not that the 8 year old is getting out of bed to play. Of course not!
So back to the bite. The "wound" if it could even be called that was cleaned, a steri-strip was placed, a few labs were run, and the patient was sent home.
However, the patient is now in the ER because Ms. Black says that "The venom of whatever bit my son is turning him the same. He's been biting me all week long!"
Then she throws in there that he has rabies too.
Good news for the boy. After a thorough physical exam, he is 100% fine. He is acting appropriately for an 8 year old with autism, his lungs were as clear as a bell, heart strong, and rabies symptoms definitely negative!
As I'm telling her all this, and telling her that we would be sending her home with a recommendation to follow-up with her primary care provider who follows his autism, she asks if we can draw a CBC.
"No ma'am, there is no indication of drawing that lab."
Then she brings up the fact that his "urine smells bad, real bad"- to which, ironically enough the patient yells "STINKY CHEESE!" Mind you, he hadn't spoken a word all visit! We discuss proper hygiene, especially as he is a bigger 8 year old who is wearning a diaper and probably sweats a lot.
She doesn't like that answer. She wants a urine dip done.
My answer would have been NO! The resident, just to appease her says, "Ma'am, I can almost guarantee you his urine will come back clean. But just to ease your nerves, if he pees in the cup, we'll run it."
She tells us "That's smart. I know he's got an infection. He definitely has vaginitis."
Hello...back it up!! HE'S got VAGINITIS!?!? Umm, I think not!!
So we run the urine, and wouldn't you know...it's completely normal!!! Vaginitis negative : )
So after running 1 more test that I would have preferred, we finally send them out the door.
Thank you for visiting the ER. Please come again soon...I'm sure Ms. Black will!!!
Maybe it's because I'm a PICU nurse at heart, and we truly do care for PICU patients. Once they no longer fit that criteria, they go to the general floor.
However, the ER is definitely NOT that way!! Apparently anyone can come in, at anytime of day or night, for any reason.
Your kid chops his finger off? Bring him to the ER!
Your lovely daughter drank your entire bottle of perfume? Take her right to the ER!
Your 2 year old has a cold? Welcome to the ER!
Your four year old is crying too much? Oh yeah, ER!
Stubbed toe? Ringworm? Rash? Definite ER!!
You would think the average person reading the above list would be able to differentiate between the appropriate ER trips, and the not so appropriate ones! But I'm begging to differ!! People bring their child into the ER for the SILLIEST reasons ever!!
Take Ms. Black for example (name totally made up). She decides that her 8 year old son who has autism has been acting "all wrong" for the last 2 weeks...ever since he got bit by an unknown animal in their house. So she brings him to the ER.
When trying to gather all the information about what brought them their, we had to revisit the whole "animal bite" incident for which they were in the ER 2 weeks ago. Apparently some animal in their house (maybe a rat, maybe a possum, maybe a raccoon) bit the kids hand right by the thumb.
Now first of all, before we move on...how many people do you know have possums or racoons routinely in the house...and close enough to biting distance!? Apparently this lady says they come in all the time and she sees their footprints on their walls when they wake up in the mornings.
So now they are wall walking, not supposed to be in the house, animals.
As a side note, she also said that the toys she puts away at night are all over the living room floor int he morning too. Great, now we're dealing with a possum/coon who likes to play with 8 year old toys in the middle of the night.
Not that the 8 year old is getting out of bed to play. Of course not!So back to the bite. The "wound" if it could even be called that was cleaned, a steri-strip was placed, a few labs were run, and the patient was sent home.
However, the patient is now in the ER because Ms. Black says that "The venom of whatever bit my son is turning him the same. He's been biting me all week long!"
Then she throws in there that he has rabies too.
Good news for the boy. After a thorough physical exam, he is 100% fine. He is acting appropriately for an 8 year old with autism, his lungs were as clear as a bell, heart strong, and rabies symptoms definitely negative!
As I'm telling her all this, and telling her that we would be sending her home with a recommendation to follow-up with her primary care provider who follows his autism, she asks if we can draw a CBC.
"No ma'am, there is no indication of drawing that lab."
Then she brings up the fact that his "urine smells bad, real bad"- to which, ironically enough the patient yells "STINKY CHEESE!" Mind you, he hadn't spoken a word all visit! We discuss proper hygiene, especially as he is a bigger 8 year old who is wearning a diaper and probably sweats a lot.
She doesn't like that answer. She wants a urine dip done.
My answer would have been NO! The resident, just to appease her says, "Ma'am, I can almost guarantee you his urine will come back clean. But just to ease your nerves, if he pees in the cup, we'll run it."
She tells us "That's smart. I know he's got an infection. He definitely has vaginitis."
Hello...back it up!! HE'S got VAGINITIS!?!? Umm, I think not!!
So we run the urine, and wouldn't you know...it's completely normal!!! Vaginitis negative : )
So after running 1 more test that I would have preferred, we finally send them out the door.
Thank you for visiting the ER. Please come again soon...I'm sure Ms. Black will!!!
Sunday, May 1, 2011
Oh the ER...day 1
I had my first week in the ER this past week. Part of the lateness of this post is my attempt to completely block out that first day.
Yes, it was THAT bad!!
But thank goodness for a much better second day (that will have to wait until a later post)!
Day 1: I walked into the physicians room where I was supposed to be meeting the resident I would be working with. Instead, I was greeted by an extremely frustrated and chaotic attending who said "Great...so glad you're here. There's a head trauma in room 1, URI in room 2, and ringworm in ring 3. Take your pick."
I'm pretty sure I just stared at her for a few seconds before words even came out of my mouth. I reintroduced myself to her her, told her I had never been in the ER before, had no idea where these rooms were that she was speaking of, and didn't know where to go from there.
She looked at me like none of these were good excuses, and said "Umm, ok which one are you seeing first???" ...and continued to stare.
I figured why not go all out and take the head trauma!?!?
Really?? In situations like this, you'd think I'd pick "ringworm boy"- but nope, I figured, Go Big or Go Home. OK, that's not really true, b/c at that moment I REALLY would have rather gone home!!
But either way....
So I walk into little 2 year old head trauma room. Thank goodness this was more like "ran into the dining room table" head trauma as opposed to one that you would've seen on ER the TV show!! I take my history, do a quick exam and go out to present the patient to the doctor. So far, I'm just assumming this is like my primary care clinical.
So I get to the end of what I gathered, and she says, "OK- diagnose him and let me know what you're going to order for him."
HELLO!!! First of all, again, this is my FIRST day...no, first SECOND here in the ER!! Second of all, even if I appropriately diagnose and treat this kid, I do not have access to order entry to do these things!!
Then, she tells me I need to "hurry up and put in a note" so that she can complete hers. What I later realized is the residents do all the work with the patient, put in orders, and then write a complete write-up (or note) that the attending then puts an addendum to.
Their oh-so complicated note writing goes a bit like this: "This MD agrees with previous note per X MD. See that note for full history, physical exam, and order entry."
Yeah, I know...feel bad for the big attendings. They get the crazy hard part of the job!
Unlucky for her though, she would be having a bit more work to do that day b/c I didn't have access to their notes. I mean, I entered one, but she wasn't allowed to just add an addendum to mine...because I'm a student!! She was SOOO ticked off when it wouldn't let her!
So my first 2 hours went pretty much like that. I had to tell myself to take nice, slow breaths several times. I figured that was the best option. Option 2 was to scream, which among the other screams in the ER may have gone completely unrecognized. And option 3 was to cry, but really, that's just not appropriate!! So slow, deep breathing it was.
And finally after 2 greuling hours alone, the resident decides to show up. THANK GOODNESS!!! Apparently, she was double booked at both the clinic and the ER for those 2 hours, and clinic won. Thanks for the notification!!!
Unfortunately for her, the attending jumped all down her throat the second she walked through the door as well, and the rest of the evening (until a new attending came on) went pretty much the same. The Peds ER really wasn't crazy AT ALL....but this woman sure was making it so! After she left, the last 4 hours of my shift weren't so bad at all.
So it was a nice welcome to the world of the ER (*note sarcasm). It was NOTHING like the PICU...which made me miss my job even more!! But the adventure must continue...and so I returned for day 2 in the ER the next day.
All I can say (for now) is the second day was much better. There was a much more relaxed attitude (thanks to a totally different attending being there), and there were even some laughs...at the patient's expense of course...but either way, it made for a much better day!!
I guess when a first experience is horrible, it can only get better from there. If that's true, the end of my six week ER rotation should be INCREDIBLE!!!
Yes, it was THAT bad!!
But thank goodness for a much better second day (that will have to wait until a later post)!
Day 1: I walked into the physicians room where I was supposed to be meeting the resident I would be working with. Instead, I was greeted by an extremely frustrated and chaotic attending who said "Great...so glad you're here. There's a head trauma in room 1, URI in room 2, and ringworm in ring 3. Take your pick."
I'm pretty sure I just stared at her for a few seconds before words even came out of my mouth. I reintroduced myself to her her, told her I had never been in the ER before, had no idea where these rooms were that she was speaking of, and didn't know where to go from there.
She looked at me like none of these were good excuses, and said "Umm, ok which one are you seeing first???" ...and continued to stare.
I figured why not go all out and take the head trauma!?!?
Really?? In situations like this, you'd think I'd pick "ringworm boy"- but nope, I figured, Go Big or Go Home. OK, that's not really true, b/c at that moment I REALLY would have rather gone home!!
But either way....
So I walk into little 2 year old head trauma room. Thank goodness this was more like "ran into the dining room table" head trauma as opposed to one that you would've seen on ER the TV show!! I take my history, do a quick exam and go out to present the patient to the doctor. So far, I'm just assumming this is like my primary care clinical.
So I get to the end of what I gathered, and she says, "OK- diagnose him and let me know what you're going to order for him."
HELLO!!! First of all, again, this is my FIRST day...no, first SECOND here in the ER!! Second of all, even if I appropriately diagnose and treat this kid, I do not have access to order entry to do these things!!
Then, she tells me I need to "hurry up and put in a note" so that she can complete hers. What I later realized is the residents do all the work with the patient, put in orders, and then write a complete write-up (or note) that the attending then puts an addendum to.
Their oh-so complicated note writing goes a bit like this: "This MD agrees with previous note per X MD. See that note for full history, physical exam, and order entry."
Yeah, I know...feel bad for the big attendings. They get the crazy hard part of the job!
Unlucky for her though, she would be having a bit more work to do that day b/c I didn't have access to their notes. I mean, I entered one, but she wasn't allowed to just add an addendum to mine...because I'm a student!! She was SOOO ticked off when it wouldn't let her!
So my first 2 hours went pretty much like that. I had to tell myself to take nice, slow breaths several times. I figured that was the best option. Option 2 was to scream, which among the other screams in the ER may have gone completely unrecognized. And option 3 was to cry, but really, that's just not appropriate!! So slow, deep breathing it was.
And finally after 2 greuling hours alone, the resident decides to show up. THANK GOODNESS!!! Apparently, she was double booked at both the clinic and the ER for those 2 hours, and clinic won. Thanks for the notification!!!
Unfortunately for her, the attending jumped all down her throat the second she walked through the door as well, and the rest of the evening (until a new attending came on) went pretty much the same. The Peds ER really wasn't crazy AT ALL....but this woman sure was making it so! After she left, the last 4 hours of my shift weren't so bad at all.
So it was a nice welcome to the world of the ER (*note sarcasm). It was NOTHING like the PICU...which made me miss my job even more!! But the adventure must continue...and so I returned for day 2 in the ER the next day.
All I can say (for now) is the second day was much better. There was a much more relaxed attitude (thanks to a totally different attending being there), and there were even some laughs...at the patient's expense of course...but either way, it made for a much better day!!
I guess when a first experience is horrible, it can only get better from there. If that's true, the end of my six week ER rotation should be INCREDIBLE!!!
Subscribe to:
Posts (Atom)