Thursday, March 19, 2009

Why Me?!?!?

I am really starting to get frustrated with the ER. With the budget issues (we are on a hiring freeze AND people are being laid off) and the bulshit that seems to be magnetically attracted to me.....I just want to say FUCK IT and walk out.

I picked up a sick as shitter last week. EMS was called for some sort of respiratory issue in an ESRD patient. When they arrived she was in cardiac arrest. Our ambulances carry the autopulses (aka geezer-squeezer) so they worked her for a while, gave some drugs, got her tubed and got a pulse back. The day shift had her lined (central and arterial) and had coded her at least one more time and on levophed when I got there. The grand plan was 1) titrate to MAP of 60 2) CT of head and chest 3) get the fuck to the ICU before she coded again. When her bed was ready I got report called and was going to go from ER->CT->ICU. That limits the travel time and makes the transfer easier. We went to CT, got her on the table and I got the A-Line (which we were not transducing while traveling) secured, the monitor and went to the control room so I wouldn't get zapped. The tech ran the head and then the other tech hooked up the dye for the chest CT. She had an 18g IV to push dye through. The scan, however, looked a little fucked up and we didn't know why.... until after the scan. I saw blood on the sheets and found that the tech had injected dye INTO THE A-LINE!

I almost shit my pants.

I did the occurrence report, checked with radiology, ICU and ER docs just to make sure there was nothing I needed to do, then went to the ICU with her. Found out she died 3/17. That same day I get a call from the head of the radiology techs. Her interpretation was that I should have stayed in the "Zap room" and supervised. Has anyone ever had to go behind the CT scanner and supervise before? Is here a policy that says so? She also argued that the A-line wasn't labeled...... which it was, in several places. So we will see what the fuck comes of this.

SO with all of the new nurses in the trauma room I haven't been in there much lately. There have been problems (as there usually are with new people). Our Level 1 (rapid infuser) seems to be the bone of contention. Someone fucked it up last week so the solution..... wait for it.... is to set it up daily with the cost (around $2000 a month) coming out of the nursing education budget. Am I the only one saying WHAT THE FUCK?!?! So we are having a hard enough time getting required education and now we have to sacrifice for one person's screw up?

On top of all this the ER is busier than ever. People are waiting hours and hours for primary care stuff. Sore throats, upper resp stuff, viral shit. Nobody has insurance anymore so they all get referred to us. The kicker... they want their primary complaint worked up and then everything else "checked out" while they are here. Then they want prescriptions, and a cab ride home. (do any other ER's out there have to give cab/bus tickets?) They won't call for a ride if they know they can get a free one. GRRRRRrrrrrrrrrr!

I wonder how hard it would be to move south and open a bar? Nursing could be a backup? Hmmm....


Blogger Shauna said...

not that i agree with it but we always had to lead-up and stand in the scan room with all our traumas when they got ct scans. the doctors and ct techs got to be in the control room...but we had to be in lead standing by the pt's side in the scan room......every time.

maybe that's why i'm infertile now.....something to think about.

7:41 PM  
Blogger jeepgirl said...

Are you serious? Thats craziness! The hospital should have to help pay for your IVF!!!! This wasn't even a trauma patient. It was me, the medic, resp therapy and 2 CT techs. Ugh.... we will see what happens!

7:34 AM  
Anonymous Kelly said...

I don't work in an ER, so maybe it's different, but we don't stay in the scan room. The RT will wear lead and bag our kids (I work in the PICU... God bless you for taking care of adults!), but we wait with the physician in the control room.

Sorry about that art-line incident! The most careful line-labeling in the world doesn't matter if the person behind you DOESN'T READ.

10:39 PM  
Blogger mojitogirl said...

That was a crappy hand you were goes to show you "If there's a line, eventually someone will squirt something through it, whether it belongs there or not." I always worried about that when I had fresh post-op heads with ventriculostomies and ICP catheters. Either they got pulled out or someone tried to inject them with something, or flush them or just MESS WITH THEM (oooh-what does THIS do?).

Head south-come work with us! Just know you'll be bored to tears, but you can probably fly AND work ER, like everybody else does. Plus you can't beat the weather!

12:48 AM  
Blogger GingerJar said...

Perhaps they should PAY a nurse to work in CT and be the DYE INJECTOR...why doesn't the tech own up that he/she made a mistake instead of passing it off on somebody else. Come on...didn't a stop cock and all that stuff shout A-LINE at the idiot????

8:50 AM  
Anonymous Keith said...

The hospital I work at only has the RT stay to bag traumas while being CT'd and the nurse and tech go with the CT tech out of the room.
We do give cab rides sometimes but I find that more and more people are expecting it.

3:36 AM  

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