Thursday, August 20, 2009

Crazy Nurses and Toilet Babies

I hate to say that my post vacation good mood was wasted, but with the drama that I walked into it was a little hard. G12 (maybe not that high, but you get me) P4 comes in with vag spotting after intense pain over 24 hours before. She hops of the stretcher to go to the bathroom and promptly drops the fetus in the toilet. Our best estimate was 16-18 weeker. Mom went over to the pelvic room and I took care if the "baby stuff." Anyone who has been in the ER knows what I mean. Usually these parents are understandably and appropriately upset. This one really didn't care about the baby, she was more worried about when I was going to let her 1) smoke 2)go outside 3) take more morphine/methadone (or crack, maybe?). She bled like stink, and the placenta didn't deliver. After 4 hours L&D was still too busy to take her, I hadn't seen a one of my other patients and to the OR we went. After those 4 hours I was begging to go out to triagony for the next 8. I was just DONE.

Last night I was in the penalty box for 12. That's our "screener desk." I do the "hi, WTF brought you here", make sure nobody is actively dying and then send them to the triage nurses. The triage nurses, one their own, are pretty cool. But together (they are both crazy as fuck AND good friends) they don't do shit. Seriously, they kept disappearing. People would go wait to be triaged and after 15 or so minutes I ended up having to triage many myself. What BULLSHIT! The hard part is that they are in the "battle axe " group that saying anything to the coordinator would be worthless.

The upside of screening is you seriously get first crack at the acute walk-in patients. When someone walks in complaining of chest pain you get a feeling if they are real or not. As soon as I saw this guy AMI popped in my mind. History of stents and htn, chest pressure for 3 hours. My triage EKG was a LBBB.

(I will admit freely that cardiac has always been my nemesis. I hate it. I can fake it like a motherfucker, but when interviewing for flight jobs that's not good enough. A very smart person has been helping with the learning curve. While I'm not an expert, I'm getting better)

So seeing a LBBB in a patient with a vague cardiac history, I hauled ass to the back, gave the EKG to the attending and puled up the old one which (TA-DA!!!) showed no block. The AMI page was sent out and the patient was in the cardiac ICU within an hour of my "hi how are you." Yea me! The triage nurses had no idea that I was even gone.


Finally I must lament that college classes are starting again. The drunk freshmen are here. One got carried out from the ED by 6 people last night. 1 on each extremity, 1 on the collar and one by the belt..... he looked like a pig on a spit!


Blogger battynurse said...

I hate the cardiac stuff too. Good catch!
Yuck on the prego, lost baby. I think the asking to go smoke and use would have made me puke.

11:49 PM  
Blogger BirthdayNurse said...

I'm sorry you had to deal with the miscarriage :( I'm on the L&D end of the world, so I know how much it sucks...big time. I don't know how your hospital works, but I know at ours, if they present to the ED we won't (well, if we have any kind of choice) admit them to L&D because they are nowhere near viability and there is nothing really that we will do to help them "prolong" the pregnancy if they are threatning mischarriage just because if they're close to miscarriage @ 16, 17 weeks...there's not much we can do. We would have sent an OB to check them out though...But still, that really sucks when they miscarry in the ED for you guys. Any number of miscarriages is too many for anyone to see, and I know we see too many.

7:00 PM  
Blogger jeepgirl said...

BDay... we sometimes send the (dead) baby up to L&D with mom. The idea is that they have more resources than we do to let mom have some privacy and to set up a memory box (with photos, armbands etc). Also thats where they go to be observed and in a lot of cases, to deliver the placenta in a more appropriate room.

8:41 AM  
Blogger jeepgirl said...

and PS... it still really sucks

8:41 AM  

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