From the Mouths of Patients

What a jerk. What jerk?

He was a jerk. He was rude to the triage nurse. He was rude to the x-ray tech. He tried to be rude to me when I went in his room a second time. His story? He stepped on broken glass at 3am with bare feet and cut his foot. Over 6 hours later he decided to go to the Emergency Department. The real story? When you have to suture someone up, they can't move, they can't go anywhere. You either talk to each other or there is a kind of awkward silence. It was indeed the real story... stepping on glass. Like so many other stories, there were a few more details. The night before, he got really bad news. He was really upset. He picked up a drinking glass and threw it against the wall, shattering it. He thought he cleaned it all up but quickly found out he missed a piece at 3am. One dressing held together by duct tape later and he went back to sleep. What a jerk, right?! Breaking glass. Being rude. The day before, he found out that "a loved one had passed". That's what he in...

Spoiler Alert: It Wasn't Just Dehydration

I didn't see the triage note. I saw 31 weeks pregnant. Nausea and vomiting. Heart rate of 130s. Easy. Check electrolytes. Hydrate. Give meds to stop the vomiting. Easy peasy. Nope! So this poor woman was an alcoholic. She was withdrawing. Before you get on your soapbox or look down your nose... Alcoholism is real. It, like other addictions, is a real beast. I did my best to pump the patient full of zofran, pepcid, ativan and IV fluids. Her CIWA (Clinical Institute Withdrawal Assessment) was as high as 34. She was at a very high risk for seizures. To give you an idea of the severity of her condition, she was admitted to the ICU - where the sickest of patients go. Inexperienced me would have had a lot to say. My perspective has changed a lot since then. In nursing school, we had to attend an Alcoholics Anonymous meeting. Eye opening. I have had so many patients on the spectrum of intoxication and with varying degrees of cooperation vs belligerence. I've had encounters with alc...

Instant Gratification: Repairing a Skin Tear

The last post dangled a part two. I don't have the energy for it. That shift was the only shift I've ever cried after work. Work has never made me cry. I've been doing this since August 2002. I've never cried. That shift was emotionally and mentally brutal. Colleagues told me it was painful to watch. It was that bad. Instead, I thought I'd show you the "fun" side of things. Procedures. In the ED we do all kinds of procedures. We remove objects from places they don't belong, we splint, we intubate, we put back together... just to name a few. The downside is that procedures take time. We live in a society that has put gold medals on throughput, how quickly you can get a patient out. Therefore, procedures can really mess up your flow. Sad, right? Here's a recent one I did. As we age, our skin naturally thins. There are other reasons, like some medications, that can also contribute to this. It is not uncommon for elderly people to have thin skin and...

Hard and Fast - That Emergency Life

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