Yesterday, volume was relatively low. Stress was relatively high.
My shift was 7 am - 5 pm. I run my side mostly by myself until the next NP or PA comes in at 10 am. For the first part of my shift, I had a pretty good MD attending who trusts my medical judgement and leaves me alone to do the right thing. He's available when I need assistance; otherwise, he's hands off.
The first half of my shift, while balancing all other patients, this is what I did:
I had an actively miscarrying young mother whose husband wasn't allowed in due to covid. Actually, she miscarried about 3 weeks previously at 9 weeks gestation. She was scheduled for a D&C yesterday, at a different facility, because even though she miscarried her body did not expel it. The night prior, she started having bleeding and cramping.
She bled heavy through the night.
She came in by ambulance.
The charge nurse never triaged her or took her vitals. She put her in a room and left it for another nurse to do. Fortunately, the nurse was able to see the patient right away.
My patient was tachycardic in the 120's at rest. She went into the 160's when I tried to assess and remove clots from her vaginal canal. I could not even finish my assessment. I had labs, an ultrasound, fluids and blood hanging before I called our OB on call. He was able to come down almost immediately and took my patient to the operating room because SHE WAS BLEEDING OUT and the charge nurse placed her in the wrong room.
I had a 90+ year old female with severe dementia and a possible toe infection. She lives at home with one of her grown children. She mostly bathes and dresses herself and is mobile with a walker. It looked like her toenails had not been cut in a year. They were rolling over to the next, causing a cut in a toe. It did not happen over night. Now there was purulent drainage (pus) and all of her toes and end of her foot were red and hot. I had an x-ray showing suspicion for osteomyelitis (bone infection). This is an easy admission.
I thought I was done. Nope. I had given report to the NP to admit the patient. It normally ends here. The physician also assessed the patient and then made it a point to come over to me and inform me that we can't call it osteo because the x-ray says "suspicious" and continued to try to educate me on stuff (thanks to my mentors/colleagues) that I already know and have done a hundred times. It was done in the most passive aggressive and condescending manor. Thanks for that.
But wait! There's more!
A noncompliant 50ish year old man with "indigestion". He is dependent upon insulin for his diabetes and also medication for high blood pressure. He doesn't take any of his medications. This is a recipe for a cardiac disaster.
He was put in a room without an EKG (to check out the electrical conductivity of the heart). Yup. You guessed it! Patient was having an acute event. Yup. Sure was. Heparin drip, admission, all the planned cardiac work up planned by the hospitalist for his admission.
Fortunately, I had a great APP partner at 10am and volume started to slow down. And. Then. It. Happened.
Check back for a part deux!
*pics are not mine. Straight from the interweb.
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