Monday, April 28, 2014

Foot Tickler

I already assessed my patient who was here with a complaint of leg pain. I had forgotten to mark his pedal pulses, so I entered his room. He was talking on the phone which normally I mind, but in this instance, all I had to do was mark his pulses. He continued to talk, so I decided to just do what I came to do.

"Hey Joe, I've got to get off the phone, there's a nurse who just walked into my room."
Then he laughed.
"Yeah. Yeah. Listen, I've gotta go - this hot nurse is tickling my feet and drawing smiley faces on them."

I stopped what I was doing and looked up at him.
He gave me this big smile, wiggles his eyebrows up and down, and then continued talking.

I silently pointed at him then shook my finger to say no, no, no and left the room.
Some people are amusing.

Friday, April 25, 2014

It's Not What You Think....

Recently I've had a string of patients with ordinary complaints that turned out to be something entirely different. I think I have good assessment skills, both verbally in interviewing patients and in physical assessments. I've been labeled a "sh!t magnetic" in the past, meaning that if I was working on your shift that day, our ER would receive a lot of critical patients. Now the term defines me in a way that we will get strange situations.

Patient's complaint: simple cough. Diagnosis: ischemic stroke.
     The patient denied all questions regarding some type of infection. Once I dug a little deeper while triaging him, he answered some questions which revealed he had some tongue numbness and the weakening of his writing hand. "I can't write things anymore." Boom!

Patient's complaint:  knee pain from a fall  Diagnosis: third degree heart block
     The patient didn't want to be there. His wife just wanted his knee checked out because he had problems with it before.

Patient's complaint:  possible urinary tract infection  Diagnosis: PSVT (paroxysmal supraventricular tachycardia) meaning a very fast heart rate.
     While the patient was receiving some antibiotics, she mentioned feeling like there were bubbles in her throat. I threw her on our cardiac monitor and her heart rate was in the 180's.

Patient's complaint:  follow up visit from an infected animal scratch. Diagnosis: nonSTEMI (heart attack without ECG changes).
     Who could have guessed this?! The patient felt really sore from an injection - it was actually atypical symptoms of chest pain.

Patient's complaint: feeling bad all over and a cough that over the counter cough medicine won't get rid of.
Diagnosis: Stage 4 lung cancer with metastasis.

Patient's complaint: partial facial paralysis, already diagnosed with Bell's Palsy. However, his hearing and vision on the affected side had diminished. Diagnosis: Ramsay Hunt syndrome.
     This was a new syndrome for me. I did notice a rash on the side of his ear and his pupils were unequal. I didn't know the diagnosis, but I knew something other than Bell's Palsy was occurring.

Patient's complaint: leg pain of unknown cause. Diagnosis: leukemia
     Now the mom of the kid told me he wasn't eating as well, felt really tired lately and he had an enlarged lymph node. I was seriously hoping this would not be the diagnosis.

It's always interesting to hear about a complaint and dig a little deeper. Sometimes a cough is just a cough and then, sometimes it's not.

Saturday, April 19, 2014

It is Done.

It's the straw that broke the camel's back. The last nail in the coffin.

My main ER job went paperless. Now, I have another ER job where we use computers for all charting, triage, etc. It's the wave of the future (unfortunately). The program we use there is emergency department friendly, so it really doesn't take away from patient care and the speed in which we work has not been affected.
The system my main ER decided to use is not designed for the ED. It is a program designed for the floors and completely inefficient for ER use. I know whenever you change a process, it will take the participants some time to adjust and get back up to speed. However, the administration has changed every process the ER. Everyone was slow, extremely slow. For example, a patient I had for a simple antibiotic injection and discharge normally took about a half an hour. That included triage, the nurse's assessment, the doctor assessment, the injection, injection wait time and then the discharge teaching. Not too bad for everything that had to be done. The whole process now took around 6 hours for a simple visit. 6 HOURS.
I had a simple oral dose of benadryl to give to a kid. Before, I could do it in a minute - give the med and chart it. It took over 20 minutes for the whole process to be completed. The inadequate computer charting for medication administration has added 15 additional steps to be completed and this is prior to giving the med. I have more steps after to chart. It also didn't help that the area where my rooms were located does not have good WiFi access. That's just peachy when you have to rely on computers for every task you perform.

We had numerous patients leave in the lobby without being seen, multiple AMAs (leaving after the doctor has seen the patient) and elopements (people leaving after being in a room and not telling anyone).

People were angry. Patients were hostile because they were waiting hours for the doctors to get in there, all the doctors and nurses were because no one knew what the hell was going on and the computer people were miffed because we did not like the inadequate system they had chosen for us. No ER doctor, ER nurse or any ER personnel for that matter was involved when this 'system' was being revamped.

The day and patient load was actually not bad if we had used our old system. It was intolerable with the new system. I'm wondering how we'll have to work when we have a busy day.

I dread going back to work on Monday. Absolutely dread it. I decided to apply for some positions I found online and quit this ER. Although we have lost a lot of nurses recently, I still enjoy working with the remaining nurses and the doctors who I know well and have had a great working relationship with for years. I've been at this ER for over 6 years. I've seen the ups and downs and rode through them. This downward spiral is something I can't ride through.

I hope I get hired for something soon. Very soon.