Archive for the Emergency Room Category

Faker

Posted in Emergency Room on November 14, 2008 by medic61

We had an interesting record recorded in the CRM software system, which I think will be obfuscated and picked up by the top CRM blogs.

Tonight in the ER, I had a woman who was seriously afraid of needles. She was there with her boyfriend for abdominal pain. The conversation went something like this.

Me:”Hi, my name is–”
Her: “OH MY GOD OH MY GOD ARE YOU GOING TO STICK ME WITH NEEDLES OH GOD!”
Me: “Ma’am, I have to start an IV. The doctor is going to want to give you some fluids and medication to help you with that pain.”
Her: *incoherent screaming*
Boyfriend: “Baby, which is going to be worse…this little needle stick or the pain in your stomach?”
Her: “THE NEEDLE!”
Boyfriend: “Then why did we come…?”

She feigned fainting. When her boyfriend let go of her hand, it sort of hesitated in mid-air and then collapsed dramatically on the bed. He rolled his eyes at me, I smiled back at him, and finished what I was doing.

The nurse comes in, looks at me, looks at her, and looks at the boyfriend.

“Hey,” she says as she shakes her. She continues feigning this unconsciousness. “Hey, listen. Anytime you want to stop pretending like you’re unconscious, that’d be great. I don’t have the time to sit around and play with you.”

Miraculously, she comes around, mentions something about feeling woozy, and how she hates needles.

It was a great day had by all.

p.s.–My best friend has a legitimate phobia of needles, so I understand people who don’t do well with needles. I do my best to be accommodating and take them seriously. But when I have three-year-old patients who deal with it better than they do, and they start acting like they’re unconscious…I lose all respect.

Take care out there,
Sam

Um…

Posted in Emergency Room on October 7, 2008 by medic61

Overheard while starting an IV last night:

Nurse: So what brought you to the ER today?
20 y/o female: I just can’t catch my breath.
Nurse: Do you have a history of asthma or any breathing problems?
20 y/o female: No, not that I know of.
Nurse: Have you ever had anything like this before?
20 y/o female: Yeah.
Nurse: Why was that?
20 y/o female: Well you see, I smoke pot about every other day…

A real post coming hopefully tonight :) Thanks for putting up with my absence!

Take care out there,
Sam

Cute

Posted in Emergency Room on October 6, 2008 by medic61

67 y/o drunk man: “Why are you poking me?”
Me: “We’ve got to give you an IV so we can give you some medications and fluid.”
67 y/o drunk man: “Oh. You’re cuuute.”
Me: “Yes sir, I’m always cute when they’re drunk.”
67 y/o drunk man: *buuurp*

Tiny Rant

Posted in Emergency Room, EMS, Miscellaneous on October 1, 2008 by medic61

Disclaimer: Anniforscia, dear, don’t read this post. Please. No one should read this post with an intense fear of needles or IVs. Thanks.

Dear Paramedic Student who shall go unnamed,

There are several things I keep in my IV bucket. Let me tell you about them. I keep a latex and non-latex tourniquet. I keep a whole bunch of Vacutainer tubes to put the blood in. I keep gauze, alcohol swabs, saline locks, syringes, tape, and Tegaderm site dressings. I even keep a whole ton of saline flushes. There’s a lot in there, I know.

But here’s the important part. I carry two types of needles. One type of needle is for IVs. It’s called an angiocath. It comes in gauges 14-24 for the IVs I use. It has a plastic catheter over the needle, and that part stays in the patient. Easy, right?

I also carry hypodermic needles that go on the END OF SYRINGES so that after I get the blood in the syringe, I can distribute it evenly into the vaccutainers. I only carry one size–18 gauge.

I keep them in SEPARATE parts of the IV bucket. You KNOW this. But yet, every single time I’ve started an IV, you hand me a regular needle when I need an IV needle. I’ve told you time and time again which is which, and even wasted supplies by opening countless needles to show you the difference. Let me see if I can clarify more.

This is an ANGIOCATH.

This is a HYPODERMIC SYRINGE NEEDLE.

Get it? No?

Angiocath…

Hypodermic needle for a syringe…

They do very different things. Please learn which is which before continuing in your paramedical education.

Sincerely,
Sam

p.s.–This rant brought to you by Sam’s raging impatience with students who don’t learn. I’m not being unfair, I’ve told him roughly fifteen times. I don’t mind correcting him, but I do fear for his patients, when he sticks them, and then realizes that he’s using a hypodermic needle, not an IV needle.

Dead

Posted in Emergency Room on September 16, 2008 by medic61

And so he died under my hands, right there on the table.

“Stop, just stop,” the doctor said to me softly, pulling the leads off his chest.
“But, I…”
“Just stop, Sam, it’s okay.”

Twenty-one years old, with his whole life ahead of him, and he’s dead. There’s no word for how dead he is. Alive, shot, dead.

His memorial tattoo for some relative or friend looks up at me. Twinkling eyes, even in that tattoo, taunt me. “RIP,” it says, but now it’s for him.

Shot in the femur. Dead.

My compressions do nothing but circulate stale blood through tired veins. The bladder has given up too, and the muscles relax for the first time in twenty-one years.

Dead.

“Time of death, 2213.” He was dead before that, but now he’s dead in the eyes of the government.

“Good job, everyone.” Yeah, right. If it were a good job, he wouldn’t be so…dead.

His arm hangs, useless, to his side. Hitting me in the leg during CPR is its final act. I pick it up gently in my hands and put it on top of his stomach.

Dead.

“Somebody get this kid a blanket, extubate him, and call the family into the meditation room.”

“This kid.” A year and a half older than me, than this kid. I’m just one kid who tried to save another kid’s life.

Dead.

I skid on some blood on my way out. Fuck it, I don’t care and neither does he.

And then a funny thing happens. I go to the locker room, and call my mom. I’ve done this after every code I’ve run. I tell her what happened, feel a little sad, and usually cry.

But tonight, I shed two tiny little tears, hang up the phone, and go back to work. I don’t spend the night thinking about him. I don’t actively confront my own mortality. I just move on.

It’s not that it doesn’t hurt–it does. It’s just that I don’t have time for it to break me down.

And for some reason, this satisfies me. I’m getting stronger, getting better at this. I still feel it; I’m not jaded. I’m just less affected.

But he’s no less…

Dead.

Hole

Posted in Emergency Room on September 4, 2008 by medic61

I hear them before I see them. Yelling over the squeak of Stryker wheels on linoleum floors; I wipe sweat from my brow and ready myself.

They didn’t give us much time to get ready. Couldn’t call in a report because things were going so haywire in the back. I hear the chatter of police scanners and grip the IV catheter a little tighter.

They wheel him in and I wonder whether or not he’s awake. He has a tube in his throat so he can breathe, but his eyes are open, moving around. I peer down at him and see his eyes going back and forth slowly.

“Is he…” I start to ask.
“No. His eyes have been tracking back and forth like that for a few minutes. ETOH on board, we got an 18 in his upper arm, but that’s all we could do.” The paramedic nods at me.
“Got it.”

I see his arm is bandaged, so I go to the other arm. He’s freezing cold, so his veins are small. I manage to get a 20 gauge IV in his left hand, but it’s not good enough for this trauma. I let everyone know about the new IV and go back to the other arm.

“I need you to cut this bandage off.”
“Sir?”
“Yeah, you. Can you cut this off?”
“Sure,” I say to the doctor as I grab my trauma shears.

I cut it off gingerly, and while I don’t gasp, I stop breathing momentarily.

“Oh, God,” I hear the doctor say, and my breathing resumes. I look down again and see a hole. There’s a hole in this man’s cubital fossa, no distal pulse. He’s severed the major artery in his right arm, and lost a lot of blood.

“Just hold pressure, okay?”
“Okay.”

“Tell me what happened,” I hear one police officer ask another outside the door.
“Drunk kid wanted to leave, couldn’t go out through the front door. Went upstairs, punched a window, and when he pulled his arm out, cut a hole in his arm. Looked like a pig got slaughtered. Don’t know much, though; no one spoke English.”
“What’d they speak?”
“Spanish.”

The doctors take note of this and look around.

“Does anyone speak Spanish?”
“I do,” I say looking up.
“Talk to this kid.”

The doctors start working on two femoral lines, and I hold pressure. I hold like I’ve never held before. My fingers tingle and wrist aches, but I hold.

“Chico, estas en el hospital. Si puedas oirme, por favor mueva un dedo.” He moves no fingers, but as I hold pressure, I speak softly in his ear. I figure it can’t hurt.

The trauma surgeon comes in and looks to the doctors to tell him what’s going on. Lost in their focus, they don’t even acknowledge his presence.

“Someone, please, I need to know what’s going on.”
“Male in his early twenties,” I say as I clear my throat, “ETOH on board. Put his arm through a window trying to leave the house. He’s got a veritable hole in the cubital fossa, and his eyes are tracking back and forth. Dr. Sykes thinks he may have some seizure activity, but there might be a closed head wound as well. PD says the room was covered in blood. We’ve got two femoral lines, and we’re on the fourth unit of blood. 20 in the right hand, 18 in the left upper arm.”

I catch my breath and look at him through my mask and faceshield while my arm trembles from the pressure I hold.

“Christ. Thank you, Dr…”
“Oh…me? No, I’m just a lab girl.”
“Really? Hell, you’re the most eloquent lab girl I’ve ever met.”
“Thank you, sir. Would it be okay with you if we put a BP cuff on this guy for hemostasis control?”
“Yeah…why didn’t somebody think of that before?”
“No clue, sir. Could you hand me that?”

He rolls the manual bp cuff my way, and I pump it up until the bleeding stops again.

“Well, let’s get this guy to OR.”

The doctors finish securing their femoral lines and he’s wheeled off. I stretch my aching fingers and glance down. My shoe covers are red. They’re bright red, and I see my gown is speckled with the same. Blood surrounds me, and I try not to slip on my way out. My nostrils fill with the heavy scent of iron, and I peel my shoe covers off as I leave.

“Get the line?” My eager coworker looks up at me, smiling.
“Yeah, and then some.”
“Jesus you’re bloody. Let’s get you some peroxide.”
“Thanks, but no time,” I laugh as the trauma pager goes off again.

Things!

Posted in Emergency Room on August 17, 2008 by medic61

Thank you all so much for the emails, IMs, comments, texts, phone calls, etc. You are all fantastic, and your concern means the world to me. I’m doing much better now, and every day I feel a bit more healed.

Also. We got five (count ‘em, five) gunshot wounds today in the ER. Here’s my favorite.

Nurse: “Sir, have you been drinking tonight?”
Man: “HELL YES I’VE BEEN DRINKING, I’M DRUNK AS SHIT! I GOTSTA PEE!”
Nurse: “Okay, sir, we’re going to put this tube in your bladder so you can pee and we can get some urine.”

*Later*

Nurse: “Sir, can you rate your pain on a scale of zero to ten, zero being no pain, ten being the worst you’ve–”
Man: “A TEN, A TEN, OH GOD A TEN!”
Nurse: “Where?”
Man: “MY PENIS HURTS, MY PENIS HURTS!”
Nurse: “Yes, sir, you’ve got a tube in your penis right now. What about your bottom, where you got shot?”
Man: “I GOT SHOT!?”
Nurse: “Yes, sir, that’s why you’re here.”
Man: “MY PENIS HURTS OH GOD MY PENIS HURTS!”
Nurse: “And your bottom, sir?”
Man: “ZERO PAIN ON MY ASS, BUT OH GOD MY PENIS HURTS!”
Nurse/Me/Everyone Else: *stifles laughter*

Take care out there,
Sam

Burn

Posted in Emergency Room on August 15, 2008 by medic61

I write because it is one of the few things that makes me feel better. It makes me feel human, complete, sane again.

This entry is graphic. It’s probably disturbing. I’m so sorry for that. I wish it weren’t. I wish I weren’t writing it. I wish my shift had been uneventful, that I had come home and been the same person I was when I went to work. But none of that is true. And so I write.

It’s been slow all day. I’ve done maybe 3 IVs, and a handful more blood draws. I sit with my chin in my hand, tapping my foot against the cabinet lazily. I refresh the screen to see yet another list of completed orders.

“Come on,” I whine to no one in particular, “can’t someone order something on somebody!?”
“Eh, you’ve only got 10 minutes left!” Amanda smiles at me and snaps her gum. I yawn in reply.

I hear the squeak of sneakers as an ED tech comes running towards us. He’s out of breath, and gets his sentence out in pieces.
“Guys…we have…two trauma codes…coming in.”
“What?” I’m trying to figure out what the odds are of two separate traumas happening at the same time.
“Two little boys…badly burned…apartment fire.”

I look at Amanda and she stares back with wide eyes. We grab our lab buckets and head to the trauma rooms to suit up.

I start from the bottom and make my way up systematically. Booties, lead coat, apron, gloves, mask and face-shield, and finally a hair cover. I start overheating immediately as we wait for the first to arrive.

Amanda goes to the second trauma room as I wait in the first. My hands are sweating as I set up the IV equipment and get the blood tubes out. I’m not sure if it’s from the gloves or my own nerves, but little sweat beads form on my brow.

As my patient arrives, Amanda comes running in. I try to figure out what’s going on, but I’m overstimulated. Amanda is crying and so is the little boy, but only one makes sense.

He’s two years old with soot around his nose, his body dark and his hair singed. He looks up at me with confused eyes, and sniffles a few times.

“Oh god, Sam, I can’t do it, I can’t do it?”
“Do what, Amanada?” Tears are running down her face, and she just stares at me in horror.
“Sam, please go to the other trauma room. I’ll do this one. Please, I can’t do it.”
“Okay.” I’m confused, but I grab my bucket and head out.

I don’t know what the smell is, but it makes me almost stop in my tracks. I quickly realize that it’s the smell of burnt flesh. I push this out of my mind as I approach this boy.

My eyes widen and I feel my heart beat out of rhythm. His whole tiny body is burned. Skin is peeling off in sheets, and he turns to look at me. His eyes are as wide as mine, but glazed over slightly. I see them shut, and before I know it he’s being intubated.

I pick a tourniquet out of my things and tie it around his forearm. I try not to think about what that will do to the skin after I remove it. I pick up his arm and look down. His tiny little fingertips are falling off. My stomach turns and I don’t think, I just act.

As soon as I’m done, I leave the room, blood tubes in hand. Amanda looks at me as we walk back to the lab. She starts to say something, but stops as soon as she realizes I’m not paying any attention to her.

The third child, a girl, was flown to a bigger Trauma Level 1 center on the coast. We didn’t have the resources to take care of him, but from what I hear, she wasn’t doing very well at all.

Then it hits me. Three little children, all seven and under were in an apartment fire. Why weren’t the parents in the beds next to them?

“Amanda?”
“Yeah?”
“Where are the parents?”
“In the waiting room.”
“Why?”
“Um…because they’re waiting?”
“No, I mean…why aren’t they hurt?”
“You didn’t hear?”
“No.” I know what’s coming, though.
“The mother wasn’t in the apartment.”

I try not to think, again. I see that I have another patient to get before I go, so I push everything out of my head like always.

“I need pain medicine,” my patient moans.
“I don’t do meds. I just stick.” I know I’m being curt, but I can’t manage to say anything else.
“Ohhhh, it hurts so bad. I need some demerol!”
“Your nurse is coming soon.”
“Oh the pain! Can’t you give me anything?”

I just stare at his arm as I secure the IV, saying nothing. I don’t look him in the eye. I know that if I were to meet his gaze, I’d be unable to keep my composure. I’d yell at him. I’d scream, I’d cry.

Get the fuck out of my ER, I’d say. Stop wasting everyone’s time so you can get high. Don’t you know that there are children who are close to death? Don’t you know that I don’t have the time or energy to waste helping you get your fix?

But I can’t. I have to treat him the same as I treat everyone else. I have to give him great care, and I have to manage not to piss him off. I succeed and leave before I can do any damage.

I clock out. I grab my things and just leave. I pass the mother of the children on my way out and I try not to ball my fists. I keep my face blank as I pass a few police officers as well. I hear some talk about the fire and just keep on walking.

I make it to my car before I break down. I call my mom and just cry. Sitting in the dark, all I can see is that little boy. All I can picture is those three children burning in their home, surrounded by smoke and flames. I can imagine the terror on their faces, the cries that no one hears. I avoid thinking about their pain, about what they were thinking. I just cry and cry to my mom.

I’m not quite sure how I made it home. I don’t live but a quarter of a mile from the ER, but it’s the longest drive of my life. Before I realize it, I’m back in my apartment, curling up in my bed, wrapping myself around a pillow.

It’s going to be all over the news tomorrow, I think to myself. It’s going to be popping up on websites and the various TV channels, but I don’t want to think about it. I don’t want to remember what I saw.

But every time I close my eyes, it’s the only thing I can see.

Gracie

Posted in Emergency Room on August 4, 2008 by medic61

The pager beeps loudly as it vibrates across the table. I pick it up and check it, knowing full well I’m about to be on my way to whatever it is.

“CRITICAL ALERT, TRAUMA 1,” it says, as if the capital letters are begging me to hurry. I grab my bucket and check it quickly.
IV needles gauges 16-24? Got them. Syringes, tubes, needles, gauze, alcohol, tourniquet, saline locks, and saline flushes? Got it all. I grab an extra pair of small gloves and stick them in my pocket as I make my way through the supply closet toward the first trauma suite.

A tech is carrying her in. She’s seizing in his giant arms, her little hands hitting his chest, her tiny feet kicking towards his neck. She can’t be more than 3. He puts her down as gingerly as he can, and I realize that other than the doctor, I’m the first one in.

“She’s in status, I need to get some meds in, get me an IV.” He’s nearly bumping his head against mine as he leans over her. He’s trying not to yell, but his voice cracks.

“I…I don’t do IVs!”
“What?”
“I haven’t done an IV yet!”
“Oh for the love of–DAVID!”

David looks up from whatever he’s doing and pushes me out of the way. People are slowly filing in, taking what seems like a lifetime. I watch impatiently as David starts the IV and hands me two syringes of blood. Obligingly, I fill the 8 tubes with it, trying to ration it evenly.

She stops moving. Her eyes are glassy and rolled back, and she’s taking on a bluish tint. I don’t really hear much, I just let myself get pushed out of the room like a rag doll. I’m not quite sure how I managed to hang on to my bucket, the vials of blood, and 8 name labels, but I find myself back in the lab, sitting on the stool with wheels.

“Sam?” I hear something coming from somewhere around me, but I don’t focus on it.
“Sam? Sam, you’re so pale, are you okay?” The backside of a warm hand against my forehead brings me back to reality.
“What?”
“Are you okay?”
“Oh, yeah, yeah, I just…yeah.”
“Um, okay. Want me to label that blood for you?”
“Sure.”

I look down at the labels as a voice comes on the intercom. Grace Perez. “Code Blue, Trauma 1.”
Grace Perez.
“Code Blue, Trauma 1.”

I don’t listen. I just watch. I go to the computer and order all the labs. I don’t listen. I won’t listen.

The doctor takes her mother into the consultation room. The heavy wooden door closes. A second later, I hear it.
“Gracie! Oh God, not my Gracie!” I sit back down and clutch at my scrub top. It feels too tight; everything feels too tight.

Her sobs choke out from behind that solid door, ringing around the ER. Guttural and real, they wrench my heart.

It’s not until later that I hear the whole story. Her mother found her seizing in her room, and panics. She didn’t call 911, but instead loads her Gracie into the car and drives her to the ER. I don’t know how long she’d been seizing, not breathing.

All I know is that when I leave, my ears ring “Gracie.”

From the ER

Posted in Emergency Room on July 29, 2008 by medic61

I’m sorry I haven’t posted in a while. That last entry sort of took it out of me, if you will. It’s hard to write something that has that sort of emotion and then just go back to “regular” stuff.

Also, my campus has decided that it is time for us residential students to be royally screwed re-installing the needed software on our computers. Until we do so, the internet doesn’t work. Every. Single. Year, I get screwed by this. I don’t change anything, and they’re like OH GOD OH GOD UPDATE YOUR ANTIVIRUS SOFTWARE! I use a Macintosh, n00b, I don’t need your antivirus…

Okay, I’m done with my nerdy little rant. Case in point, until the unhelpdesk decides to show up at my door to complete my work order (which may not be until Friday), I’ve got nothing. And it just so happens to be my few days off. So I’m left wanting to cry.

In any event, I bring you some recent happenings from the ER.

Me: “Hello, sir, my name is Sam, I’ve come to get some blood from you for labwork.”
Man (veritably covered in tattoos and piercings): “Oh, hi. This isn’t going to hurt, is it?”
Me (kidding with him): “Maybe a little, but you look like an old pro!”
Man: *chuckles*
Me (after setting up and finding a beautiful vein): “Alright, quick pinch.”
Man: “OH GOD, THAT HURTS SO MUCH! OH I THINK I’M GOING TO PASS OUT!”
Me (removing needle): “All done.”
Man: “That wasn’t so bad.”

Man: “Oh, hell, you’ve come to get blood from me, huh?”
Me: “Yes, sir, but it won’t hurt nearly as bad as that IV they started in the ambulance did.”
Man: “This? Naw, this didn’t hurt.”
Me: “Well good, then!”
Man: “Alright, do whatcha gotta do.”
Me: “Little pinch.”
Man: “OH, SHIT!”
ED Tech I love: “Watch your language, there’s a lady present.”
Man: “I don’t give a SHIT! Oh shit oh shit that hurts that hurts.”
Me: “All done.”
Man: “About friggin time.”
ED Tech I love: *eyes man angrily*

Me: “Hi, ma’am? My name is Sam, I’m here to start an IV on you.”
Lady (about 85, tiny as can be, little spider-like veins): “Okay, sweetheart, you just do whatever you need to do.”
Me: “Now, since they want to take you back to CT and put some contrast in your veins, I have to start an 18 gauge IV in the crook of your arm. It’s a little bit bigger than the one I’d like to start, but they really need it to be that big for the contrast.”
Lady (smiling happily): “No problem. I understand.”
Me: *selects biggest of the tiny veins*
Lady: “I have really small veins, I’m so sorry.”
Me: “Don’t even worry about it, I can get one right here.”
Lady (after I stick her): “Oh, you’re so good! I barely felt that at all.”
Me: “Good, after the people I’ve stuck today, I was beginning to think it was me.”

Repeat that last scenario with a little 8 year old boy.

Tell me, what is up with manly men wimping out with teeny tiny needles. I draw blood with a 22, usually. If they’re crying about it, or have small veins, I’ll use a 23 (butterfly). I mean, really, people. After that 12ga in your ear that you worked to stretch, my 22 should be no big shake.

Me: “Hello, my name is Sam I’m here to get some blood from you.”
Lady: “Oh, Sam, what a beautiful name. You have beautiful skin. You’re just so beautiful!”
Me: *blushes* “Oh, well thank you very much, you just made my day.”
Lady: “I used to do what you’re doing. It’s fun for a while, but don’t do it for life.”
Me: “Oh, I don’t plan to.”
Lady: “Good.” *stage whisper* “Get out while you still can! Go…be a model or something!”
Me: *laughs* “I have something a little more exciting planned.”
Lady: “What?”
Me: “Finish school, get my master’s in Emergency Management, become a firefighter and a paramedic, do that for a while, bridge to RN, become a flight nurse, and eventually try to fix what’s wrong with EMS.”
Lady: “Can I come with?”
Me: “Absolutely.”

Me (with a paramedic student in tow): “Hi, ma’am, how are you doing today?”
Lady: “Just fine, thanks.”
Me: “Great! I’m Sam, I’m from the lab, and this is Barnaby” (side note: his real name is quite ridiculous, so he gets a ridiculous name for the blog) “who is a paramedic student here.”
Lady: “Very nice. Are you two married?”
Me: I…uh…whaaa?
Barnaby: *turns red, tries to hold in laughter*
Lady: “You two just look so perfect together! Are you dating?”
Me: “No.”
Lady: “Well, you should be. Barnaby, you should really get your priorities straight. You need to ask her out before you lose a good one.”
Barnaby: “Will do, ma’am.”
Lady: “And you, missy. You need to make sure that you don’t marry a bad one. You’re too pretty to marry a bad one. You should marry Barnaby.”
Me: “I’ll keep that in mind. Now, let me see this arm.”

Working in the ER has certainly been an experience. From gunshot wounds to stubbed toes, STEMIS to pimples, I’ve seen a lot in the month I’ve been there. I’ve been grabbed to hold chest tubes during insertion, do compressions, and assist in foleys. I’ve also cleaned up vomit, blood, and done bed-changes. I’ve done a lot, and it’s only been a few weeks! I really can’t wait to see what is going to happen the longer I stay.

Take care out there,
Sam