Today was such a busy day... at one point we had all 21 patient rooms full, plus the 6 fast track rooms, 3 people in wheelchairs waiting in the hallways, 6 people in gurneys waiting at the entrance, and Lord knows how many people in the waiting room. And to think I was optimistic at the beginning of my day... 0700
On the soapbox: if you're going to lie to me, the police, the EMS workers, the nurse, etc about what happened to you last night, make the lie a really good one... but make sure you tell the same lie to everyone or else we'll know you're lying. Also, don't make it so that I actually care or worry about you at the beginning, because by the end when you're calling your pimp/boyfriend who beat the crap out of you last night to the point you lost consciousness and for which you're now refusing medical treatment to come get you, I'm not going to hesitate to have you sign out AMA (against medical advice) just so that you'll leave. Really. Harsh I know, but seriously...
Off the soapbox: little old ladies who have nothing better to do than sit around an ED all day getting pain medication and being fed box lunches make sure you come in early in the morning when the ED is generally less busy so you'll get into a room you can occupy all day. Make sure that your presenting complaint is something vague but still serious enough to warrant a full work-up. Lots of tests means lots of time spent sitting and waiting around. After all, the worse thing you'll have to endure is having an IV put in when you first get there.
On the soapbox: the local nursing home sucks. When a patient is unresponsive and turning blue, a nebulizer treatment is not going to help them. Instead, wait another two hours and then try the nebulizer treatment again. Then call an ambulance, not 911, just the ambulance because with that extra time you can collect the patient's medical records from 1997 to send over. Not that I could use anything relevant to what's happening now. Luckily, the hypoxia isn't going to be the cause of death. No, that would be the massive infection this patient has from a bowel infection that's probably been going on for the last 2 weeks which made them unresponsive in the first place. At least they had a Health Care Proxy who agreed to make the patient DNR/DNI. They understood that the patient would not want their suffering prolonged. About the only positive in this case.
Off the soapbox: if you come in having had a heart attack in the past and the pain is exactly the same, I can call your cardiologist who is going to admit you directly and I don't have to do much work... nope, not much.
On the soapbox: if you know that you have bleeding ulcers because you've already pickled your liver into cirrhosis, go ahead and have another drink. Like 1/2 a pint of vodka. This time when you suddenly pass out, bang your head on the sidewalk and give yourself a nice head bleed, you might just gently fall off to sleep.... and not wake up. Or you'll be brought into the ED vomiting up blood and requiring blood transfusions. Oh, and the crack you smoke won't help your situation either. Might actually hinder some of our care. Yeah. Really.
Off the soapbox: even though I am in the ED I still get to stick big long needles into people's bellies and drain off fluid (ascites). Then I get to proudly showcase all your fluid... all 5 liters of it on the counter... woohoo!
each bottle = 1L, 4L = 1 gallon, 1 gallon of fluid weighs 8#, so I took off almost 10 pounds of fluid from this patient.
End of shift: 2100 = 9 p.m.
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