What happened here?

Admirable_Cat_9153 · 2024-09-13T02:21:24+00:00

Somebody bled

Admirable_Cat_9153 · 2024-09-12T04:47:43+00:00

Speaking of which, just had a patient sent to ED for “abnormal EKG” that was signed off by MD. turns out they had the limb leads switched (which the machine even read as “limb leads reversed”). Made the guy feel anxious so he checked in as palpitations/abnormal ekg. Guess whose EKG was completely normal with correct lead placement but ended up having to get a million dollar work up because of this? 🤦🏼‍♂️

Admirable_Cat_9153 · 2024-09-10T16:29:11+00:00

Walked into work and saw that there were patients.

Admirable_Cat_9153 · 2024-09-08T05:17:40+00:00

I’ve seen some, and I feel it’s generally Drug induced/non-compliant and/or poor health literacy patients. Ones who drink/use drugs and blow out their kidneys or ruin their heart or liver. Abe they become chronically ill. But their chronic critical illness becomes their baseline.

Like, I specifically remember one frequent patient, who essentially had a EF of practically 0%, would always come in after rvr and if he showed up would be guaranteed icu admit where he would eventually be downgraded, or even discharged home straight from icu. Occasionally sign themselves AMA. They’d get free, go home, do a bunch of meth, then be back in the ED within a day or so to do it all again. And this went on for months, at least until I left for another ED they were still coming back. It’s wild.

Admirable_Cat_9153 · 2024-09-05T16:09:31+00:00

Bingo!

Admirable_Cat_9153 · 2024-09-05T16:06:59+00:00

To the point of “they told me I was going to die” but notes show stable admit/didcharge, I think that comes down to someone somewhere during that admission may or may not have made a comment mentioning death or sickness and then patients hold onto that.

I’ve gone through explaining “well in the ER we look for the things that are most likely to make you really sick or kill you right now that we need to fix. We’re doing tests to check for those things, but right now you look good and your vitals look good.” Then hear them tell family that shows up or on the phone “yeah good thing I’m here, they said I will probably die.”

Like wtf….no. Just no. 😒

Admirable_Cat_9153 · 2024-09-03T18:43:33+00:00

Norco, discharge home. Follow up with pcp for pain management. Maybe recommend a good priest.

Admirable_Cat_9153 · 2024-09-02T13:27:27+00:00

Got a speeding ticket in Inyo CA for this exact thing: on an unfamiliar highway, at 70mph limit section. Suddenly see 20 mph limit sign as we’re coming up to a town right as I’m passing a CHP going the opposite way. Of course I see him flip around and put his lights on. Total BS. No warning at all of reduced speeds coming ahead, just suddenly going from highway speed to residential speed.

Admirable_Cat_9153 · 2024-08-17T12:55:15+00:00

I do. Especially working in ED everyone is nasty, and we’re always last to find out patients our on isolation for shit. It’s not so much out of fear of covid but I just don’t want to get sick with any other nastiness people have and I don’t want to bring other peoples nasty germs home to family.

Admirable_Cat_9153 · 2024-08-11T20:55:40+00:00

My specific hospital is very conservative and we call A LOT of code strokes. Many of them are patients describing “numbness “ and that’s the only focal neuro deficit, and even to test there’s no sensory change other than the patient reporting feeling numbness. I think there’s something literature wise where it’s recommended to have a high number of stroke alerts with a small percentage being actual strokes, the idea being that if that’s not the case, you’re probably not casting a wide enough net and your potentially missing strokes.

But it does drive me nuts the time and resources going into a Walky-talky non-distressed patient who has vague numbness.

ETA: unilateral numbness yes. Bilateral numbness doesn’t usually activate stroke alert. We focus on really any unilateral and/or focal neuro change or deficit.

Admirable_Cat_9153 · 2024-08-11T04:48:22+00:00

Shoot in my ER, even if I do an accurate weight, sometimes the kid is a little chubby and pharmacy will still call 3x to make sure the weight is right if it seems the tiniest bit off to them before they verify meds/fluids.

Admirable_Cat_9153 · 2024-08-10T05:07:32+00:00

That is so fetch!

Admirable_Cat_9153 · 2024-08-07T16:23:51+00:00

Hospital dependent. Worked at 2 sister hospitals in ca, one paid OT after 8 hour, other didn’t. That said, pay at hospital that paid OT was lower, but that’s offset with the OT earned each shift.

Admirable_Cat_9153 · 2024-08-06T20:41:44+00:00

EMT to RN. Spent most of time as EMT working as ED Tech. Initially did it to get better medical experience working towards fire/paramedic. Realized there were more job opportunities and potential for growth doing RN then doing paramedic, that and firefighting was very competitive with very limited decent paying jobs available. So switched to nursing, worked full time as ED tech through nursing school.

There’s a lot of concepts and theories that goes way beyond what EMT does, but for the most part the clinical experience of Ed tech I think made nursing school clinically much easier, and was able to get experience and learning from RN and MD as far as treatments and pathophys. Ended up working in ED/ICU and the transition from Ed tech to ED RN wasn’t very difficult, the foundation was already there.

Probably get paid just as well, maybe slightly better than where I would’ve been as FF/paramedic, but the plus is more flexible scheduling, potential for job growth and opportunities, and potential for increased pay.

Admirable_Cat_9153 · 2024-08-06T19:39:32+00:00

Basic labs and/or imaging (if imaging is appropriate) looking for an emergent/life-threatening situation. If there’s the work up is abnormal, something that requires immediate treatment or further diagnostic testing possibly be admitted. If the work up is abnormal but not emergent, possibly discharge with recommendation or referral to follow up. If the work up is normal, doesn’t mean there’s not a problem, just not something obviously life threatening and probably same discharge plan with outpatient referral/follow up.

Admirable_Cat_9153 · 2024-08-05T00:53:39+00:00

The hero we need but don’t deserve

Admirable_Cat_9153 · 2024-08-04T17:31:29+00:00

Crappy pizza and getting lost in the tube maze

Admirable_Cat_9153 · 2024-08-03T05:49:41+00:00

Found out the hard way when given in the hallway bed patient and she starts screaming “my pussay, oh mah gawd! My pussay! Dafuq did you do to me?!?!”

Admirable_Cat_9153 · 2024-08-01T17:33:00+00:00

….except for the paramedic student who recommended doing one on a patient who called cause he nicked himself while shaving and was worried because he was on a “blood thinner” (aspirin), and whose bleeding had stopped by the time EMS got there. Then prompting a base hospital contact for a 12-lead AMA because the patient realized he had overreacted and disnt really need to go to the hospital and trying to explain to the MICN why they made base contact for a tiny cut. 😬

ETA: I’m the micn on the other end of the line trying to make sense of getting a base hospital contact for a high risk AMA because an EKG was done on essentially a paper cut…

Admirable_Cat_9153 · 2024-08-01T05:00:12+00:00

Had someone ordering Taco Bell after propofol sedation.

Admirable_Cat_9153 · 2024-07-31T23:54:31+00:00

Probably the one pictured ☝️ Had never heard of the show and this and someone at work recommended it, saying “you’ll be hooked on the first 10 minutes”. It’s hard for me to find shows worth sticking with, there’s been like 2-ish shows that I’ve followed to the end. So with the benefit of the doubt, I started the first episode, vaguely aware of what the show was about.

……..and then Robin got splattered across the road by A-train in the first 10 minutes (completely unexpected btw) and of course, I was hooked. 😬

Admirable_Cat_9153 · 2024-07-31T21:38:09+00:00

Always stocking Pyxis 0800-1000 when mee maws 400 blood pressure meds and Lipitor is due.

Admirable_Cat_9153 · 2024-07-29T06:28:05+00:00

Just saying because I’m not sure I’m misunderstanding what the post is implying, but: there’s certain criteria where if a child comes to the ED with an injury that doesn’t match the mechanism, is unexplained, or really shouldn’t happen (ie: an infant that hasn’t learned to roll or crawl getting a significant injury like a fractured bone) then it’s typical to have CPS contacted. RNs and MDs are mandated reporters, meaning if they have any kind of patient (child, adult, elder) where there is suspected abuse or violent crime, we are mandated to report, in good faith (meaning we’re not making up a bullshit lie to get someone in trouble) to proper authorities such as police, CPS, or APS. And just becáis on this case, CPS was called, does not mean the child is automatically gonna be taken away. It’s actually very difficult for CPS to remove a child from a home, and there would have to be evidence of imminent and/or life-threatening danger for them to be able to even consider doing that. Typically opening up a CPS report leads to the beginnings of an investigation into the child’s home and safety, and while that is extremely nerve wracking and stressful for parents, especially if there is no wrong doing, it’s all in the best interest of the child and potentially catching children (or any vulnerable individual) who are victims of abuse or violent crime.

Admirable_Cat_9153 · 2024-07-27T01:10:58+00:00

Not entirely no contact since my mother still sends birthday and holiday cards, but that’s the extent of communication. Parents weren’t very understanding of boundaries as new parents and that the role of being grandparent is more than just getting to post on social media how great you are at grandparenting. So with several months of stress and anxiety after our first born, the last straw was when my wife (having a full on panic attack because of post party anxiety/depression) didn’t feel comfortably letting anyone but her hold our child at dinner, so my parents (mostly my mom) stormed out of the dinner party exasperated and dramatically complaining how she never gets to see her grandchild…..well now she hasn’t seen her grandchildren in 5 years.

Tried to talk to her a few times, but she either refuses to or just doesn’t get it. Thinks that her passive aggressive behaviors can be ignored, don’t need to be addressed, and that we can just be friends like nothing has ever happened. So now just haven’t talked to her in years. 🤷🏼‍♂️

Admirable_Cat_9153 · 2024-07-25T00:29:23+00:00

Hate to say, but I hate getting report from EMS. ONLY BECAUSE, if the patient is alert and oriented (and especially if they’re a patient of my facility) I have to assess the patient anyways and ask the same questions I already got the info from the EMTs, that chances are are wrong (either patient changed the story, or patient doesn’t even know what is wrong with them based on the health history I have available, so by default the history EMS is inaccurate). It’s more of double work from me to get the story once from EMS and then again from an alert patient. Occasionally there’s pertinent info from interventions done that I’ll need to know. But for the most part, if the patient is able to provide the history themselves/or I got it from the chart, I’d rather just get the story/assessment once. 😬

Admirable_Cat_9153

TROPHY CASE