Thursday, July 19, 2007


I love almost all the docs I work with, some more than others, but for the most part they are a great group and listen to us and we work as a team to get patients out of our er as quickly as possible whether it is up to the floor or out the door. But there is this one doctor, that I just feel really has it in for me. I don't know if I have pissed this doc off or what, but there have been a coupla incidences that have made me go, huh? First one was an honest mistake on my part. I was a new nurse to the er, from an ICU that was pretty much run by the nurses, we made ALOT of patient care decisions. We also responded to codes on the floor which were run by residents, who did not have alot of experience, ergo the nurses ran the codes. I had a patient that came off of the ambulance into a bed (in a tootie room no doubt), and started "acting funny". She couldn't sit still, she was all over the bed and was complaining of lower back pain, that spread after sublingual nitro given en route, and leg numbness. Well I placed her on the monitor and was getting her history. In the middle of the history fhe gave me the Q sign. I yell out for the crash cart and help, position her in bed, and sure enough, no pulse even though there is a juctional rhythm in the 30's on the monitor. I have one of the other nurses bvm her, a tech do compressions and I put her on the defibrillator. I bust open the cart and give an amp of epi and an amp of atropine (both 1 mg), the doc has not made it into the room yet. I send another nurse for the doctor, we resume CPR, and in 3 minutes, I give one more amp of epi, monitor is showing and accelerated Juntctional rhythm at 80, still no pulse. It is then the doc shows up, and is mad because I have already given 2 mg of epi and 1 mg of atropine and the doc was not aware of the code. Well, I informed the doc I was a little busy and figured when I called for the crash cart, it might get someone's attention(which it apparently did since everyone in the er who did not have an md liscense had made their way into the room), as I have said, bad foot in mouth disease. Patient ended up not making it, and I apologised to the doc for my words and explained that I was new and we did things a little differently where I was from, but I was covered under ACLS protocols. I thought we had made up and all was good until....

We had a patient come in whose ICD was firing like every 10 minutes. The monitor showed a paced rhythm with varying runs of Vtach, though it was a perfusion vtach. When the runs were long enough, the ICD fired, just doing its job. Sats were 94%, but this was on a NRB. I ask respiratory to get me an ABG, she does and the PO2 is like 52. I show this to the doc (who is on the phone to cardiology about the patient). When the call is over, I am asked, who ordered this? I said that I asked for it to be drawn, that I thought it would be a good value to know since hypoxia could be causing Vtach, which is causing the ICD to fire, hearts act really irritable when there is not enough o2. And I get told that the order will not be signed off since this doc did not order it. I am standing there slackjawed and flabbergasted, this patient's pO2 is only 52 on 100% O2! It is not like I stuckthe patient and the gases ended up being ok. Luckily I knew the cardiologist on call very well and he wrote the order to cover my butt, but I was so madI could spit! Can anyone tell me why this doc might not have wanted ABG's?

Now that I have been there a little while and gotten to know this doc a little better we are feeling each other out little by little and getting along a little better, in fact I like this doc as a person, just not my favorite one to work with.

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