Friday, August 31, 2007
Here is yet another thing I can not comprehend about some people. Our ER has instiituted a new "family friendly" policy that allows children to come back to see patients. Prior to last week, if at all possible, we really stressed that children be at least 14 before coming back. I say if at all possible, because we do get patients that come in with there children and no one to watch them, so of course, the children have to come back with the patient. I have some issues with this policy. First off, there is no reason for children to be in our ER. Our hospital has a pediatric ER, the only children we get are level 1 traumas, all others go to the other ER. This being said, our ER is not child friendly. It is a big, scary place, It scares me most days. We have crazies, people with appendages hanging off, people with tubes coming out of every orifice imaginable, beeping noises everywhere, traumas and full arrests coming in through the middle of the hallway, etc. Not too mention, the ER is where sick people come. There are the worst imaginable germs, EVERYWHERE. About the only other place I can think of that might have more germs is in an ICU that keeps septic people all the time. I am all for sick people being able to see their kids and grandkids and nieces and nephews. I think that more visitors speeds the road to recovery. The ER, however, is a place where (hopefully), the patient will not be for too long. Hopefully, we will get the patient stabilized and treated and either discharged, to a room or the ICU. Then, as long as the patient is on the floor, for the most part, family members can throw a reunion if they want to, with hardly any interference from the nursing staff, esp if you share the food. I say all this because the other night while working, I had 4 different patients' family members bring in young children. When I say young, 2 of these children were less than 3 weeks old, 1 was 18 months and the other probably about 6-7 months. The children were well behaved, in fact being it was between midnight and 230 when these patients were here, most of them spent the visit sleeping. Now I understand that they were worried about their family members who were rushed into the ER by ambulance, but there is NO WAY I would even consider bringing my newborn to our ER. I didn't even take my newborn to walmart or church or anywhere else for that matter, until they were 6 weeks old and had their beginning immunizations. As for older children, well some of the images I see stick with me and give me nightmares, what about a 7 or 8 year old? I just don't think any good can come out of children being able to visit in the ER. Oh, the funny part about the 4 family members? The patients themselves are were discharged to home within 4 hours of their arrival.
Thursday, August 30, 2007
I am a HUGE college football fan and I am tickled pink to have watched my first official game of the year, hate that MSU got blown out, wish it was a better game, but it was at least a college football game and an SEC game at that! Bring on the sleepless saturdays, (I work every Fri and Sat night), BBQ, chips and cheesy fight songs, too bad Lee Corso has to be in on the deal too. Still, I can not wait until Saturday.
I had my first official train wreck a few nights ago. Now when I said train wreck in my old unit, it was a patient that was sick as all get out, on all types of pressors, intubated and circling the drain with a thousand comorbidities and septic. Not here in the good ol' ER. I had an actual train wreck. Gentleman fell asleep on the tracks, was hit by the train and thrown approximately 40 feet into a concrete abuttment. Our good folks at ems gave us the heads up as they were bringing in other patients, medic 4 is working a pedestrian vs train. I slowly set up my trauma room, really not expecting to get this patient, I mean dude was hit by a train and thrown. After 30 minutes, I was about to go grab a bite to eat, really thinking that this was not going to make it to our hospital when the radio goes off. Giving us report. Ped vs train, vital signs stable, noticeable deformities to left arm and right femur, gcs of 14. I am floored. Not only am I getting this guy, but he is stable and talking!!! They bring him in and he does have two very nasty breaks, his r humurus is sticking out or the skin and the arm is at an awkward angle. The left leg is quite a bit shorter than the right with and obvious deformity to the femur. We intubate, so that we can adequately control his pain, and possibly reset some of his fractures. This guy has no other injuries. And, prior to intubation, he was totally with it and quite angry at the fact that we "ruined his buzz". BAT was 402. Positive for cocaine and thc. Now in my few months in the ER I have decided that crack, in fact, does not kill. It gives superhuman strength to people and allows them to survive the wildest traumas imaginable without a scrape on them. Roll your ATV off the edge of a 70ft cliff? No problem, if you are positive for benzoylecgonine (fancy word for cocaine, technically it is its metabolite, but whatever) you will have a 6 inch lac on the back of your head, no other head injury and no broken bones (and of course you were not wearing a helmet). Contrast this with the gentleman sitting at the red light that gets rear ended by a car whose brakes had failed, neither positive for any drugs or alcohol, crash speed estimated at around 35-40 mph, and the driver of the stationary car dies and the driver of the failed brakes car is a paraplegic. If we had thrown some crack into the equation, think, both of these lives could have been spared. I also am fairly sure that crack is also a highly potent fertility drug, but the verdict is still out on that, my er dr's aren't quite into proving my theory by ordering urine drug screens on all my pregnant patients for my sake of research=(.