Workplace Violence

Ten Out of Ten has a great post up about a sad, but all-too-true reality of working in the ED: the violent patient.

The LA Times also calls attention to this issue, reporting that 25% of ED nurses surveyed reported experiencing physical violence more than 20 times in the past 3 years, while almost 20% reported experiencing verbal abuse more than 200 times in the same period.

Just the other week we had a patient arrive tied down to an EMS stretcher.  Status post assault, his face looked like a swollen pumpkin, multiple bruises covered his body, and footprints could be clearly seen on his back.  As we transferred him over, I couldn't help but feel sorry for the kid; this was obviously the work of multiple assailants.

Yet as he fought with the staff, throwing punches while screaming obscenities and racial slurs, I could begin to imagine how he managed to incite a brawl.  For trying to hold his arm still as a nurse searched for IV access, I received two punches myself, and another when we transferred him to the CT scanner.  Like Ten out of Ten's patient, he eventually needed to be intubated for his safety and ours.

Sometimes it's a thankless job, but somebody's got to do it!

How To Save a Life

"I did the thing whatever lifeguards do whenever you drown and can't breathe anymore.  That's what I did, but only three times and then he started to breathe.  Then I knew he wasn't dead."

So explains 7 year old Kenny Bagby, who saved his brother's life by performing CPR he learned from reading a Boy Scout manual.

Are you CPR certified?  One class could help you save the life of someone you love.  To find a CPR course near you, try calling your local fire department, or search for an American Heart Association class here.

Who's Calling, Please?

"Anybody have a patient over at CT scan?" the secretary called out to the workstation as staff mulled about.

"I think I do," mumbled a nurse distractedly as she charted.

"She's seizing."

That's certainly one way to jolt people into action.  I ran with the nurse over to radiology, while another nurse hustled over to the Pyxis to grab meds.  We found her unresponsive by the time we arrived, and I bagged her as we rushed her back to the trauma bay.  After a slightly frenzied couple of minutes we had her intubated, placed on a portable monitor, and back on her way to the scanner.  Turned out she had a massive bleed in her brain.

Never a dull moment.

Feast or Famine

Complain as I might when we're busy, the only thing worse is hanging around with nothing to do.

Over the weekend, a patient presented to triage with thoughts of jumping off a bridge.  With no one-to-one sitters available from the pool, my job for three hours was to make sure he did not succeed.  I always feel bad for psych patients who must endure the noise and commotion of a busy ED that isn't particularly well suited for their care, and I try to do the best I can to keep these patients comfortable.  Nevertheless, sitting is my least favorite part of the job.

It didn't help that once again we were getting slammed with traumas, and I was unable to help out.  As MDs, nurses, and techs ran from room to room trying to stay on top of things, one gentleman parked in the hallway noticed my obvious lack of movement and commented, "Everyone else is so busy.  How come you just sit there?"

Thanks for rubbing it in, dude.

My Mistake

Walked into an exam room to do an EKG on a new patient, and as I placed the leads I asked if she was having any chest pain.

"Oh yes," she replied, "in my stomach."

Trying to clarify that, I asked if she was having pain in her chest in addition to the stomach pain.

Pointing to her stomach, she explained, "Yes, real sharp chest pains, right here in my stomach."

"In her stomach," echoed the son, nodding gravely.

"So you're having chest pain," I asked while pointing to my chest, "in your stomach" as I moved my finger to my abdomen.  Trying a different approach, I decided to ask if she was having any stomach pain.

"Oh no dear," she replied, puzzled at my confusion.  "Just in my chest."

Bad Omen?

Lately I've found myself needing some extra cash to help support my education habit, so I've been applying to whatever scholarships I can find.  Today I received login information via email for an online application.

Should I be concerned that the first two letters of my assigned password are FU?

Take It Off

It's not often that an attending asks me to take off my shirt.  Proud as I may be of my emaciated runner's physique, a summer spent under the fluorescent lighting of the ED does not a bronzed Abercrombie model make me.  Thus, I was a little taken aback when the question was posed yesterday, and wondered if I had become the unwitting participant in some sort of sexual harassment training.

It turned out that a kids summer camp was making a field trip to the Big City ED, and the doc needed a volunteer to undergo an ultrasound demonstration.  More than happy to strip in the support of education, I headed over to the trauma bay and hopped on the stretcher.  Listening to the oohs and ahhs as the attending narrated a tour through my liver, gall bladder, and lungs, I noticed a pause once she switched to the cardiac probe.

As my heart valves opened and closed on the monitor, the attending leaned towards me and asked in a slightly concerned and doubtful tone if I was an athlete.  With a resting pulse in the 40s, I reassured her that my bradycardia was perfectly normal.

Apparently I have the running down, it's just the physique part I have to work on.