Another Day at the Office

Arrived in the ED this weekend and immediately did a double-take as a man in full clown makeup and a patient gown carried his urine specimen cup back to his stretcher.

Shortly thereafter, two guys who had been electrocuted while doing some rewiring arrived in the trauma bay, one with scorched holes in his underwear where the electricity shot through his body.

Of course, being the weekend, it didn't take long for the parade of intoxicated patients to arrive, some spitting and throwing punches.

After helping place one in restraints, I turned around to see a psych patient sprinting down the back hallway trying to escape. His IV ripped out, blood spilled from his hand and trailed in a stream behind him.

Perhaps he was set off by broken fire alarms that went off three times in twenty minutes.

But the greatest fiasco of the evening?

For a terrifying few minutes, we were out of toilet paper.

I Have a Fever...

...and the only prescription is more Olympics. Speed skating and ski jump were great yesterday, and I can't wait for hockey and curling to start!

Winter Reminders

Can't believe it's taken this long for someone to pull an ER winter classic, but last night I saw my first snow blower vs. finger of the season. I have yet to see a finger win. Don't get me wrong - it's pretty cool to watch a doc file down the bone so the skin flaps can be sutured together, but far less cool if it's your own digit being whittled.

And while we're on the topic of winter safety tips, don't forget to check the batteries on (or purchase) your carbon monoxide detectors!

Jersey Shore Chic

Mad props to the visitor of the patient in Bed 5 last night. Despite the cold, despite the snow, this guy was willing to make the ultimate sacrifice to race to the ED as quickly as possible.

That's right, after a full day of gym/tan/laundry, this studly family member rushed to put on his designer jeans, stylish jacket, and gold chains, hastily gelled his hair, and flew out the door without even noticing he had forgotten his shirt.

What were a couple frosted chest hairs when compared to the seconds wasted by covering up his pectorals?

We in the ED salute you, Walking Around Shirtless in the Emergency Room With Your Jacket Unbuttoned In The Middle of Winter Guy. If only Snooki were in Bed 6...

Keep Still!

It seems like common sense to me, but apparently there's a subset of the population that doesn't realize the importance of keeping your arm still when someone has a needle in it.

KeepBreathing has a post up that reminded me of a patient from a while back. After delicately inserting a 25g butterfly into what I swear was his last functional vein, I could only watch in horror as the patient decided to wave his hand wildly to convey his point while speaking with the doctor. Butterflies in the hand may be painful, but I'd much rather have that than an IV inserted in my neck.

Please, if someone has a sharp pointed object inserted into your flesh, do us both a favor and don't move!

Nursing Home Fail

After grabbing a set of vital signs on the pleasant but confused nursing home patient who had just arrived in the ED, I found her chart to document. Glancing at the inter-facility transfer form, I discovered the reason she had been taken from her room, put in an ambulance, and driven across the city in the middle of the night.

The patient, according to the form, was an "elopement risk."

In the ED we work up altered mental status. We work up UTIs. We work up chest pain and shortness of breath.

How exactly did they want us to work up "elopement risk?" Watch her for an hour and make sure she didn't run away?

I Can't Get No Satisfaction

Like many hospitals throughout the country, the Big City Hospital is feeling the pinch of the recession and doing everything it can to improve patient satisfaction in the hopes of retaining its customer base. Down in the ED, we've seen a variety of new initiatives designed to lower waiting times and facilitate rapid dispositions.

Armed with this renewed zeal of customer service, one of the RNs approached a patient who beckoned from the hallway. "Look man," the patient implored, "you guys gotta let me go. I've got a really important meeting to make."

At 0130.

The RN politely explained that while we do everything in our power to send patients home in a timely manner, the fact that the patient was currently dependent on Ativan to prevent his alcohol withdrawal seizures limited our ability to comply with his request.

Stressing the high quality of the crack he was scheduled to purchase, the patient again repeated his desire to be discharged.

Later in the morning, we received a call from the nurse taking care of him after he was admitted to the floor. In yet another effort to secure a rapid discharge, the patient was offering to reduce the amount of time spent waiting for the elevator by insisting that he would simply jump out the window to score his crack.

For our inability to assent to his treatment demands, I'll bet we receive low marks on his patient satisfaction survey.