Thursday, July 9, 2009


Let me just start off by saying ER was extremely awesome! It really had me rethinking my choice to be an OB nurse. I was nervous at first but once I figured out where things were located and established rapport with the ER nurses and docs, things were great. I had to toss my fear of IV insertion out the window cuz I really didn't have much choice, LOl. I just had to go in there and get it done. I wasn't successful at every attempt, but I am no longer as scared. I can also pop in a Foley quickly and without a nurse there to guide me through it.
I did get to insert my first NG tube. That was cool. The guy was really dreading it cuz he had one before and knew it wasn't fun to have a tube stuck up your nose and down your throat. His family was in the room and when I was introduced as the student who would be performing this skill, the teenager in the room said in a condescending way.."Umm, just what kind of grades does she make in school, I don't know if I want her to do this or not..."LOl. needless to say, I acted like I had done this a couple hundred times and they never knew the difference.
Here is the part were things get interesting. It was a Wednesday and it was day #3. I had just gotten to work and things were quiet. All of a sudden someone is trying to get into the back where the ambulances come through. A few of the nurses go see what is going on and guess what, it's a trauma.. a real trauma. A man in his fifites was laying fence according to his friend that brought him. A 2 1/2 in steel pipe had landed on his head (not sure how though) and he was bleeding out his head really bad. He was pale and diaphoretic and shaking. He was complaining of neck pain so we got him onto the stretcher and immoblized his neck. Further inspection showed a huge laceration to the back of the head. CT comfirmed a skull fracture, and fractures to the neck and spine. We flighted him out an hour later so he could visit the neurosurgeon. When he left he was still able to wiggle his toes.
The rest of the day was filled with the usual clinic cases...toothache, arm pain, abdominal pain, fever..mostly drug seekers wanting pain meds. Sad, but reality.
The next day was my day in triage. That was kinda cool. By lunchtime I had gotten the hang of it. That evening I got to take part in a sexual assault exam on a little girl the same age as my daughter. It hit home and I really didn't know what to do with myself and my thoughts once I got home. I didn't realize how much this happens in my community. It is heartbreaking and I'll try to post on that at a later date, but for now, lets continue with my ER experience.
Friday was exciting. I was discharging a patient when it happened. The one thing that Iwas still afraid of.....A CODE BLUE...My heart started racing and I went to check it out. 85 yr old male came into the ER with shortness of breath, then he stopped breathing and a code was called. Doctors and nurses were cramped in a little exam room (not the normal trauma room) and I just kinda hung back in the corner watching and not wanting to get in the way. All of a sudden I was called upon to help with chest compressions..OMG, that was craaazy. His chest felt like one of those stress balls, you know the ones the you squeeze. His whole chest wall had caved in and ribs were broken. I couldn't quite go as fast as the other nurses, but thank goodness for that respiratory tech, he guided me through. I gave out pretty easily and someone relieved me. WOW, my first time to do chest compressions and I was actually apart of saving someones life. We got him stable enough to move him to the big trauma room. We had him on the ventilator and I was helping a nurse clean him up. He was an alcoholic and he had vomit all over him so we needed to get things straightened up for the family. He had a sister and niece and that was it. When we rolled him over, he started bleeding out his mouth. We suctioned and suctioned and he just kept bleeding so we got on order to hang blood. His family didn't want him to recieve blood after we had it started. We had no documention stating his wishes but they did at home. We couldn't stop the blood until they brought us legal documents. He would die without that blood. Just a little bit of an ethical decision to be made. He was alive when I left but he did pass on the next day.
Monday was exciting too. ER was busy. People were waiting in the lobby for 5-6 hours and they were unhappy. Can't please everyone, but when your here for your daily drug fix and we have people being brought through the back by ambulance, tough s**t. It is hard to be sympathetic when you see the same person 3 times that week for the same damn toothache. This is the ER, not a dentist office. We did have 2 more codes and they happened at the same time. In the same room. One made it and the other didn't. While this was happening we had someone having a stroke and we were trying to get them flighted off to the stroke center. 3 codes for me two days in a row. Chest compressions twice. I talked to a nurse over the weekend who has been one for over 20 years and she has never done CPR. Such a good learning experience I have had this summer.
I wrapped up my rotation with some grossness. 19 year old presented to ER with complaints of vaginal discharge after sex this am. Okay, that's just great. Doc does a pelvic and guess what he finds......a month old tampon. She was horrifed and I bout fell over from the smell. How does that happen? Guess it happens alot. Needless to say, her boyfriend was a little angry.
I will leave you with that and I am off to ICU next.