Monday, October 17, 2005

Ladies and Gentlemen, The EmergiAwards!

And the EmergiAward is presented for:

Fastest Relief From a Pain Shot Award: 5 minutes. Patient is writhing, moaning with tearful sobs, nauseated, photosensitive, holding the sides of their sunglasses as they rock their head from from side to side. Injected with Dilaudid and Phenergan. After five minutes, sitting painfree on the side of the bed and very appreciative.

Worst. Luck. Ever. Award: Patient gets hypodermic needle through sandal while walking in a park.

Worst ED Set Up Award: Goes to a local university teaching hospital, world renown for just about everything else except the lay out of the ED. While the rest of the facility is state-of-the-art, the ED is a 1960s time warp. The metal detector you have to go through to enter the ED is modern, though. The staff is great, the care (both medical and nursing) is competent, but the unit itself is small, cramped and swarming with nurses, interns, residents, attendings and, oh yes, patients. Even the trauma room is small. Which leads us to the....

Worst Assignment Ever Award: while employed by the above university teaching hospital, I was given the "Hell Hole" assignment. This meant that I was responsible for six monitored patients in a small, windowless room AND the psych isolation room right across the hall that required q 15 minute observations/documentation on the patient locked inside. One RN. No LVN. No tech. Just me. And, oh I almost forgot..... about a gazillion interns/residents/attendings/ all wanting to know where the labs were and why Patient X was still in the ER. Or informing me that Patient X wasn't getting admitted yet because twenty other Medical Services had to see them and it HAD to happen in the ED. Or sitting at my desk hogging my charts (except the interns....I let them use my desk, they were cool). Funny, the administration was shocked, shocked that I resigned after 10 weeks. I've heard through the grapevine that the unit is now staffed more appropriately. I don't mind working hard, but I will never tolerate working stupid.

Most Ridiculous MD Order Award: Conscious sedation. Patient: child with a laceration. In the middle of the night. On a major holiday. In a full ED and with 8-9 patients in the waiting room. With only two RNs, one of whom would be tied up with this patient for a full ninety minutes. Let me put it succinctly: No way, dude. No freakin' way.

You Can Run, But You Can't Hide Award: Patient on west coast recognized by a nurse who just moved from the east coast as one of the known drug seekers in her old east coast hospital. Busted!

Oddest Response To a Negative X-ray Award: Look of absolute devastation when told extremity not fractured. Poor guy, don't you just hate it when dreams of an insurance settlement slip through your fingers? Patient giddy with delight over crutches, however, so positive patient feedback expected....

Most Patients Presenting In a Single Family At One Time For Triage Award: Six (ages 6,5,4,3,2,1)! They all had colds.

Sweetest Man In the Entire World Award: Patient is elderly, frail delusional female who presents with the belief that her eyes are falling out. ED MD tells her that not only are her eyes not falling out, but that they are beautiful.

Unclear On The 911 Concept Award: Patient with multiple, penetrating thoracic trauma picks up spouse at home before stumbling into ED, pale, diaphoretic and near syncopal.

Just Plain Stupid Award: ER staff allows 35-year-old female with acute abdominal pain and bleeding to fill bladder by drinking two liters of water before pelvic ultrasound, only to then say, "Gosh, you are going to surgery! Here is an NG tube...." and I can give the details of this one because I was the recipient of the NG-induced epistaxis! I will never, ever consent to an NG tube again as long as I live unless I put it in myself. At least I know how to DO it!

Best Straight Shooter Award: Intoxicated, combative, restrained patient needs to urinate immediately. Patient turns to the left side, inches gown up and proceeds to shoot a stream of urine TWELVE FEET away from the gurney. Standing ovation received from all male staff in a thirteen-foot radius.

Who's The Parent Here? Award: Parent offers liquid antibiotic to Toddler, who says NO!
Parent turns sheepishly to ED RN stating, "Oh dear, he doesn't want it". Five seconds later, the medication is traveling down the toddler's esophagus via a syringe wielded by said RN. RN advises parent to remember that parent is (1) older (2) bigger (3) in charge and (4) it doesn't matter a rat's tutu what Toddler wants or doesn't want; some things are NOT negotiable. Parent marvels as though hit by an epiphany.

And so there you have it. The first group of EmergiAward recipients. Unless stated otherwise, the above situations have all been sanitized for patient protection and are composites of many, many patients, nurses and doctors I have worked with over the years. ; )


At 10/17/2005 09:02:00 PM, Blogger Heather said...

Thanks for making me laugh tonight!

At 10/17/2005 11:01:00 PM, Blogger Julie said...

Brought back a few memories of my own experiences; great stuff

At 10/18/2005 10:00:00 AM, Anonymous geena said...

I loved the You Can Run, But You Can't Hide award!!
These were GREAT!! You should submit them to Grand Rounds.

At 10/18/2005 01:28:00 PM, Blogger kenju said...

Great, Kim! But I have questions.
1. What is the alternative to conscious sedation? Is it to knock them out? This is probably a stupid question, but.....
2. What were the multiple,penetrating thoracic traumas caused by?
Or do I really want to know?

That reminds me of the time I was in the ER with a lawn mower to foot injury and a girl came in with her hand caught in a meat grinder. I was about to lose my cookies over her - and so was my surgeon!

At 10/18/2005 02:41:00 PM, Blogger Kim said...

This was a simple laceration. For those you usually use a "papoose board" that holds the patient in with velcro straps. I call it the "Huggy board" because essentially that is what it does. They can yell but they can't move. Then we hold the head while the sutures go in. When we are done, we are done, and so is the patient.

At 10/18/2005 09:16:00 PM, Blogger Jimmy K. said...

I saw your comment on A day in the life of a blogger and laughed. I moved up from a flappy bird to an adorable rodent, I was so proud of myself and then the next week I was back to a flappy bird. I was crest fallen, had no idea you could go backward... anyway you comment was excellent.

At 10/19/2005 11:38:00 AM, Blogger Third Degree Nurse said...

What a great picture!!!! Loved the commentary, too. Hats off to you; I know the ED is not for me.

At 10/20/2005 05:20:00 AM, Blogger Dr. Deborah Serani said...

OMG, this is totally hilarious. What great work!!!!!!!


At 10/25/2005 06:56:00 AM, Blogger D.P. said...


At 10/26/2005 10:29:00 AM, Anonymous Dennie said...

Hi! I love your blog! I'm a RN from TN, not working due to health problems. I made a web page in the 90. It's should have been kind of a blog, but they didn't have them back then. Anyway, I love to read stuff that other nurses have written, and especially when it's well-written!

Stop by

if you'd like to check it out. Mor nurses, mostly fun stuff.



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