As an emergency room (ER) nurse, we start another 12-hour shift in the local “24-hour body repair shop.” We take report from the off going shift.
The nursing report in the ER is short and sweet, but a few words speak volumes when you know the treatment plans by heart.
“Room X is a 58 year-old male passing a kidney stone, 18 gauge IV in right arm, second liter of NS (Normal Saline) wide open, pain free after 5mg of morphine.”
“Room N is a 60 year-old male with musculoskeletal type chest pain relieved by 30mg Toradol iv, has a saline lock (IV access without fluid running) left forearm, drew a rainbow (multiple different colored blood tubes for lab) labs (tests are) cooking, normal EKG, history of hypertension, can't afford his meds.”
First in for the Day
We're interrupted by an Emergency Medical Services (EMS) crew coming in the door with an intoxicated male, wearing Siamese friendship bracelets (handcuffs), who needs jail clearance. The police tried to help him find his family to take him home, but he was so belligerent to the police that he talked his way into jail. We direct them to a corner where his mouth won’t offend too many other people. I break off from report to go triage him.
Shaggy, bearded mid 40's male, who has wet his pants. He’s a frequent flier, so I know him by name, know his medical history, and who usually comes for him if he's behaved and can go home sober. He denies needing medical care but isn't able to guess the right date when asked. So, we draw blood for an alcohol level to calculate when he'll be legally sober and we no longer are responsible for him.
Mental note: bet the new doc that Shaggy's blood alcohol will be around .320—legal is less that, at .080. I get lots of free sodas that way and experienced staff won’t bet me anymore.
An Accident and a New Arrival
The EMS radio blares “inbound with a 17 year-old male unrestrained driver in a one car rollover +ETOH (alcohol on board but only 17), airbags deployed (was going at least 30 MPH), found ambulatory at the scene, denies pain, alcohol, and need for treatment. Bleeding from full thickness lac (laceration) on his chin, lost a few teeth during the event. No loss of consciousness (what little he has) full spinal precautions in place, parents are on the way (poor parents!) ETA 5 minutes. Assign them to a trauma room.
A registration clerk grabs my arm and asks me to check on a car outside the front door. Mama has 2 children at home and number 3 has just arrived on the car floor. The nursing assistant brings some supplies (how do they always know what's needed before I do?). I quickly wrap the baby and clamp the cord noting the time carefully for the birth certificate. Born outside a sterile environment, the baby will be monitored in the ER until stable and will go to Pediatrics instead of to the cleaner New Born Nursery. Mama goes to labor and delivery to finish delivering the placenta.
The new doctor begrudgingly hands me a soda and asks if I gave the second dose of morphine to the patient in room X. I tell him I hadn't logged onto the computer yet, but would do so now and catch up with the orders on my patients.
Winning a Bet
On the way, I ask the police watching Shaggy if they want coffee. Police hate sitting around the emergency room and the nurse don't blame them. (Mental note—Shaggy has wet himself again and there's a puddle on the floor. Call housekeeping; give them the soda I won.) A second officer arrives and informs us that Shaggy is being released with a court date assigned and in a heartbeat both officers are gone. I tell them thanks for the present (Shaggy).
I finally have time to make a route past the coffee machine to my computer terminal, and I take a sip of coffee as I log on to catch up with my patient’s orders. A quick glance at my watch tells me I've still got 11 more hours left to be an emergency room nurse.
If you also work in the ER, how does your shift go? Share your experiences in the comments.