Saturday, August 28, 2010
You can pierce damn near anything
I walked around the corner just in time to see our newest ER physician walk out of the GYN room pale and shaking his head. He looked up at me and with all sincerity said "I didn't know you could pierce those things" I replied "Oh, it only gets better".
Friday, August 20, 2010
The Hat
One of the best interventions I witnessed over the years.
A creative physician assessing an actively psychotic, hallucinating and escalating pt brought in by EMS would successfully stop the process by asking "Did you have the hat on"? It always seemed to cause the pt to tune in and say "What hat"? The physician would calmly explain "The tin foil hat. If you make a hat out of tin foil and wear it when they start to communicate, they can't get through to you and your safe". Escalating psychotic patients would stop, look up and say "I didn't know that". No more problem, they had a plan now. They settled down, were admitted to the psych unit without the whole explosion, restraints fiasco. As they left for the floor one of us would always say "Good luck. Next time, remember the hat".
A creative physician assessing an actively psychotic, hallucinating and escalating pt brought in by EMS would successfully stop the process by asking "Did you have the hat on"? It always seemed to cause the pt to tune in and say "What hat"? The physician would calmly explain "The tin foil hat. If you make a hat out of tin foil and wear it when they start to communicate, they can't get through to you and your safe". Escalating psychotic patients would stop, look up and say "I didn't know that". No more problem, they had a plan now. They settled down, were admitted to the psych unit without the whole explosion, restraints fiasco. As they left for the floor one of us would always say "Good luck. Next time, remember the hat".
Monday, August 9, 2010
No Room in the Cooler
Cruise nursing had some strange moments. This said by an ER nurse who thrives on adrenalin and strange moments. This was a cruise line that catered to a senior crowd. That meant that a huge percentage of the 1200 passengers were obese, Diabetic and had started smoking non-filtered Camels and Luck Strikes at the age of 14. Now, they were spending 10 days eating 5 desserts a day, drinking heavily and doing the "pursed lips" breathing after dancing. I can't tell you how many would wander down to the infirmary 4 days into the sail and say "I left my medicines (all nine) at home by mistake". The infirmary stocked only a very small selection of medications but would provide prescriptions so the individual could wander off the ship and find a pharmacy at the next port. Pre-existing CHF took it's toll.
On this particular cruise #4 seniors went into full blown CHF and "passed over". The standard procedure was to put them in the cooler down below until the next port, then ship them off to home with their family member. I guess the "cooler" didn't have enough room for all #4. So I was told to "call the flower girl and tell her it was now housing a body and not to freak when she went down in the morning to gather her plants. Can't say I've ever had to make a call like that from the ER.
On this particular cruise #4 seniors went into full blown CHF and "passed over". The standard procedure was to put them in the cooler down below until the next port, then ship them off to home with their family member. I guess the "cooler" didn't have enough room for all #4. So I was told to "call the flower girl and tell her it was now housing a body and not to freak when she went down in the morning to gather her plants. Can't say I've ever had to make a call like that from the ER.
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