An exciting week of being a nurse AND a PA! (warning- gory picture:)

So far my month in the ED has been pretty dang awesome. I've learned so much about medicine but probably more about people that come into the ER. I really really really do my best not to judge people but in the ED, you almost have to. It's crazy how great people can act to try to get pain meds from you, I've been fooled so many times already. They use the typical

"doc, I know you can help me, not many people have been able to. THere has to be something going on with me, this pain is unbearable (all while in tears) and I wouldn't be here if i wasn't at my wits end."

So naive newbie over here buys into it and really starts thinking of all the terrible things that could have bee n missed on a CT or the multitude of other studies the pt has had, all of which are completely normal. I distress myself thinking of all the things on a differential and present it to my attending really concerned. He takes one look in the room, without even really entering the room, and goes, "ok, got it, she's going home." His explanation was that she has "the look." Apparently, and i think I am starting to catch on, whether its good or bad, the look is just something you can just pick up after years working in an ED. There really isn't a way to describe it, its has no real specific features, but you know it when you see it. Is it just a biased/prejudiced opinion against the way some people look that come into the ED? Maybe, to some extent. But when "the look" proves to have a specificity of about 98% for diagnosing somebody as a "frequent flyer, drug addict that makes up stories for pain meds", I'd say there's some validity to that, not just biased and jaded opinion.

Here are some more highlights from this past week:

-On the way to work, not even in the ED yet, was driving and witnessed a teen vs. car accident right in front of me! It was pretty scary seeing the kid fly in the air and land on the street not even 20 ft from my car. For a split second I thought "holy crap, this kid is dead, I really hope there's a doctor in the area..."
And then i had the "oh crap, this is all me...the doctor in the area...ahhhhh that's me!!!" So before I could finish that thought and even begin to freak out about how I wasn't really sure what I was doing, my car was parked in the middle of the street and i was running over, in full scrubs as i was on my way to the ED, to see what was left of this poor kid who, by the way, was hit straight on by an extremely old driver going no less than 40mph!  The kid, Antonio, was 16yrs about, was laying on his back just moaning in pain, left arm road rashed to hell, totally mangled, lacs all over his face. It was crazy because for the first time ever, I was telling people what to do, what not to do, and to calm down. It was funny, if you're a med student you'll appreciate this, I almost spouted off the "sir sir are you ok? you call 911, you  go get a crash cart!" line from BLS/ACLS lol. But anyway, he was lucid enough to know what happened and to thankfully tell me his mom's phone number.  It was almost 8 minutes before the paramedics came and all i really did was hold his head still and straight and have someone else hold his legs. After a few minutes he lost consciousness and most likely went into shock, just in time for the paramedics! (whew!) So I was able to talk to the medics and give them pretty much the story and most of what they needed. As I'm standing there with Antonio's blood on me, about to turn around and head back to the car to head to work, one of the medics walk over, shakes my hand and says..."thank you, he's lucky such a great nurse was around to help."   Awesome lol.

- Going with the same "all females in scrubs are everything BUT doctors" theme, I was called "PA" by an asshole doc for my ENTIRE shift yesterday. It's me third week in the ED, he's seen me a million times with other docs. And he calls me, not even by my name, just "PA." He says things like "hey Dr. B, i got this great case for PA if she's interested." Most of me wanted to just correct him and tell him to at least learn my f'ing name. I don't mind as much if you think I'm a PA or a nurse, but at least have the respect to learn somebody's name for God's sake!

- Saw a lady with  blood glucose of 1617, this is not readable on a finger stick. She came in in DKA (diabetic ketoacidosis) with a pH of 6.7. The pH that is compatible with life is no less than 7.0. We intubated her, pumped her with fluids and insulin as fast as we could, and just sort of watched her deteriorate. Her husband was out of town an last spoke to her at 0730 and found her at 6:00pm...which means she was probably in DKA most of the day. Her husband didn't seem too concerned in the ED, she'd been in DKA before, just not this bad. He said her insulin pump hadn't been working right lately. His only comment was "so is she saying overnight?" It was really sad to stand next to the doc who flat out told him, "well actually, her chances of living until tomorrow are slim."

- Got to reduce this sweet complete wrist disarticulation:

 The story was this mexican lady who, naturally, was skateboarding at 2am while drunk fell and landed on her wrist. Her hand was literally dangling by the skin and that bone popping out is her ulna. The pre-reduction x-ray showed that both radius and ulna weren't even close to her carpal bones, pretty gnarly. Needles to say, the reduction was cool. I yanked on the hand while helping the doc push the bones back into the right spot. I was super lucky that night, thank you lady for being drunk and contributing to my learning!











- Witnessed a carotid massage ACTUALLY convert somebody back to normal sinus rhythm...that actually worked! I thought it was just in books. It converted right back to a-fib in 5 minutes and we had to cardiovert her, it worked for a bit! Crazy!

- For the first time I appreciated the honesty of a drug addict. Lady came in for being "zonked out" in a grocery store, nobody knew what was wrong with her, she walked there, sat down, and was out of it. After medics and nurses asking her if she had pain anywhere, the whole sleu of "protocol" questions, I was annoyed at her babbling and fighting with everyone and spitting on me, I just asked "what's wrong with you???" She politely responded in her slurred speech "nothing,  just took a handful of methadone and xanax." My response, "ok great, bye!"


That's it for now. I'm in the Peds ED next week so I'm excited to be with the little ones that just make me happy.  Something about a Madagascar decorated portable x-ray that just makes me smile :-)