Vegas times

[SixFive]

I rarely get to go out this stint in Las Vegas since we are raising our young niece and nephew now. Only played poker three times since we started back to work in August.

This is is still a heck of a place, and healthcare is in huge need of reform. That?s how it is everywhere though...

We have a patient who is 25. He is autistic, and they have classified him as a suicide risk BC he jumped off his second floor balcony. He is severely delayed and can speak, but he is like a three year old child. He broke his right lower leg, and he had to have a big surgery that left him with an external fixator. This means he has a metal device on the outside of his leg with screws down through his skin into his bone to stabilize the fractures so they can heal. Bearing weight or putting any weight through this leg is a huge contraindication while that device is in place.

Behaviorally, this young man has shown no signs of behavioral problems or suicidal ideations. However, one night, he became agitated. Yelling, pushing, hitting, and KICKING with this injured leg. Security was called, everybody runs in the room, and of course that makes the situation worse. Looking over his medications, it?s now 10pm, and he hasn?t had any pain medications since 6 that morning! Typically, the patient asks for pain medication, and we give it to them. However, in mentally disabled patients or those who don?t normally communicate, you use alternative pain scales or better yet your common sense. Obviously, the kid needs pain medicine BC he has metal rods and huge metal device sticking out of his leg. Anyway, imho, his pain has made him agitated, he can?t properly communicate, and now there are four security guards holding him down Bc he is ?fighting? staff.

This poor kid broke my heart. I was helping also, and I was trying to hold and protect his operative leg. He was kicking and pushing off the bed with it. He had Herculean strength it seemed! I could feel his bones moving around and crunching in there! It was awful. In this chaos, his IV came out to complicate matters. Further frustration arose because the doctor came to assess the situation, but he was a scared resident :facepalm: who didn?t know what to do. That means we have to wait for him to call his supervising resident and then the doctor, etc., and nobody wants to make a decision or do anything! Meanwhile, the poor kid is still going crazy and I?m sure in horrible discomfort.

The first order was for Haldol 5 mg IM (shot in the muscle). What a joke!! This treats psychosis. This kid is in pain. He needs pain medication. Anyway, I go out and talk to the resident. With these guys, they don?t know what to do, and they?re scared. I have been a nurse longer than this resident physician has been alive. I know what to do. I know what the patient needs. I tell him the kid needs a good old IM shot of Demerol and Phenergan 50/50. It will guaranteed take care of his pain and get him comfortable and calmed down. The resident is cautious. The patient is almost 250 lbs.

Anyway, we finally get the orders we need, and as expected, he?s a happy kid again in an hour with no fighting. I restart an IV on him, and I get the resident to order scheduled pain medication so he stays medicated, and we don?t have to deal with this avoidable situation again. Meanwhile, I have 7 patients of my own who I need to take care of Bc this was not my assigned patient.

More stories to come.

 

[zoomer]

I rarely get to go out this stint in Las Vegas since we are raising our young niece and nephew now. Only played poker three times since we started back to work in August.

This is is still a heck of a place, and healthcare is in huge need of reform. That?s how it is everywhere though...

We have a patient who is 25. He is autistic, and they have classified him as a suicide risk BC he jumped off his second floor balcony. He is severely delayed and can speak, but he is like a three year old child. He broke his right lower leg, and he had to have a big surgery that left him with an external fixator. This means he has a metal device on the outside of his leg with screws down through his skin into his bone to stabilize the fractures so they can heal. Bearing weight or putting any weight through this leg is a huge contraindication while that device is in place.

Behaviorally, this young man has shown no signs of behavioral problems or suicidal ideations. However, one night, he became agitated. Yelling, pushing, hitting, and KICKING with this injured leg. Security was called, everybody runs in the room, and of course that makes the situation worse. Looking over his medications, it?s now 10pm, and he hasn?t had any pain medications since 6 that morning! Typically, the patient asks for pain medication, and we give it to them. However, in mentally disabled patients or those who don?t normally communicate, you use alternative pain scales or better yet your common sense. Obviously, the kid needs pain medicine BC he has metal rods and huge metal device sticking out of his leg. Anyway, imho, his pain has made him agitated, he can?t properly communicate, and now there are four security guards holding him down Bc he is ?fighting? staff.

This poor kid broke my heart. I was helping also, and I was trying to hold and protect his operative leg. He was kicking and pushing off the bed with it. He had Herculean strength it seemed! I could feel his bones moving around and crunching in there! It was awful. In this chaos, his IV came out to complicate matters. Further frustration arose because the doctor came to assess the situation, but he was a scared resident :facepalm: who didn?t know what to do. That means we have to wait for him to call his supervising resident and then the doctor, etc., and nobody wants to make a decision or do anything! Meanwhile, the poor kid is still going crazy and I?m sure in horrible discomfort.

The first order was for Haldol 5 mg IM (shot in the muscle). What a joke!! This treats psychosis. This kid is in pain. He needs pain medication. Anyway, I go out and talk to the resident. With these guys, they don?t know what to do, and they?re scared. I have been a nurse longer than this resident physician has been alive. I know what to do. I know what the patient needs. I tell him the kid needs a good old IM shot of Demerol and Phenergan 50/50. It will guaranteed take care of his pain and get him comfortable and calmed down. The resident is cautious. The patient is almost 250 lbs.

Anyway, we finally get the orders we need, and as expected, he?s a happy kid again in an hour with no fighting. I restart an IV on him, and I get the resident to order scheduled pain medication so he stays medicated, and we don?t have to deal with this avoidable situation again. Meanwhile, I have 7 patients of my own who I need to take care of Bc this was not my assigned patient.

More stories to come.

Good stuff. Keep em coming.

 

[Old School]

great work SixFive


I am a living and breathing recipient of great hospital care in the past.

and so many times it was a nurse who stopped,listened and reacted to my needs.

I make it a point to thank all the staff who help with my visits for whatever necessary.

Your stories say alot about you youngman...all good..

 

[SixFive]

Thanksgiving toilet

Thanksgiving toilet

Thanksgiving Day is a day I have always loved. Family, food, and most importantly, a reminder to think and ponder about what we have and our blessings. I like to count my blessings and always be thankful, but our lives consume us, and we sometimes forget how blessed we are.

This year, I had to work. It was my first week back on day shift. Nights is a killer both to your body and family. It?s just so unnatural to be awake all night. Anyway, I have a patient who is in her 40s. It?s my second day with her, and her diagnosis is pneumonia. Her real problems though are all social in nature. She has two small children at home and two adult children. The young adult children call her frequently on the room hospital phone. I can overhear the conversations a bit while I?m in the room, and I know that neither of them work, both are girls, and one of them has a drug problem. The patient (Jan) cries frequently especially after speaking to them.

Jan lives with her boyfriend. He also makes her cry after they speak on the phone. She handed me the phone to speak with him so I could update him on her condition. Patients have me do this regularly. Mostly it?s Bc they don?t understand or speak English well, but sometimes the situation arises where the family doesn?t believe the patient. This boyfriend is a clown and very controlling. He?s probably abusive too. This is important Bc it?s my job to offer the patient services or intervention by the appropriate personnel if I think there is abuse. She wholeheartedly denies this though, and when she gets a discharge order, she wants to go home. This boyfriend is caring for her children and often bitches at her for being in the hospital blaming her for how wild the children are.

Her first concern is that she can?t get home Bc her bus ticket is expired, and she has absolutely no money. She goes on to tell me that she lives in a very dangerous neighborhood. Her bathroom doesn?t even have a toilet! She told me the landlord will not fix it, so for three months now, the family of 6 has been using a bucket for toileting. When was the last time you were thankful for a toilet? For me, it was Thanksgiving Day.

I made sure Jan?s Oxygen level was stable, I had already obtained the breathing treatment machine for home breathing nebulizers, I assured her new prescriptions were sent to her pharmacy, and I did extensive teaching with her. I decided to take her out myself in the wheelchair. I don?t have time for that Bc it?s terribly busy, but i like to do it when I can. I can get a breath of fresh air mainly and get out of the hospital for a minute. I tell Jan we are taking a small detour, so I wheeled her down to the cafeteria. The hospital graciously gave us a Thanksgiving Day ?meal ticket?. I fulfilled mine in a to-go box and delivered to Jan. She thanked me, and she said she was going to share with her children since there was no food at home. I then took her to the emergency room security office and handed them the cab voucher I had obtained for her. I also gave her a small amount of money that will mean far more to her than me. She thanked me profusely and hugged me, and I in turn thanked her.

Count your blessing and be thankful for working toilets, shelter, food, electricity, and all the conveniences we certainly take for granted.

 

[kickserv]

be thankful for working toilets, shelter, food, electricity, and all the conveniences we certainly take for granted.

Yep.

 

[hedgehog]

Great stories Sixfive, thanks for sharing

 

[SixFive]

Glad u all like the stories.

41 year old woman comes in the hospital. She has this raging, infected abscess in her antecubital fossa (bend of her arm). She doesn?t know what happened and thinks it might be a spider bite. An ultrasound test confirms what we all know already... she has a broken needle in her arm

She needs surgery of course to cut out the needle and also to clean the wound, break up all the loculations of pus, and debride any dead tissue. After the surgery, she has an epiphany. She remembers what happened! She and her husband were at a strip club. One of the strippers there was shooting up and stumbled into her. She figures that at this point, the stripper?s needle went into her arm, and the force from the fall made it break off. That must have been what happened

I always tell patients that I treat everybody the same no matter how poor their decisions, and telling lies only makes the treatment take longer. She must have really thought us all morans at the hospital :142smilie

 

[zoomer]

Glad u all like the stories.

41 year old woman comes in the hospital. She has this raging, infected abscess in her antecubital fossa (bend of her arm). She doesn?t know what happened and thinks it might be a spider bite. An ultrasound test confirms what we all know already... she has a broken needle in her arm

She needs surgery of course to cut out the needle and also to clean the wound, break up all the loculations of pus, and debride any dead tissue. After the surgery, she has an epiphany. She remembers what happened! She and her husband were at a strip club. One of the strippers there was shooting up and stumbled into her. She figures that at this point, the stripper?s needle went into her arm, and the force from the fall made it break off. That must have been what happened

I always tell patients that I treat everybody the same no matter how poor their decisions, and telling lies only makes the treatment take longer. She must have really thought us all morans at the hospital :142smilie

Or the spider was carrying a broken needle when it bit her.

 

[SixFive]

Wall shits

Wall shits

So, I?m working in the ER yesterday, and my job is going to be taking care of patients who are admitted, but there are no beds to put them in. There are around 30 in the ER, so the plan is to move some out of their ER rooms and into the hallway 😑 BC we all know that the ultimate hospital experience is to be taken off your hospital gurney in your own private room to sitting in a chair in cramped hallway to receive your care.

Anyway, this is the decision, so I only request that the charge nurse put patients there who are ambulatory, not confused, and continent since I?m not going to be able to change beds or give a patient a bedpan in the open in front of everybody. The first patient I get I know well which is a terrible sign. She?s 40, and she is always at the hospital for sickle cell crisis. Basically, her red blood cells are abnormal, and this can cause severe pain especially in the joints. Easy enough, just give her pain meds and fluids, right? Nope... this lady is all but an invalid by choice. She refuses to get up or walk, and to complicate matters she is blind, so she just screams like a baby whenever she wants something. This patient certainly doesn?t meet the standard I have politely requested, and I know she?s going to be a huge problem. She is on a gurney at least. I get several other patients who are fine, but two of them have hot gall bladders. They both need surgery, and they are both in pain. I do my best to keep them comfortable in their chairs in the hallway. That?s exactly where I would want to be if I was nauseous, had diarrhea, and in terrible pain

I?m in the middle of calling the surgeon and coordinating with the OR staff when Ms. sickle cell starts yelling and going ape shit. She has to pee. I tell her she needs to walk to the bathroom (I know she can walk BC she lives at home and by the way she can move around on the gurney), but she says she can?t. I remind her she is in the hallway, and I can?t very well put her on a bedpan. She keeps yelling, so the charge nurse sends me a nurse apprentice who graciously wheels her into a just emptied room to assist with the bedpan.

After I get my two patients off to surgery, I get two more to replace, and patients come and go as rooms open up in the hospital. The cycle of putting patients in the hall from ER rooms to my hallway chairs is relatively smooth, and I only have one family member who complains. I empathize with he and his wife, but there?s nothing I can do about it. I?m not making these decisions nor am I assigning beds.

Ms. Sickle Cell is always complaining of pain, and I medicate her as I can per my orders. The transporter comes to get her, but she says her arm hurts, and I see her IV access has failed 🤦🏻 This is a huge problem because she has been in the ER and hospital so much she has terrible venous access opportunity. Starting IVs is my thing, and if anybody can get her, I can. I know I can?t send her to the floor with no IV, so I tell the transporter to cancel while I get to work on that, and then I?ll rebook her transport when I get it. Restarting her IV is an exercise in futility. I can?t get her. I communicate with the attending and ask if we can just leave the IV out because the patient is just in the hospital for pain control and was unable to fill her home pain medications. I didn?t mention that this is her 10th trip to the ER this month, and she was admitted and discharged 5 of those times. The physician says ok to no IV, I request transport again, but then the physician changes her mind. I tell her I need a midline BC I can?t get an IV, I put in the order, and transport arrives.

Awesome, I?m finally able to get her out of there! The transporter arrives, I give him the paperwork, but then he asks me for a mask. I ask why, and he says, ?because the patient shit on the wall?. I was like :wtf: I walk over to her gurney, and sure enough, she has had a gigantic blowout with poop on the walls and a big puddle on the floor that has seeped out all the way under the gurney into the hallway 🤦🏻 FML...

I get some blankets off an empty gurney and throw it on the puddle of liquid poop in the floor to contain it. We can?t clean her up there as already discussed, so I find a room nearby that is empty Bc the patient has gone for a test. I scoot that gurney over and make room so we can wheel in Ms. Sickle cell. The transporter and another staff member help me clean her, change the bed, and clean the gurney. Housekeeping comes to clean the hallway and wall, and she goes to a room upstairs.

The ER begins to empty, and by the end of the day, I just have one patient. I suppose it was a pretty good day overall although at times super frustrating and overwhelming.

 

[MadJack]

kurby

 

[Old School]

kurby

don't know how they do it...day after day...

 

[MadJack]

don't know how they do it...day after day...

Nope. Neither do I.

 

[yyz]

don't know how they do it...day after day...

Nope. Neither do I.

Employee discounts at the cafeteria?


:toast:

 

[freelancc]

Glad u all like the stories.

41 year old woman comes in the hospital. She has this raging, infected abscess in her antecubital fossa (bend of her arm). She doesn?t know what happened and thinks it might be a spider bite. An ultrasound test confirms what we all know already... she has a broken needle in her arm

She needs surgery of course to cut out the needle and also to clean the wound, break up all the loculations of pus, and debride any dead tissue. After the surgery, she has an epiphany. She remembers what happened! She and her husband were at a strip club. One of the strippers there was shooting up and stumbled into her. She figures that at this point, the stripper?s needle went into her arm, and the force from the fall made it break off. That must have been what happened

I always tell patients that I treat everybody the same no matter how poor their decisions, and telling lies only makes the treatment take longer. She must have really thought us all morans at the hospital :142smilie

keep up the good work..

 

[MadJack]

keep up the good work..

I don't think he likes the Vegas hospitals. How are the hospital(s) up your way?

 

[yyz]

I don't think he likes the Vegas hospitals. How are the hospital(s) up your way?

Las Vegas is a sewer between the bright lights and the suburbs. I dont envy Clint's position at all.

I should have done some write-ups over the years!

:scared

 

[Dr Feelgood]

Did someone say shit??? Come play at the poop plant for a day!!

#SmellsLikeMoney

 

[SixFive]

Back to the ER today, 🤦🏻And I have this dickweed named Gregory. He?s homeless, and I love to help homeless people. Feed them, offer them services, a safe place, and the ability to clean up. This guy though is a punk. He comes day after day and complains. Somebody always is stealing his things supposedly, and he always wants a catheter. This is a man who can walk and is oriented, but he always tries to con the nurses into putting in a catheter :wtf: he says he needs one BC he?s going to drive to Detroit

This guy is the epitome of a button bitch. He presses his call light constantly for food, drinks, to hand him his homeless bags of crap, to complain about other staff, and to request security. He always want to report his valuables being stolen. Nobody wants to get within 10 feet of him much less go thru all his bags of crap xsto

Anyway, I finally get him a room assignment and out of the ER. Once he got up there though he raised hell Bc he didn?t have a private room. Gmafb! What a terrible patient not to mention horrible human being.

 

[MadJack]

he says he needs one BC he?s going to drive to Detroit

:mj07:

 

[SixFive]

AMA failure

AMA failure

I have a friend in Kentucky who is physician. He says that he his favorite acronym in medicine is AMA. This stands for Against Medical Advice and generally refers to a patient who decides to leave the hospital before the physician determines they are medically ready to leave. He jokingly says this Bc usually this is the type of patient who is difficult to provide care related to non-compliance or just being a jerk. Why waste the time and money of the taxpayers to come to the hospital only to sign out AMA because you need to smoke a cigarette or for any trivial reason? I had a regular patient back home who would come to the emergency room for chest pain 2-4 times a week, be admitted, then leave AMA the next morning Bc she needed to drink. Why admit her in the first place? Well, she would always have elevated heart enzymes and out of control hypertension. She was likable, and relatively an easy patient, but still the whole process got old really fast.

Yesterday, I had a patient who I knew right away was going to leave AMA on my shift. He was 42 with a diagnosis of bilateral arm abscesses. He?s a heroin user, and we commonly get patients with his history admitted in the hospital. The treatment is to lance or sometimes do an I&D surgery on the abscess, IV antibiotics, pain control, and IV fluid hydration (supportive care). The abscesses are caused BC the heroin is cut with who knows what and non-sterile/dirty injections. The user also exhausts his veins, so resorting to skin-popping or muscling is used which will cause more frequent abscesses.

The nurse who gave me report said he was getting Morphine 4 mg and Dilaudid 1 mg for pain. The Morphine for him is a waste of time because of his high opioid tolerance. The Dilaudid is more on track, but it would have to be about 2 mg every two hours instead of every 4. Patients who are used to using heroin in large amounts like him start to become ?dope sick? pretty fast, and they just can?t stand it. The body gets addicted to the heroin and starts to withdraw with symptoms like pain, nausea, vomiting, diarrhea, anxiety, restlessness, tachycardia, and abdominal cramping. They keep using heroin BC the ?dope-sickness? is such a horrible feeling. Dilaudid is nicknamed Hospital Heroin, so to keep him from leaving, you essentially give enough of it to substitute To stave off the dope sickness.

I liked this guy. I treat everybody like I would want my folks treated no matter their circumstances until they give me a reason not to do so. He was honest about his habit which he said was $100 a day. I asked him if he worked, and he said he was a trained plumber. He can do side jobs, but BC of his addiction, he can not keep a regular job. I asked him if he got his money by hustling, and he said he did. I usually see patients with a $40-$60 a day habit. $100 is a lot of heroin! He told me he starts to have withdrawal symptoms at about the 6 hour mark. I told him it must be exhausting for him to hustle enough to keep that up. Have you ever thought about being a heroin user as being hard work? If you had no money, no possessions, and no family/friends to help, could you come up with $100 a day? It?s so sad that he has not been able to kick this and use his street-smarts and resourcefulness to do something productive.

I communicated with his physician several times during the day, and he seemed to care, but his hands are really tied as to what he can do. This guy is already ordered big doses of opioids.

I tried to confirm his methadone dosing with a local clinic, but I could not. If I could have obtained an order for methadone, he might have been comfortable enough to stay. I know this guy is going to leave, and I can?t do anything about it. He did end up leaving around 3pm. He apologized to me and thanked me for helping him and caring. I gave him a little money for the bus even though he didn?t ask for it. I gathered up some food for him to go, and told him how to get out of the hospital, and he left. I didn?t mention earlier, but he has a wife who is also a heroin addict. I know he was worried about her, and this is another reason he was leaving. I know women who are addicted have to resort prostitution/sexual favors to hustle their money, so I?m sure he had all those thoughts running thru his mind as well.

Lastly, his story is a common one. He was hurt on the job and prescribed pain pills. The opioid crisis hit, so it became very difficult for him to get his prescriptions, so he started using heroin BC it?s so much cheaper than street pharmaceuticals. $100 a day for heroin is probably on the lines of 640 mg of oxycontin which would have a street value of over $1000. If you didn?t know, many doctors who had been prescribing opioids for their patients completely stopped. Some would offer referrals to pain doctors, but many did not. The ?opioid crisis? made it difficult for many people who have legitimate chronic pain to get their medications. Of course, using heroin is a poor choice, but it?s just not as easy as lumping all users as worthless ?dope heads?. There are so many sad stories and ruined lives. I have seen so many heart-breaking cases, and it?s even more sad to me that I can?t do anything about it when my job is to help people.