I am on night shift for the next 10 weeks. Getting used to this is a bear. If any of you have noticed my posting quality dropping off, that’s why. They have me on the 4 pm to 4 am shift. The extra $6 an hour in shift differential is nice, but it’s been awhile since I worked nights and is taking some getting used to. I’m just getting to bed while the wife is getting up to go to work. I worked on Labor day, which gets some good bonus money. Time and a half, plus the $6 an hour for shift differential. Still, tired.

Since I have been dragging, I didn’t get a lot of time for researching the news today, so instead I will tell you what’s up in emergency medicine. This week, we saw some interesting stuff. Here are some of my more notable patients:

  • A guy complaining of abdominal pain and constipation. He had a large blood clot in the main vein that runs from the digestive system to the liver (Portal Vein). It was 85 percent blocked. Because he was so big and the clot so large, he got the largest loading dose of Heparin I’ve ever given- 10,000 units.
  • A man who came in with groin pain. We had to let him know that he has testicular cancer.
  • A woman with congestive heart failure. She damned near died when her lungs rapidly filled with fluid. She was joking with me and fine. I left the room and 10 minutes later, she was gasping for air and needed BiPAP, a nitroglycerine drip, and Lasix. At one point, I thought she was going to code.
  • A guy who did code. Wasn’t my patient, but a code is all hands on deck. He used the bedside commode, passed about 1 liter of blood, then went into cardiac arrest.
  • A woman who stabbed herself 10 times because “I was sad.” She remembers feeling sad, and said the next thing she remembers is seeing the knife on the floor and being covered in blood.
  • A woman who took some penicillin and had an anaphylactic reaction to it.
  • A woman that had been trapped in a burning vehicle who had a hoarse voice and a cough.
  • Interestingly enough, I didn’t have any COVID patients this week, but other nurses did.

We have been mostly at 3:1 nurse:patient ratios until 9pm when the mid shifters leave, then we go to 4:1. That means I see anywhere from 10 to 15 patients per day. One thing that gets me is how grown adults who are covered in tattoos can be afraid of needles. I’m talking people in their 30s, 40s, and 50s who cringe, and even cry when you start an IV on them. Three of my patients in one night were actually SCREAMING at the top of their lungs because I started an IV on them. In one case, a woman’s heart rate went from 90 to 150 while I was getting her IV.

Anyhow, since my work week is done, I now have 5 days off in a row. That means I have work to do around the house.

Categories: Me


Dirty Dingus McGee · September 9, 2023 at 8:30 am

I have a few tats but am NOT a fan of needles. Worst time I had was 2 1/2 years ago, ended up admitted to my local hospital for a blood infection that went sepsis( my fault. waited too long). 28 hours after I was admitted I had surgery on the infected area. For the next 3 days I had 4 IV’s running pretty much non stop each thru a separate needle. Worst part was for the first 6 days I was there(was in there for 8), every 4 hours or so a tech or nurse assistant would show up to check my vitals AND draw blood for a test. By the time I left by arms looked like I was a junkie.

Grumpy57 · September 9, 2023 at 10:40 am

The comment above on multiple IVs got me to thinking. I haven’t seen many central lines (subclavian) in the past 10-15 yrs, seems we went to midlines and PICCs (peripherally inserted central catheters). Also haven’t seen a triple-lumen in forever……

Re: COVID – I’m still seeing it in the ED but haven’t admitted anyone DUE to it (i.e. pneumonia, hypoxia, etc). And certainly no one in the ICU on vents. ALL of the COVID I do see, patients state they took the “vaccines” (some did not do the boosters though). This is NOT saying our COVID patients are limited to those who received the “vaccine”, merely saying our patients stated “X”.

Anyway, just an observation….

    Divemedic · September 9, 2023 at 11:18 am

    I saw two different patients get IJ’s this week. The MDs are avoiding femoral lines because of a higher risk of CLABSI. I see patients with and without getting COVID. I think that it seems like most COVID patients have been vaccinated because most of them have, as in most of the general population has.
    According to sources, 81 percent nationwide have received at least one COVID shot. Some states (CT) have a vaccination rate of greater than 95%, while at the other end, Wyoming is at 59%.

Aesop · September 9, 2023 at 12:35 pm

Welcome to my world, 28 years and counting.

Sent a COVID pt. to the tele floor with sepsis and bilateral pneumonia.
He’ll probably be home in a week. This is not the 2020 COVID.

Had three other suspicious ones, but they all tested negative.
One CHF, and two others with pneumonia, but not COVID.
One of whom will probably be checking into the Eternal Care Unit in the next 24 hours.
Just not in my bed, on my shift.
Two more shifts to go this week.

    Divemedic · September 9, 2023 at 12:58 pm

    This new COVID strain seems to be presenting with GI issues.

Kentucky Headhunter · September 9, 2023 at 1:03 pm

(MANY years ago) I did inpatient night shift (11p-7) for 8 weeks and then transfered to days. I just couldn’t sleep past noon/1pm no matter how tired I was. I was getting loopy from lack of sleep so I was lucky I found I day shift open on a decent unit. Was dong 10a-7p at an ED where the night shift was trying to recruit me for a 9p-9a. I said no way, no how. Not for any amount of money.

Unknownsailor · September 9, 2023 at 3:17 pm

I worked 7 PM to 7 AM many times during my 20 year career in the Navy. Always on deployment on a carrier, of course. IME it takes me at least a week to swap schedules and be totally coherent and not sleepy when swapping my sleep schedule around like that. Generally the leadership knew that people would be grabbing catnaps during the first week, so they didn’t schedule as much work to do as the normally would. It helps that during the first week of a deployment that nothing much is going on, just transiting from CONUS to wherever we are going. The 1 hr time zone changes every 2 days help a lot, too, as you head east or west as the case may be.

    Divemedic · September 9, 2023 at 4:01 pm

    I did that when I was in the Navy, too. A couple of differences this time around:
    – I’m not 20 years old anymore. Hell, I’m not even in my 40’s anymore.
    – When I did it back then, you swapped it for weeks at a time. Now, I am doing it for the three day workweek and then back to a normal schedule for the rest of the week.

TRX · September 11, 2023 at 8:53 am

> The extra $6 an hour in shift differential is nice,

Most places I worked swings or mids, they acted like 50 cents an hour extra was outrageous generosity.

Weetabix · September 11, 2023 at 3:35 pm

Scared of needles: about 14 years ago, I developed Adult Onset Still’s Disease. Apparently it’s rare. I was in the hospital while they were testing for it, and they took a LOT of blood – I was anemic when I was discharged.

Anyway, the phlebotomists came in at all hours. I’d heard people hate them, so I tried to be extra nice to them – they have a necessary job to do. When one would come in apologetically telling me they needed blood, I’d tell them, “Take what you need. I’m going back to sleep. Let me know if you need me awake for something.”

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