Got to work, got my room assignment. took report, and all three of my patients seemed easy. After an hour of just sitting there, watching patients who were not really any trouble, I started thinking that I was going to have an easy shift for a change.
I was wrong.
I discharged a patient and wheeled her to the front door. When I returned to my little slice of the ED, there was an EMS crew waiting there for me with a patient. They told me he was normally on oxygen at home, and was coming in because it was taking more effort than usual to breathe. They hadn’t bothered to try for an IV, because they didn’t think it was needed. On 6 liters, his SpO2 was 88%. It got worse from there. So I called a respiratory alert. The respiratory therapist was busy, so never came. The doctor decided that the man was septic and ordered antibiotics. I gave them and went next door to the next patient.
I heard yelling and went back to see what the problem was. The patient was having an anaphylactic reaction to the antibiotics. Yep, turns out that he had an allergy that he didn’t know about. I had to do an emergency override for Epinephrine, steroids, and Benadryl. That was when the patient next door decided to desaturate. Then I had another EMS truck come in with a cardiac emergency. In the middle of that, the charge nurse came in and told me that I was getting a fourth patient.
All while the joint commission was there.
Fourteen straight hours of that. So that’s why I didn’t want to post yesterday.
9 Comments
Grimpy51 · March 2, 2024 at 7:35 am
All in a day’s work in the ED…..
Your patients are lucky to have you as their RN
Boneman · March 2, 2024 at 7:53 am
God bless. I had a wave of exhaustion wash over me just reading that. Well… that and a touch of anxiety. Anaphylaxis is downright frightening.
Have you ever had any experience with an incoming with Stevens Johnson Syndrome? It’s rather rare and tends to elude diagnosis initially. At least that was my observation. Totally off the wall and I can’t even recall what the immediate treatment is at the onset. Cooling blankets… Gamma Globulin… a number of things. I just remember a lot of chaos. It was not myself but my daughter. Scary. For some reason your experience and the telling fired up the old tapes here. Sorry to ramble a bit.
Glad you were able to keep all that stuff under control. I would imagine that you keep rolling through it as you must and as you’ve trained yourself to do, but once all is done and over at end of shift you must just want to collapse.
I know I would.
If your patients didn’t get the opportunity, I’ll say “THANK YOU” for them. I know I always try to ensure I let the folks know who care for me that I’m grateful.
Hang in there, Man!
anon · March 2, 2024 at 8:05 am
praise be to you for what you did and do on a daily basis. You are one of the good ones.
All the best to you
jimmyPx · March 2, 2024 at 11:07 am
I work in a hospital and I don’t know how you and the doctors and nurses in the ED do it every day. As one ER nurse told me, she likes constant action and change — you never know what medical condition that you will see and have to treat.
Of course the other thing is that you also have to deal with crazies and people acting badly constantly. At my hospital system, the security people now have to wear lite body armor due to being attacked.
God bless you and the hard working ED staff.
D · March 2, 2024 at 8:43 pm
> They hadn’t bothered to try for an IV, because they didn’t think it was needed.
When the hell did they get to start deciding that?
Our policy was “they’re going to get an IV in the ER no matter what, so we might as well get some practice in and bill for it”.
Divemedic · March 3, 2024 at 12:33 pm
That’s been the case for awhile. I didn’t start an IV for patients that didn’t need it, back when I was still a street medic. There is a risk in every medical procedure, even just IV access. Why risk giving your patient an infection unnecessarily?
The trick is knowing when and when not to start an IV. In this case, the medic was wrong. A patient who is on 6 liters and only has a saturation in the 80s needs an IV.
D · March 3, 2024 at 2:14 pm
Hmm. I did my tour back in the early 2000s and the medics I worked with all started IVs no matter what. If you’re sick enough to call 911, you’re getting an IV and O2 at a minimum (obviously with a few contraindications).
We only saw the patient for the first 45-60 minutes of care, so there wouldn’t be enough time to see an infection develop–but honestly, how often does that happen? If you clean with alcohol and iodine, I would imagine the number is extremely low…but I was just an ambulance driver / cot bitch, so I honestly have no idea.
Noway2 · March 2, 2024 at 11:10 pm
“ So that’s why I didn’t want to post yesterday”
Completely understandable. Thank you for fighting the good fight.
Aesop · March 3, 2024 at 1:46 pm
BTDTGTTS.
But hey, after those shifts, you usually sleep really well.
Best wishes.
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