Shift 73 and 74

Shift 73:

Busy shift.  Started out pretty busy, stayed busy pretty much the whole shift.  Only one thing really interesting to talk about. I had one patient that came in with chest pain.  She presented like most of my patients with chest pain- which is while complaining of different symptoms, she was not in what appeared to be any distress.  She had the pain for five hours or so, so it would seem it was not a heart attack or anything.  The EKG tech came in to do an EKG and I went into another patient's room to give a medication and send her home.  The doctor comes into that room and says, "Gabbi, I need you urgently."  So I turn around, look at him and go out of the room.  Outside the room he says, "You know that EKG we did next door?  Well, she had a major heart attack."  I asked him if is was a STEMI (which is a bad one) and he said yes.  For STEMI patients they would get tPA (very potent clot buster) if the patient qualified to take it, and would be transferred to another hospital for a cardiac catheterization. Unfortunately, since she had waited too long, we couldn't do either of those things, so we had to give her what we could and she went to ICU.  If she came in time, it would have been my first "Cardiac Alert" call.  I don't even know what happens when that call is made.  Its not made very often.

That's all for that shift.

Shift 74:

Busy, but not as busy as the day before.  We also had an extra nurse so that made things go better than they could have.  I never had my own assignment the entire shift, but during day shift I covered some lunches for the nurses. During night shift, the charge nurse had me float, which was nice. I guess I basically floated the whole shift. I don't get to do that often on nights, or days for that matter. Also during night shift, we had the NBA Finals game on (Go Heat!!) and we ordered pizza and wings.  It wasn't slow at night, but it was ok enough where everyone was able to keep up.  We also had one ICU hold, which eventually turned into two. That means, we have ICU patients, but the ICU is full and doesn't have beds for the patients upstairs. Once there is shift change, an ICU nurse will come to the ER to take care of the patients since they really need the extra attention that we can't give them. If a patient we have turns out to be an ICU hold, we don't get an ICU nurse right away because the administration has to get staffing to handle the patient load in the hospital, so they may have to call in agency nurses.  Thats why we don't get a nurse until shift change.  Anyway, the ICU patients too up two of our rooms, so it seemed busier than it was.  Also, we had a lot of very sick people this shift.

Some interesting things:  

• We had a stroke alert.  The patient came in and besides all his other symptoms, her was unable to communicate.  Later on in the shift, he was talking to us.  That was neat to see.  
• We had a patient that came in that fell.  Turned out he had a subdural hematoma (bleeding in the space between the brain and the skull).  This is bad because the blood can collect rapidly and compress the brain tissue causing damage.  He was being transferred to another hospital because of the surgery he needed to have done and as it turned out this guy was alert, awake and talking when he came in.  While awaiting transfer, he was lethargic and unable to be aroused.  He had to be intubated before he was transported.
• I had a patient that I helped take care of that had a pressure ulcer (bed sore) on her bottom.  The nurse that was taking care of her asked me to take a picture of it because she hadn't had a chance to yet.  (We take pictures of all wounds that are present on patients to document that they were there upon arrival and not caused by the hospital).  Anyway, this was THE WORST, hands down, pressure ulcer I had ever seen.  The smell associated with bad ulcers are indescribable.  This was bad.  It was all I could do to not vomit.  Good thing I was behind the patient trying to take the picture so she couldn't see me dry heaving.

Anyway, that's all for now.  Overall, it was a good shift.  Tomorrow I have two more days back to back, then a day off (which I am moving, so I will be exhausted).  Until then......