Photo finish!

...between the paranoid schizophrenic and the self-injurious borderline girl. The situationally-suicidal drunk was in the race before he ran by a TGI Friday's, but he dropped out to keep from seizing.

Obit

There was a patient who coded for hours and hours in our department. Rhythm checks revealed PEA. Bedside cardiac ultrasound showed no heart movement. Chest compressions for two HOURS. HOURS. Yes two HOURS. She never had any palpable pulses not borne of CPR.

Nurses were questioning the ethics of the doctor who didn't stop the code and were threatening to stop coding the patient on their own. The family was standing in the corner watching their fully-nude relative be the subject of much yelling, chest compressions, 6 amps of bicarb, and 50 gallons of epi while someone put in a central line and another "compressed" a sunken, hopelessly broken sternum at 100 BPM.

The patient's obituary (which was taped to our break room door as is tradition when we recognize a patient in the obits) read the following:

[Patient] died peacefully surrounded by family after a long battle with [her disease].

No she didn't, dammit. She died in the most horrific, brutal, and terrifying way possible for all involved. I'm sure this family is going to be riddled with nightmares.

Errors of omission

I think one of the things that is slightly mentally taxing about my job is reviewing all the patient orders and stopping for 0.4 seconds to think if anything is missing, not just if something that is ordered is unsafe or whatever. Any shmuck off the street knows that you can't prescribe Unasyn to someone with a penicillin allergy, but as I become more and more experienced at this job, I keep finding little errors of omission.

Now, I'm not talking necessarily monumental omissions like forgetting a pressor on a septic patient with a blood pressure of 60/30, I'm talking the "oopsie" forgotton heparin protocol for new-onset atrial fib or the "oopsie" omitted troponin for an old guy with shortness of breath of unknown origin or a magnesium on a chronic alcoholic (it's not part of the basic metabolic panel, gotta order it separately, yo).

I sit here now and wonder how much crap I didn't know to ask about when I was new at this. Floor nurses, at least when I was a floor nurse, are not used to thinking about what is missing. Sure, you might notice if no tylenol is ordered, but when did I ever look to see if an EMG was set up? Uh, never.

So, if you're an ER nurse, you have to use your noodle and find the missing thing that may lead to a diagnosis. Warning, if you do start doing this, you'll start blaming yourself for stuff.

Sure, it's not my fault legally if something is missed because I'm not the doctor (unless, I guess, something really stupid got omitted like a head scan on an acute stroke patient), but, it is my fault, ya know...to me...

Need a book for a crayzee in your life?

Ask this guy. He's got the mad hookup. I wonder if he's got anything on coping with the torturous effects of fibromyalgia.

Delusion or obsession?

Psych patients are rarely memorable, but awhile ago, I had an interesting psych patient.

Essentially, she thought random people on television were going to help her have a baby. She emailed them, phoned in to the producers of newscasts and talk shows over and over again, watched these shows over and over again waiting for them to "announce" that they were going to help her. She also thought regular things in the community like treadmills or whatever could help her as well. Like, if I run on this treadmill, it will help me have a baby. Not "if I get fit, it will help me have a baby", she thought the treadmill itself was going to cause, uh, implantation to occur. She thought I was going to help her have a baby. She thought the blood pressure machine was going to help her have a baby. Baby, baby, baby.

It turns out that the lady and her husband (God bless the poor bastard) had been having trouble conceiving, so over a long period of time, she went from mild obsession regarding pregnancy such as looking at pregnancy websites and using fertility charts and reading books to this where she was unable to function due to the baby obsession. By the time she came in, she wasn't sleeping, eating very much, nor doing much else besides obsessing about babies and pregnancy.

It occurred to me that I didn't know, for the purposes of charting, if this was an "obsession" or a frank delusion or some combination of both. When does an obsession become a delusion? Hmmm....She was too old to have like new-onset bipolar or schizophrenia and had no other psychopathology other than depression.

Fentanyl and etomidate

We gave the above-mentioned drugs to a young man who'd dislocated his shoulder. Soon after popping it back into place, it looked as if he was starting to wake up.

Doctor: How you feeling?

Patient: Like SUPERMAN! Up. Up. AND AWAYYYYYYYYY!

We didn't even try to choke back our tears after that one.

Are prescriptions like the soda machine at Burger King if you dine-in?

*Sigh*

h/t to Christine