It is one of those days. Patients continue to pour in one after another and just when you feel that things are truly getting dangerous with two or three patients at risk of dying someone who is even sicker rolls in. The feeling I get on shifts like this is a sick uneasiness. Like getting caught on my skiff in 10 foot swells; no longer wondering if it will capsize but which wave will strike it just right.
Our nursing staff is younger and more inexperienced than I have ever witnessed. Most of them working in the critical care areas have been out of school for less than a year and most of the nurses in charge are clueless. Seriously. Scary clueless.
In my 8 hours we saw…
A dialysis pt. with fever. A dialysis pt. with fever and hypotension. A dialysis pt. with fever, hypotension and confusion. A 77 year old man with altered mental status. A status epilepticus. An 80 year old with abdominal pain and fever just discharged from the ICU. An 85 year old with chest pain that just left another hospital today at 5pm with intractable angina and idiopathic gastrointestinal bleeding. A Fourniers gangrene (scrotum gangrene) that went to the OR. A gun shot wound. Another gun shot wound. A large scalp laceration with profuse bleeding. A liver laceration from a car crash. A spinal fracture from a car crash. A large subdural hematoma with 4cm of brain effacement. A persistent bradycardia requiring transcutaneous pacing. A 75 year old with COPD and altered mental status. A pyelonephritis. A 79 year old with fever and altered mental status. An overdose. An infectious tenosynovitis that went to the OR.
Of those, we had 2 intubations and 9 central lines… two of which were performed in an open hallway.
We would have seen more but there are no hospital beds, so when I left tonight at 11pm, the above listed patients were still in the Mecca’s ER. The finger amputation and the rest were waiting in the lobby, with little hope of being seen tonight. The patients who were not admitted waited for over an hour to be discharged as the young nurses were barely able to keep up with the vents, lines and medications muchless the discharges.
I also covered the psych Pod; Committed four people, sent two to rehab and went fishing for one hard to find “vaginal” paperclip that turned out to actually have been placed in a rectum.