Intern humor

Q-Optics, surgical ergonomics - redefined
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InternHumor

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It's getting that time of year where we are all transitioning to a new year, new responsibilities. I want to start a post of floor calls that have been amusing, funny or downright ridiculous.
I’ll start:

BEEP BEEP BEEP
ME: Hi, this is so-and-so returning a page.
NURSE: Hi doctor. Miss Johnson in room 2 has cut off her Foley, both her JP drains and is walking down the hall with scissors.
ME: Cut off??
NURSE: Yes.
ME: Cut off her person, but the tubes are still in her?
NURSE: Yes.
ME: Um…. Well go get her and I’ll be right up
NURSE: Ok.
ME. Also, take the scissors away from her.
NURSE: Ok. Thanks.

When I arrive at bedside, sure enough, she has the cut end of JP drains sticking out both sides of her belly and the cut end of a Foley coming out from below. And she still had the nurse's scissors in her hand...
That wasn’t in the Intern Handbook we got at orientation…
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Are nurses really this dumb or is it just a feeling you get when reading this site due to selection factors?
 
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psychforme said:
Are you serious?
Click to expand...

Yeah, this doesn't really sound like the nurse's fault.....unless she planted the scissors in the patient's room and whispered "just cut 'em and go!" in her ear......



Wait! Maybe.....the patient was a nurse......
 
SLUser11 said:
Yeah, this doesn't really sound like the nurse's fault.....unless she planted the scissors in the patient's room and whispered "just cut 'em and go!" in her ear......



Wait! Maybe.....the patient was a nurse......
Click to expand...

1. Not keeping track of her stuff letting the patient get ahold of her scissors.
2. Instead of doing her job pages the intern.
3. After catching the patient and returning her to her room - still she still doesn't take back the scissors.

So it was the fault of the nurse. The nurse also failed to rectify the situation.
 
WOW!!! this post has become a train wreck... How about some funny intern stories.
 
psychforme said:
1. Not keeping track of her stuff letting the patient get ahold of her scissors.
2. Instead of doing her job pages the intern.
3. After catching the patient and returning her to her room - still she still doesn't take back the scissors.

So it was the fault of the nurse. The nurse also failed to rectify the situation.
Click to expand...

Based on previous posts, you haven't done any rotations yet. But, when you do, you will find....

1) Many rooms have supplies in them that will be useful in bandage changes. Having a pair of scissors in a patient's room (particularly if the patient isn't suicidal) isn't unusual.

2) The patient could very well have stolen the scissors out of the nurse's pocket. When you start carrying around a white coat with its pockets crammed full of patient lists, dressing supplies, saline flushes, a stethoscope, and a cell phone, you will find yourself leaving stuff behind you by accident. It's hard to keep track of that much stuff.

3) IN THIS CASE, IT IS HER JOB TO PAGE THE INTERN. I WANT to know when stuff like this happens. She did what she was supposed to do, which is notify the physician on call. A foley that is just hanging, and no longer draining into a bag NEEDS to be removed, and have a fresh one put in. JP drains that are no longer draining need fresh bulbs - and, depending on where the patient cut the drain, may need to be surgically removed. (If she cut it close to the skin, and cut through the sutures holding the JP in place, the JP tubing could slip back into the abdominal cavity.)

It's the physician's responsibility to take care of this kind of stuff.

4) Yeah, she didn't take the scissors back. Maybe the patient threatened to harm the nurse, maybe the nurse didn't feel safe taking the scissors back. Maybe the patient had multiple pairs of scissors hidden around the room. Who knows?
 
psychforme said:
1. Not keeping track of her stuff letting the patient get ahold of her scissors.
Click to expand...

Fair enough if the patient was known to be mentally unstable. Many patients, especially surgical patients have dressing supplies, including scissors, in their room.

Who knows...maybe the patient stole the scissors from the nurse. This is a definite possibility.

2. Instead of doing her job pages the intern.
Click to expand...

Her job is, after discovering the problem, to page the resident on call.

3. After catching the patient and returning her to her room - still she still doesn't take back the scissors.
Click to expand...

Fair enough. But maybe the patient threatened her, or she couldn't find the scissors.

So it was the fault of the nurse. The nurse also failed to rectify the situation.
Click to expand...

Other than taking back the scissors if she could and possibly not leaving the scissors in the room if the patient were deemed to be likely to pull such a stunt, sounds to me like she did her job.
 
smq123 said:
3) IN THIS CASE, IT IS HER JOB TO PAGE THE INTERN. I WANT to know when stuff like this happens. She did what she was supposed to do, which is notify the physician on call. A foley that is just hanging, and no longer draining into a bag NEEDS to be removed, and have a fresh one put in. JP drains that are no longer draining need fresh bulbs - and, depending on where the patient cut the drain, may need to be surgically removed. (If she cut it close to the skin, and cut through the sutures holding the JP in place, the JP tubing could slip back into the abdominal cavity.)
Click to expand...
I think the nurse could do this scut. You don't need 3 years of schooling to call the intern any time there is a problem. Either she does it herself or nursing is a useless profession.

Winged scapula said:
Her job is, after discovering the problem, to page the resident on call.
Click to expand...
Her job is bring back the patient to her room, take away the scissors, replace the catheters and then call the intern if she feels like disturbing him.
 
psychforme said:
Her job is bring back the patient to her room, take away the scissors, replace the catheters and then call the intern if she feels like disturbing him.
Click to expand...

She'll need to let the intern/resident know, in case the intern/resident would like to...

a) order wrist restraints
b) order ativan/haldol
c) order a psych consult.

If this is new, and the patient is delirious, the intern will also have to begin doing a medical workup as to why. Any delay (i.e. because the nurse decided not to say anything) is sure to bring a severe verbal beat-down from the senior resident AND the attending.

So, really, you want the nurse to bother you for it. She did her job.
 
smq123 said:
She'll need to let the intern/resident know, in case the intern/resident would like to...

a) order wrist restraints
b) order ativan/haldol
c) order a psych consult.

If this is new, and the patient is delirious, the intern will also have to begin doing a medical workup as to why. Any delay (i.e. because the nurse decided not to say anything) is sure to bring a severe verbal beat-down from the senior resident AND the attending.

So, really, you want the nurse to bother you for it. She did her job.
Click to expand...
Sure, she can page the intern... After doing her job as a NURSE not as a paging service. She can order wrist restraints herself. Ativan/haldol for a patient who has left her bed? Prio #1 is getting the patient into bed - not chatting on the phone. Either catch the patient or tell one of your coffee-drinking colleagues to do it while you call the intern. If it takes the intern 5 minutes to answer the page should the nurse let the patient stroll out of the hospital with her catheters flying in the wind?
 
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psychforme said:
She can order wrist restraints herself.
Click to expand...

Since when?

Most hospitals require that any physical restraints be from a physician order. Nurses can't order them.

psychforme said:
Prio #1 is getting the patient into bed - not chatting on the phone. Either catch the patient or tell one of your coffee-drinking colleagues to do it while you call the intern. If it takes the intern 5 minutes to answer the page should the nurse let the patient stroll out of the hospital with her catheters flying in the wind?
Click to expand...

Calling an intern to alert him/her of a serious situation such as this is hardly the same thing as "chatting" on the phone.

Whatever; the nurse did the right thing in this case. But since you seem so determined to hate all nurses (despite not having done any clinical work yet), I'll just leave it at:

:troll:

OP - Sorry that your excellent idea for a thread devolved into....this. :(
 
smq123 said:
Since when?

Most hospitals require that any physical restraints be from a physician order. Nurses can't order them.
Click to expand...
Well, excuse me for not knowing about a bureaucratic rule that exist for no reason. I sure can't wait for my clinical rotations where I will learn the bureaucracy so I can also be an awesome great person.

smq123 said:
(despite not having done any clinical work yet)
Click to expand...
The medicine is in the books.
 
psychforme said:
Well, excuse me for not knowing about a bureaucratic rule that exist for no reason. I sure can't wait for my clinical rotations where I will learn the bureaucracy so I can also be an awesome great person.
Click to expand...

<sigh>

It's not about the fact that you didn't know about these bureaucratic rules yet. I didn't know it either until I started 3rd year and did psych.

But it's the fact that you're faulting a nurse (and, in turn, calling all nurses stupid) for something that, actually, isn't her fault.

And the medical KNOWLEDGE is in the textbooks. But the way that hospitals work, when you should be notified of patient events, and which patient events that you should be notified for, is not.
 
I thought this was going to be a great thread. Can we move on from the nurse/scissor story?
 
smq123 said:
<sigh>

It's not about the fact that you didn't know about these bureaucratic rules yet. I didn't know it either until I started 3rd year and did psych.
Click to expand...

I would also add that the need for a physician's order to put restraints on a patient is NOT a "bureaucratic rule that exists for no reason." If a patient needs to be put in restraints, then there is something very wrong with them that needs to be evaluated by a physician.

psychforme said:
The medicine is in the books.
Click to expand...

You're going to do great in third year with an attitude like that...
 
Ok, I have a story from a friend who is finishing internship. They were going to do some radiologic examination of the GI. But the radiologist had a brain fade and put the barium contrast in the central line instead of the PEG...
 
Sheesh, calm down all you speculators. I was there, you were not. The story IS funny.

1) This nurse is a great nurse and the whole incident was harmless, hence the humor.
2) The patient grabbed one of those crappy 'Nurses' Scissors' that come out of parstock and are on nearly every surgical patient's bedside tray for dressing changes. For those who are surgical interns, you know that they are ubiquitous. They are not landscaping shears, they are crappy little scissors that barely cut Kerlex.
3) The part that was also amusing is that this patient was about 4-foot 6 and 95 lbs, hence it didn't take much to get the scissors from her and get her back in the bed. She really was harmless with the sciccors.
4) I came up so fast that there was little time to do much.
5) She wasn't so demented or out-of-control that it was a major issue, just some benign sun-downing. Poor thing!
6) Also, she was stark naked and standing in the room when I came up.
7) Ultimately she did fine. We did some enviromental modification and she responded well.

Enough of the 'nurse-bashing'. BRING ON THE FUNNY STORIES!
 
So I was finishing up Saturday rounds when the PGY-3 calls me...

BEEP BEEP BEEP

PGY-3: Hey InternHumor, thanks for your help today. Can you just take out the staples on Ms. Harris before you go? She has had her staples in for 2 weeks now. I am about to head out too.
Me: Sure.
PGY-3: Thanks.

So, I go over to Ms Harris's room, grab a staple remover and take out her laparotomy staples. We chat as I pop them out. Very pleasant lady. I finish and look at the wound and it looks ok. A little redness on the sides, but nothing major.

"Well, Ms. Harris, everything looks good. We'll probably have you home soon!"
Ms Harris:Ok. Great. COUGH! COUGH!

....and now, I'm looking at all of her small bowel...completely evicerated right in front of my face....

Ms Harris: "Oh my!"
Me: "Oh my is right!"

BEEP BEEP BEEP

PGY-3: Hey Intern Humor, what's up?
Me: I hope you're not home yet.

We ended up getting her fixed within a week ot two and she ended up doing fine. It wasn't funny then, but now looking back, I laugh every time I think of her bowels nearly hitting me in the face as she coughed!

Yikes!
 
InternHumor said:
5) She wasn't so demented or out-of-control that it was a major issue, just some benign sun-downing. Poor thing!
6) Also, she was stark naked and standing in the room when I came up.
7) Ultimately she did fine. We did some enviromental modification and she responded well.
Click to expand...

:laugh: Poor lady.

I was rotating through a surg onc service last year. Little old lady in her 80s had some major abdominal surgery, and I saw her on the morning of POD #1.

She's sleepy, a little groggy, but is otherwise with it. PCA is doing its job - little pain.

I have a foot out the door, ready to write a progress note that patient is totally fine, etc., etc. She stops me with a question....

"When can I hold my baby? I can't wait to hold my baby! Please, doctor? I can feel my milk starting to come in."

:eek:
 
This story comes from on of my favorite nurses on the floor. She is really good and really good to me. She called me about a lady who had recently had an AV fistula created.


BEEP BEEP BEEP

Me: Hi, this is InternHumor
Nurse: Hi, Intern, this is FavoriteNurse. Ms. Johnson has a funky smell coming from down there.
Me: Down where?
Nurse: Down there.
Me: Where?
Nurse: There.
Me: She had surgery on her arm, what do you mean she has a funky smell from down there? She has a funky smell coming from her arm?
Nurse: No. Lower.
Me: Lower?
Nurse: Lower.
Me: Lower than her arm?
Nurse: Lower.
Me: Lower than her belly button?
Nurse: Lower.
...LONG PAUSE...
Me: Oh. Um, well, what kind of funk?
Nurse: Yeasty funk.
Me: Yeast?
Nurse: Yeasty.
...LONG PAUSE...
Me: Well, FavoriteNurse what am I supposed to do about it?
Nurse: I think you should give her a one time dose of diflucan.
...LONG PAUSE...
Me: FavoriteNurse, In general, I don't perscribe a new medications for a patient with new conditions that I haven't examined.
Nurse: So, you'll telling me that you'll be right over to examine her?
...LONG PAUSE...
Me: Diflucan it is.
 
InternHumor said:
Me: Well, FavoriteNurse what am I supposed to do about it?
Nurse: I think you should give her a one time dose of diflucan.
...LONG PAUSE...
Me: FavoriteNurse, In general, I don't perscribe a new medications for a patient with new conditions that I haven't examined.
Nurse: So, you'll telling me that you'll be right over to examine her?
...LONG PAUSE...
Me: Diflucan it is.
Click to expand...

You're a better person than I am.

I would have just told FavoriteNurse that we'll give the patient an outpatient appointment for the OB/gyn or FP as soon as the patient is d/c'ed from the hospital, and they can examine her and give her the diflucan. Until then, just don't breathe deeply when in that patient's room.
 
While I don't know if these are only humorous if only in my head. I am very glad intern year is over.


3AM on Sat night in hospital
BEEP BEEP
Nurse: Hello, doctor, i wanted to inform you that ptB had itching after I gave her morphine.(In my head..why is she telling me this now at 3am, the patient has been on morphine for 3 days)

Nurse cont: I saw that benadryl was ordered(In my head..want to hang up phone now), I gave it to her (must hang phone up, get back to bed)

Nurse cont: and her itching went away, I thought I should let you know(in head...still want to hang up phone)

Me: thank you for telling me:) let me know if there are any more problems.(In head....why were pagers ever invented)



Intern on busy trauma rotation....
BEEP...BEEP.....BEEP BEEP...BEEP

5 pages in 7 minutes and still rounding with attending

Nurse: Hello, doctor, i was wondering if I could give Pt B some water with her pills

ME: do you know what diet he is on

Nurse: It says NPO except sips with meds(In my head...must hang up now)

Nurse cont: so is it ok to give him some water?(in head.. uh?!?....OMG)

ME: yes, he can, thank you



Later that day different nurse

BEEP...BEEP

Nurse: Hello, doctor, I have pt D, he is on a clear liquid diet, can he have hot tea? (don't want to answer just want to hang up....patients get coffee every morning when on clears)


ME: Yes, hot tea is a clear liquid



Just wanted to give a brief example of all those pages that you just don't want to answer and shouldn't have to...i do have plenty more
 
toomuch said:
While I don't know if these are only humorous if only in my head. I am very glad intern year is over.


3AM on Sat night in hospital
BEEP BEEP
Nurse: Hello, doctor, i wanted to inform you that ptB had itching after I gave her morphine.(In my head..why is she telling me this now at 3am, the patient has been on morphine for 3 days)

Nurse cont: I saw that benadryl was ordered(In my head..want to hang up phone now), I gave it to her (must hang phone up, get back to bed)

Nurse cont: and her itching went away, I thought I should let you know(in head...still want to hang up phone)

Me: thank you for telling me:) let me know if there are any more problems.(In head....why were pagers ever invented)



Intern on busy trauma rotation....
BEEP...BEEP.....BEEP BEEP...BEEP

5 pages in 7 minutes and still rounding with attending

Nurse: Hello, doctor, i was wondering if I could give Pt B some water with her pills

ME: do you know what diet he is on

Nurse: It says NPO except sips with meds(In my head...must hang up now)

Nurse cont: so is it ok to give him some water?(in head.. uh?!?....OMG)

ME: yes, he can, thank you



Later that day different nurse

BEEP...BEEP

Nurse: Hello, doctor, I have pt D, he is on a clear liquid diet, can he have hot tea? (don't want to answer just want to hang up....patients get coffee every morning when on clears)


ME: Yes, hot tea is a clear liquid



Just wanted to give a brief example of all those pages that you just don't want to answer and shouldn't have to...i do have plenty more
Click to expand...

Actually, these are all the kinds of calls you get when you've been deemed to have mistreated/snubbed the nursing staff. The nurses in these examples all likely know what they should be doing (I'll bet many in these examples are experienced) -- they are f-ing with you because this is how they get revenge, by bothering you with every little thing. Establish a better relation with the nurses (bring food maybe) and a lot of this kind of call goes away.
 
Law2Doc said:
...these are all the kinds of calls you get when you've been deemed to have mistreated/snubbed the nursing staff. The nurses ...know what they should be doing ...this is how they get revenge, by bothering you with every little thing. Establish a better relation with the nurses (bring food maybe) and a lot of this kind of call goes away.
Click to expand...
What are we in grade school.... "revenge"? I would strongly discourage you from feeding these nurses and feeding this problem. Bringing cup-cakes to such nurses just empowers and promotes the continuation of this behavior.... it is also unprofessional on your part.

Nurses are supposed to be professionals. They should act as such. Likewise, you should act professional. Just as the days when physician intimidation was allowed if not acceptable are over; so to are the days of punitive nursing being acceptable is over. Punitive nursing has the potential to result in patient injury. Either an unnecessarily fatigued physician makes a mistake, is intimidated into a theraupy to make a nurse "happy", or fails to respond to a critical page in a timely fashion because past experience of innapropriate pages (i.e. crying wolf). Bottom line, a nurse that can not follow basic patient care orders is incompetent to nurse. A nurse that plays these overt tactics to anger, harass, and fatigue a physician is unprofessional and endangering patients. He/she is gone often about the time an error will be made by the fatigued resident. The resident is on 24+ hr shifts, at around 80/wk. The nurse does his/her 3 x 12 hour shifts a week. Harassment is harassment.

If a nurse has a problem with an MD or anyone else, he/she can "write-up" or report innapropriate conduct. On the flip side, administrators are more and more recognizing innapropriate nursing conduct. Programs are increasingly looking at innapropriate paging practices. I have heard of the RRC reviewer actually going back to a program/PD and commenting/noting unprofessional ancillary staff and resident harassment. If your nursing staff are 1. hazing the intern or 2. engaged in harassment/punitive paging I advise you take the name of the nurse, time of page, question and relavent facts and in an objective manner report it to the nurse manager and/or CC to an appropriate residency administrator.

JAD
 
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Law2Doc said:
Actually, these are all the kinds of calls you get when you've been deemed to have mistreated/snubbed the nursing staff. The nurses in these examples all likely know what they should be doing (I'll bet many in these examples are experienced) -- they are f-ing with you because this is how they get revenge, by bothering you with every little thing. Establish a better relation with the nurses (bring food maybe) and a lot of this kind of call goes away.
Click to expand...

While that may be true in some cases, I'd venture that the vast majority of time these are new nurses making such calls.

I have received calls exactly like those above and was never someone the nurses were trying to F with. Almost invariably its a new nurse grad who thinks you have to know every detail about patient management (example number 1) or someone who isn't very bright.

Calls like these need to be directed to the nursing supervisor and if she has any sense she will educate her nurses that these are not appropriate pages, any time of the day.
 
psychforme said:
...a story from a friend... They were going to do some radiologic examination of the GI. But the radiologist ...put the barium contrast in the central line instead of the PEG...
Click to expand...
:bullcrap:The way GI barium contrast is... comes in a jug or tall bottle and/or mixed in a cup and/or sucked into irrigation syringe and/or have techs all over him/her. Not very amenable to central line injection. Not buying this one.

Thank you for playing. Try again when it is something you know first hand as opposed to a tale from a friend.
 
JackADeli said:
:bullcrap:The way GI barium contrast is... comes in a jug or tall bottle and/or mixed in a cup and/or sucked into irrigation syringe and/or have techs all over him/her. Not very amenable to central line injection. Not buying this one.

Thank you for playing. Try again when it is something you know first hand as opposed to a tale from a friend.
Click to expand...

How would it matter if the contrast came in a bottle? He said the only difference between the tubes was color.
 
:slap:

Got to agree with others....
After reading the ignorance and obstinance about nursing, now GI barium, it would seem acurate to believe the individual is either:

a. troll with no medical background (I think we are dealing with junior high...)
b. troll that is just enjoying playing dumb and trying to simply inflame with ignorant comments...:bang:

:troll:
 
JackADeli said:
:slap:

Got to agree with others....
After reading the ignorance and obstinance about nursing, now GI barium, it would seem acurate to believe the individual is either:

a. troll with no medical background (I think we are dealing with junior high...)
b. troll that is just enjoying playing dumb and trying to simply inflame with ignorant comments...:bang:

:troll:
Click to expand...

Yeah, apparently it's a well known fact over in the sociopolitical forums.
 
Winged Scapula said:
Not to mention size of the tubes, location (abdo vs chest/neck), different caps...
Click to expand...
Yeh, as you, I, and even the candy-striper would know.... it would take significant effort to get the barium into a compatible delivery device and then infuse into a central line... If one succeeded in all of these hoops and hurdles without realizing how abnormal (the effort) from usual radiology practice, I think you would then be wondering why the viscous/chalky solution did not infuse into the thin caliber central line....
InternHumor said:
... one of my favorite nurses on the floor...

Nurse: Hi, Intern, this is FavoriteNurse. Ms. Johnson has a funky smell coming from down there.
Me: Down where?
Nurse: Down there.
Me: Where?
Nurse: There...
Me: Lower than her belly button?
Nurse: Lower.
...LONG PAUSE...
Me: Oh. Um, well, what kind of funk?
Nurse: Yeasty funk...
...LONG PAUSE...
Nurse: I think you should give her a one time dose of diflucan.
...LONG PAUSE...
Me: ...In general, I don't perscribe a new medications for a patient with new conditions that I haven't examined.
Nurse: So, you're telling me that you'll be right over to examine her?
...LONG PAUSE...
Me: Diflucan it is.
Click to expand...
I loved that one.... That had me laughing when I read it last night!!!:highfive:
 
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Um I have no idea how either a central line or a PEG look I just relay 2nd hand info.
 
JackADeli said:
Yeh, as you, I, and even the candy-striper would know.... it would take significant effort to get the barium into a compatible delivery device and then infuse into a central line... If one succeeded in all of these hoops and hurdles without realizing how abnormal (the effort) from usual radiology practice, I think you would then be wondering why the viscous/chalky solution did not infuse into the thin caliber central line....
Click to expand...

Yeah, the radiologist had to have more than a "brain fade" but perhaps a major CVA, what with all the steps that one would have to go through, outside the normal protocol and not realize that something was wrong.

Of course, I did once have a SNF nursing aide pump tube feeds into the pancreatic drain instead of the PEG, but my standards for her were much lower AND that tube was at least on the abdomen as opposed to a central line (but that didn't mean I wasn't upset since the man had been on service for months and succeeded in being readmitted for this in less than 36 hrs. :rolleyes:)
 
psychforme said:
Um I have no idea how either a central line or a PEG look I just relay 2nd hand info.
Click to expand...

Well, that's the problem. Instead of asking us what we thought about it, you assumed you knew more than you did (or that your source did). I think you can see from the pictures below, they are VERY different.

PEG tube (some have two ports - but as you can see, its just a flip top cap which opens up so that feeds can be instilled; the COLOR will vary by manufacturer):

als11_8PEG-tube-ex1.jpg


For fun, here's another species with a PEG:
peg1.jpg



CENTRAL LINE/TRIPLE LUMEN CATHETER IN THE RIGHT SUBCLAVIAN (note Luer Lock caps so that solutions are inserted with a special needle; the caps are not removed):
central_line.jpg
 
Winged Scapula said:
Well, that's the problem. ...you assumed you knew more than you did... I think you can see from the pictures below, they are VERY different...
Click to expand...
You has more patience then I. Given the ease with which this individual proceeded to speak about what a nurse's job is or isn't in a manner that reads like a paperback novel/drama representation.... then talks about basic medical devices with less knowledge then a junior high student... I am impressed.

But, I still concur with others....:troll:

PS: I hope not your cat....
 
why is one blue, one red and one white?
 
psychforme said:
why is one blue, one red and one white?
Click to expand...

With a triple-lumen central line, you can each of the three tubes for a different purpose. The different colored caps help you distinguish which tube is which.

They don't have to be blue, red, and white. The one that my school's hospital uses has brown, blue, and white caps (it looks like the one in this picture).
 
InternHumor said:
...LONG PAUSE...
Me: Diflucan it is.
Click to expand...

So good! :laugh:

Life as an EMT...

beep beep beep
(pager: hospital discharge)
me: Hi Dispatch, we got your page. Do they need us right away? We just got our food and we haven't had a break in...
dispatch: yes, it's urgent. expedite.
(sigh)
5 minutes later, en route....
beep beep beep (pager: call dispatch)
me: Hi, you rang?
dispatch: Why are you guys so late? I'm going to tell (the company owner). The hospital is furious and we are going to lose our contract!
me (eating big mac as I drive): ...the hospital was 10 minutes away, we got the page 5 minutes ag...
dispatch: expedite.
5 minutes later...
me: Hi, we are here for patient X (who apparently needs an "emergency discharge")
nurse: Oh, that's nurse X's pt.
me (with a smile): And nurse X is?....
nurse: ...on lunch.
me: ah, I see. I'll be in the corner over there when you need me.
(no response)
30 minutes later...
nurse X: Oh, you're here for "room 12"
me: that's the one, is she ready to go?
nurse x: We're still waiting for her paperwork...


Another quickie....

I'm driving the ambulance and listening to my partner in back, who has a really thick Russian accent, and I love, but happens to also be a little incompetent.
partner to patient: (really, really loud) How old are you, baby?
pt: Ninety-two
partner: NINETY-TWO?! All your friends die already!
 
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psychforme said:
Um I have no idea how either a central line or a PEG look I just relay 2nd hand info.
Click to expand...

Obviously.

I have difficulty believing that any Rad/MD/licensed nurse could make that mistake.....and I have seen some doozies. It would completely impossible for reasonable practioner to draw/ inject PO barium into a central line. Betwwen the fact that it is too large an amount to generally be injectable, generally opaque and and not packaged to be drawn up in a sterile manner. And as far as mixing up lines - you cannot mistake an IV line for any form of feeding tube. These days the tubings are generally made to be incompatible in size or to have incompatible ports so that those errors do not occur.

(Though I have heard of caregivers mistaking peritoneal dialysis caths/suprapubic foleys/feeding tubes/etc. especially several years ago, when they were closer in size to one another)
------------------------------------------------------------------------
As far as taking things away from patients, most nurses learn that we cannot just take things from patients, unless they are imminently threatening themselves/other patients' safety. I have a couple of coworkers that ended up with stitches after being slashed by a little old 80something year old, that did not want to give up a piece of equipment that he had picked up. You ask for the scissors back, if they refuse, you ensure that they do no more harm, calm them and then get the scissors away from them (the more you pressure a confused pt, the more likely someone is going hurt, or the more aggravated you make the pt.) If more danger IS imminent, you call security (or psych/geripsych assist).

As far as restraints, there are numerous groups trying to have them banned due to perceptions that they are inhumane and an infringement on pt rights, and that they are dangerous, resulting in numerous deathes every year. As such, they require an MD order and that order must meet certain standards. One cannot write a PRN order, it must specify type of restraints, and have a time limit (no greater than 24 hours, or must be renewed). Even all 4 side rails up is considered a "restraint". And while these regs may be stricter depending on state/facility policy, nurses generally cannot apply restraints without an (some exceptions apply). And if restraints are DC'd, the MD must be called again for a new order, in most situations. The entire order has to be rewritten and signed at minimum every 24 hours.

Trust me, the nursing staff hate these regs, also.

While the nurse could reinsert the foley, s/he cannot do much about the JPs without an order. In addition, in keeping with JCAHO, HCFs are trying to get foleys DC'd sooner - the MD might prefer the foley left out, in keeping with decreasing catheter related infections. Not to mention that it is not smart to reinsert tubes until the pt is better controlled.

(As much as there are many deathes due to restraints, one has to wonder how many deathes occur by confused patients getting up and falling, or from injuries that restraints might prevent.)
 
caroladybelle said:
I have difficulty believing that any Rad/MD/licensed nurse could make that mistake.....and I have seen some doozies.
Click to expand...
I think you misunderstood something. I know the story is true. I don't know how the radiologist made the mistake.
 
psychforme said:
Um I have no idea how either a central line or a PEG look I just relay 2nd hand info.
Click to expand...
psychforme said:
I think you misunderstood something. I know the story is true. ...
Click to expand...
Um, no, there is no misunderstanding... First, a plea of ignorance and "just relay 2nd hand info". Now, you pose some degree of definitive knowledge.... I think the answer throughout is clear::troll:

You should consider moving on to another highway bridge under which you might make a comfy home.:thumbup:
 
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