Another day in the ED

Like I said last quarter of my Emergency Department (ED) rotation that it was my favorite, and it still stands as my very favorite rotation yet. I'd like to preface with the famous words of Chris Farley in Tommy Boy, "That was AWESOME!"

Really, it was. I went on a Friday night and morbidly hoped something bad would happen to people so I could see and help out in any way. Well, bad things did happen...unfortunately for the pts, but great for me. I assisted a male RN that night. Here is a few things I saw and did that happened:


1. A man sawed his middle finger about 1 1/2 inches long and it was open, oozing blood with bones and tendons showing. The distal portion was just hanging, and it obviously needed surgery. I IV-pushed some pain meds. I irrigated and flushed his open, gaping wound to clear debris and other particles out of it. It was a little messy, but so cool. Surprisingly, I didn't get queasy.


2. A woman fractured her tibia and I wrapped her leg in an ortho stirrup binder that hardens and stabilized the leg until her surgery 3 days out. I had only seen it done once before, but I got a chance to bind, wrap and secure her leg.

3. I started an IV (the 1st try), on a patient. She was going to have a lumbar puncture to test her cerebro-spinal fluid. I watched the MD poke, dig and finally find a spot where CSF fluid leaked out. When it comes out it is a clear liquid and about the same consistency of blood. I took the samples to the lab which came up negative.

4. An elderly gentleman needed a Foley catheter in. I took the assignment and went to work. The normal Foley tube is pliable, and it wouldn't go all the way through to his bladder. He had a large prostate. With a sterile technique, I used a Coude catheter. The tip is curved and firm. With a little elbow grease, I successfully got the catheter in and was able to measure his output.

5. I did a respiratory assessment on a little 1yo with RSV. Not much else, but it was great to hear the baby's lung sounds and breath sounds.

6. I helped clean a "mentally challenged" pt's briefs. He was a very touchy-feely kid. Luckily he tried to kiss the male RN and not me. :)

7. And finally, the winner of the night goes to: A trauma patient with a respiratory code!
The patient came in from the ambulance. He was breathing, but unconscious and not responding. I arrived to the room and it reeked of stale urine. The man was unconscious for at least 1 day, maybe 2. He had soiled his pants and it was disgusting. With the foul urine smell, he had stunk up the entire ER in a matter of minutes. In the ambulance, the paramedic tried to intubate him, but went down his esophagus and was putting O2 into his stomach. When I saw him his stomach was so distended it looked like it was going to pop. The MD tried 2x's intubating him, and another MD was ready with scalpel in hand to give him a tracheotomy. Good for the patient, the MD finally got the ET tube in. Once they put an NG tube in, his stomach became much flatter. They needed all hands on deck. I couldn't help because in a code/trauma situation, I as a student am unable to help because it is not within my scope of practice yet. So they asked me to record everything they did to the patient, including meds given and the amount and the procedures performed. I documented all the MD's orders for meds and labs to perform. Also I had to take vitals every 5 minutes on the guy. They were able to stabilize him and bring his O2 sats to 92% up from 78% at its lowest. He stabilized and was sent for a CT scan and then to ICU. It was quite exciting in that one room. It took over an hour and it was impressive of how the doctors and nurses worked so quickly and calmly under all that stress.
Working in the ED is something I think I can definitely do in my nursing career. Let's just see how I like OB and I might change my mind.