Wednesday, September 23, 2009

Appropriate transfers, you're doing it so wrong.

Ugh. The state of nursing in other facilities that we get patients from is nothing short of frightening, frankly. I won't even go into the stupid crap like the PEG tube replacements that the geriatrics docs should do at the nursing homes but are too lazy to, or the DNRs with low 02 sats (what are we going to do, intubate them?) but stuff that can only fall under the category of why-the-f would-you-ever-call-an-ambulance-for-this?
My favorites lately, from the nursing homes- a lady who banged her knee on a cabinet, denying pain, with a little bruise, who they sent via EMS to rule out a fracture; a hypoglycemic patient with a blood sugar of 95 when EMS arrived- supposedly, the patient had a sugar of 20 that they gave glucagon for. BS. When they arrived, they asked if they still wanted to send the patient-oh, absolutely. He was acting "altered". Oh, by the way, he had Alzheimer's. A 35 year old down's syndrome patient with a twitching knee. Really? One of our sassier ER docs has actually called and gotten in yelling matches with the nursing home doc on multiple occassions over the inappropriate crap they send over.
Probably even better is the psych facility down the street. I'm really starting to wonder if any RNs are actually employed at this place. Transfers we've gotten include: a ten year old with a fever. No tylenol or motrin given for 8 hours. A patient who was detoxing from cocaine that they woke up at 4:30 AM. He was confused, so they decided he was having a stroke. He was probably about 38, and had no facial droop, no weakness, no suggestive symptoms other than confusion that could easily be explained by the fact that it was four in the freaking morning! I always love the countless "altered mental status" patients they send us that need to the "medically cleared" who are either on drugs or withdrawing from drugs. Uh, yeah. They're sluggish and feel like crap and are mentally a little slow because they are withdrawing from an addictive substance. HOLY CRAP.
The absolute best, however, is the crap we've been getting this last week- I can't believe I'm saying this- but CPRs in progress from other hospitals. Seriously. Well, one hospital, specifically- a long term care facility that basically see ICU style patients day in an day out. Their patients code. They are sick. Do they run the CPR as they are trained to do? Nope. They call the ambulance and send it across the street so that when the patient dies, someone else has to do all the paperwork. We've gotten two of these in the last couple of days. Usually, by the time the EMS has been dispatched, arrives, does their work, and gets them to our ER, the patient has been down at least half an hour, but usually longer. They are always older patients with tons of comorbidities, so the docs usually call it after 1-5 minutes, as they should.
Man. I know I enjoy work more than most people- I work in the ER because I have to bust my butt there and it makes the time fly- but how lazy can you possibly be? I can't tell if these people are really so medically stupid that they're actually concerned about the conditions these patients are dealing with, or if they are so lazy that they are looking for any excuse to call EMS so that they don't have to do their work and take care of their own patients. Either way, it makes me want to drive across the street and smack them in their faces.


  1. That's lousy! Clearly they prefer to dump their loads on you thinking that will release them from liability and responsibility!

  2. Hey, I had to lock my blog so I don't know if you can still get to it, email me and I'll add you.

  3. yes, i need to get it together and add you! your blog rules, I've been telling everyone the story about the lady crapping in front of the walgreens, freaking priceless!