Tuesday, May 22, 2012

Life Saving Interventions

In case you were wondering, staffing still blows.   Also, there seems to be an extra bus route running to Hood Hospital now, cause, yeah. So obviously, when my inevitable one-to-one septic shock respiratory distress with no IV site patient with the crazy family member comes rolling through with door, it's just me and ER BFF for ten minutes until she has to go back to her own sick ass patients. Rad charge can't help, because she is also triage because that's how shit is now.  Staffing you with enough people do your job safely is not gonna happen. Anyway.  Not really the point.
Point is, I got this.  Well, I mean, not all of it, since I have charted zero of my interventions, but the initial labs are sent, all the necessary tubes are in all the necessary parts to the patient, all 3 of my pressors are on board and maxed out, and the antibiotics are going now that I've call the pharmacist to make sure I can give them in the same tubing as the vasopressors as I am now also out of places to put this stuff. Okay? Yeah, I will be here for three hours after my shift charting all of this, but all the necessary interventions to keep the patient alive are being taken care of. Key words being NECESSARY INTERVENTIONS TO KEEP THE PATIENT ALIVE.
The criteria for these sort of things seem to be pretty universal among most of our ER doctors, but in this scenario, Dr. Stick-up-the-ass seemed to be rather confused, so lets just do a quick rundown of things that WILL NOT save a patient's life, and thus are not cause for eye rolling and sniveling, snotty bitching about how everything wasn't already done an hour before the patient got here because you would have had it done already.  Off the top of my head:
-urine pneumococcal antigen level- hey, sorry, people maxed out on 3 vasopressors sometimes don't make urine, but obviously that's my fault.
-lactic acid level- imma go out on a limb here and say it's going to be HIGH.
-home med list- hold on, let me zero this art line again real quick now that the patient is back from CT, then I'll look through the visit history and maybe a doctor has been nice enough to write down what is surely 800 different meds in the history and physical which you have access to so I can copy them for you right now. If that doesn't work, I'll just turn off the patient's versed drip and ask her to write them down for me real quick.
-finding out who the patient's PCP is-see above
-post Tylenol suppository administration rectal temp-it's a two person job getting in there dude, but feel free to glove up and give me a hand at any time.
Ugh.  It's all whatever, but let me just say I'm really over the assumption that because you're an ER doctor that you can somehow do my job in your sleep.  That isn't how it works at all.  And of course, all of this dickishness occurred exactly one day after one of the cool doctors was hanging out and talking to us about how all of our jobs were equally hard an no one was better, but that we were part of a team that had to work together to be successful.  I wish some of these turds understood this, but I guess I should just be grateful that I work with a lot of doctors who do.


  1. Wow...wow...Some doctor's can be such jerks, I know we have a few of them hiding around here too...

  2. Where are the techs during all this?

  3. Reminds me of a doctor I follow on Twitter who recently posted something like "This is the worst code brown I've seen in 15 years of being a doctor and a parent". I'm thinking....okay, you've probably seen a few dirty diapers in your time. But since when do doctors have anything to do with ADULT code browns in the hospital?? (not to mention that this doctor is a neurologist). Most doctors run right out of the room if the patient even wants a blanket.

    1. Agreed. BUT. If there is a doc in the inter tubes that would help out with a code brown, it would ABSOLUTELY be Dr. Grumpy. Most pro-nurse doctor blogger I've ever seen, so I assume he is probably the same in real life.

  4. EXACTLY! The other day I had six patients including a two-on-one similar to above...AND we're supposed to make follow up call backs to patients to ask them how their ED visit the day before was and do stocking AND we get written up if they aren't done...right. What don't these people get?

  5. ...should have been two-to-one, but was one-to-six...

  6. Thank you for reminding me once again how lucky I am that I don't work with MDs...... :)

  7. SerenityNowHospitalMay 24, 2012 at 7:59 PM

    Is Dr Stick Up Ass the new-er buff one that likes to watch his triceps flex as he does chest compressions?

    ER Doc

    1. No, if you're talking about the one I'm thinking of, me and him are cool and I think he might have a minor doctor crush. No, we're talking Dr. Previously the greatest ICU nurse that ever lived before he graced the universe with his decision to become an MD. Which actually explains a lot. MISS YOU. So tired of holding these whiny bitches hands through the grueling process that is seeing patients and putting orders in the computer.

  8. Here is an MD take:
    -urine pneumococcal antigen: I'm giving antibiotics anyway. Who cares.
    -lactic acid level: nice to have as a baseline, AFTER lifesaving interventions in place.
    -Home med list: patient's home antihypertensives not important right now.
    -PCP: not an intensivist so not top priority to me.
    -Post-Tylenol rectal temp: are you kidding me? Fever is the least of that patient's problems.