Wednesday, April 25, 2012

Yesterday, I received a 30 year old patient, transferred from an ICU at another hospital, for our Angiogram. This fellow was using his phone and texting almost continuously, while also stating that he had continuous chest pain. He was able to walk around without any difficulty, and truly exhibited no evidence of classic Cardiac disease. Sure enough, his heart-cath was normal, and what he needed to do, was drop one-hundred pounds.

Why the story? He shouldn't have been in an ICU, because that classified him as “critical”, and thus, needed an ICU nurse. It was a waste of resources.

Much later in the day, we received another patient from another hospital. She was a train-wreck. A classic, little-old-lady, previously very active, had fallen five days back and fractured her Humerus. She went to the Emergency Room of her hospital, whereupon they sent her home with an immobilizer sling, and told her, come back next week, and we'll fix that thing.

After being home for four days, where she probably slowly and unknowingly bled from her fracture, she had chest pain, and after quite a few hours, finally returned to her hospital. She had previously been diagnosed with stable cardiac disease, but never had undergone an angiogram. So, really it is no surprise to me, when her Troponin levels were quite high, and sure enough, she had suffered a heart attack, secondary to blood loss and the trauma associated with a little-old-lady falling down, and not being properly treated.

And did you know, that critical thinking, trumps protocols? Apparently, over at hospital -X, they follow protocols; in particular, the one where you place the person with a non-STEMI on a Heparin drip, Plavix and Aspirin. I know that sounds like a good idea, but not for the senior citizen with the broken arm, who is already anemic! This lady needed an emergency blood transfusion, before she could be rushed to the Cath Lab. She was clearly critical, needed an ICU, but had not been classified as such, at her home hospital. For us, this created a potential resource crisis, because now we needed two nurses to do the rapid-prep, to get her ready for her angiogram, and our staffing level was at its lowest point of the day. 

And to top it all off, a system-wide (as in multi-hospital and across several States), computer crash occurred. Nobody could chart a flippin' thing, or even check Labs or Diagnostic studies. Yessiree-Bob, how we love our EMR!

I saw this patient head out the door to the Cath-Lab, and soon after, I departed for home. If an ambulance crew ever tries to take me to hospital-X, I'll stun-gun the EMT driver.

Don't Go Back There

Hospital horror stories
Patient's will relate,
And we're the last in line
To invest in their fate.

A week spent elsewhere
Almost killed this fellow,
He's severely anemic
With skin bruised and yellow.

So we're documenting like crazy
To prove we didn't do it,
Taking pictures and tissue samples
Short fix?; we'll fish-glue it.

And casually, I'll suggest
If there is ever a future day,
Where you need to use a hospital
Don't go back there, no way.


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