Sunday Night at work was wonderful. I started with 3 walkie talkie patients....which NEVER happens. So I was in my glory. I knew I was open to get a 4th patient since I had such easy patients. No problem. I've got plenty of time to admit someone and my new admit was also an easy patient. So I just knew Monday night would not go as well. Never is it possible to have 2 great nights in a row.
Monday night I got 3 of my patients back. Great, I think. The charge nurse gives me an admission while at the same time one of my patients is getting discharge orders. Wonderful! @@. I take report from the ER nurse. It had to be one of the worst reports ever given. I'm hoping he's a new nurse, otherwise....he doesn't belong in nursing. The patient's name sounded very familiar to me, yet I couldn't place her face. I'm told she overdosed on morphine tablets....but didn't mean to. She took 10 times the dose she was supposed to. Ummm, that doesn't sound like an accident to me. Apparently she was just trying to get rid of the pain. At least that's what she told them when she was still conscious. Fastforward approx 2 hours later and I'm told they gave her 2 doses of Narcan & she's still unresponsive, but has lots of secretions that they are suctioning. Ummm, ok??? He goes on to tell me she has normal saline running at 100 ml/hr through a #24 IV in her thumb. And that they bolused her with 1,000 ml's. I asked how was her urine output. He sounded surprised & answered honestly....he didn't know. I asked does she have a foley cath or a diaper on...since she's unresponsive & obviously not getting up to pee. The ER nurse doesn't know. He's reading through the orders when I ask if she has any oxygen on. He replies 2 to 4 liters. Ummmm, which is it? He isn't sure. And he proceeds to tell me he cannot get an O2 sat on her. Then how do you know this drug overdosed unresponsive patient is getting enough oxygen? He doesn't know.
Now I'm starting to wonder if our ER has any doctors...because this is making no sense. I ask what her rhythm is. He says sinus tachy at about 120 or so. No one is concerned about that rate. Guess they're just happy she has a heartbeat. He proceeds to tell me she is a Baker Act & requires a sitter. I thought this was a little silly as she was unresponsive, but she obviously was a threat to herself, but ok. Only there is no sitter available. WTF? This is a joke, right? I hang up with ER cause now anything I ask, I get the generic response of "I just got this patient.". I go to my charge nurse & tell her I do not think this obviously unstable, critical patient belongs on PCU. Since no sitter is available, she calls the supervisor & refuses to accept the patient. Later I hear that she is in ICU, still unresponsive, on a Narcan drip with a blood pressure in the 80's and a temp of 103 and on the verge of being intubated. I want to know who the heck made the decision that she belonged on a PCU unit. Ridiculous!!
I did end up getting an admission. Luckily, it was after I discharged my other patient...who by the way was so happy to go home, that she surprised me by giving me a hug and a kiss on the cheek. I don't usually like strangers getting that close to me....unless we're talking about someome like say Tim McGraw or Luke Bryan. :). It was sweet though, so I didn't flip out.
I'm off now for 8 days...yay! Celebrating my mom's birthday tomorrow, then the Katy Perry concert on Thursday & a nice lobster dinner on Saturday night! Yum!