03 August 2006

You want me to do what?!

My last Emergency Dept time was on Sunday afternoon. I came in feeling much more confident in my ability to start IVs, and that I could generally handle whatever was going on. As I was walking in the back entrance, I heard the ambulance sirens heading toward the hospital. Excellent, customers right away.

What arrived were four patients from a two car accident. Mom, Dad and 9-month old baby from one car, and teen driver from the other. I immediately missed the stick on Mom, partly because as soon as I stuck her and wasn't in quite the right place she started hollering and cursing, so I gave up and the nurse took the second stick. Baby was screaming because nobody could take him out of the car seat until the MD okayed him, but he turned out to be okay and settled down. Actually, Dad was the only one to even walk out with a cervical collar on, which is pretty good considering their car rolled over. Teen driver was fine and released within an hour.

Later, I was talking with a dog-bite patient, and I got an immediate IV in his right hand without any nurse shoulder-riding. He got a little fluid and a bunch of IV antibiotics. But the good part is that when the animal control cop showed up later, I was the only one who knew when the guy had been bitten, and his helpful description of the animal at large - "I don' know what kinda dog it was. But it was big and brown, bit me and ran off." I laughed at this, because I'd asked him if he knew the dog or who it belonged to, or even what kind it was. Patients make me laugh sometimes, especially ones who are my age and friendly.

Aside from missing several more IVs (as in, I stuck people and didn't get the IV where it needed to be), I declined another procedure that would've given me big bragging rights. There was an actual intubation that happened while I was there. Since it was a patient I hadn't been with, I poked my head in and said that I heard a rumor there was a tube going in. The doc looked up and said, "Yeah. You want it?" My first reaction was holy crap! You can't be serious! And then I realized he was serious, and he would literally let me stick a tube down a real live sedated person (even though my protocols are really only for "dead" people -cardiac arrests).

I've never even seen an intubation on a real person, so I chickened out and declined. When he lifted her jaw to put the tube in, I noticed that she didn't have any teeth and then I was disappointed I didn't try. For those not familiar, you use a laryngoscope
to lift everything out of your way so you can see the vocal cords and pass the tube through them - and as you can imagine from the picture, sticking something metal in someone's mouth runs the risk of hitting, and breaking, their teeth. My biggest fear about the procedure is smashing up someone's teeth. I'm not really worried about the tube placement or anything in the hospital because obviously there is someone right there breathing for the patient and the doc right there to put the tube in if I couldn't. And still, I was so shocked by the offer that I declined before I thought through all the reasons I should've done it.

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