Projectile Puker and friends

puking,vomit,family guy, emt, crazyI haven’t written in what seems like forever…sorry to all the readers- I’ve been so busy. Enough about me, you come here to read about the emergency room- so let’s get started.

A guy comes in and out of the waiting room, walking up to triage- “I need to check in, no wait,” then walks out. This guy is more indecisive than a teenage girl trying to pick out a prom dress. We get him to check in and now the battle is to get him back to a room- his thought pattern is extremely erratic- he’s been smoking crack. He’s so off the wall that the decision is made that once we get him back to a room- he will immediatly be placed into restraints.

The restraint isn’t easy- he’s fairly athletic and quite strong- plus he’s screaming, “HELP!” at the top of his lungs. He’s frantic as we hold him down- “I need water, then I’ll be ok,” two seconds later, “HELP!” By the time we’re done- both him and the bed are completely soaked in his sweat. Once he’s fully restrained and we go hands off- he says, “that wasn’t so bad!” Two seconds later he yells, “SECURITY!!!”

He was medicated and took a good nap till the crack ran it’s course.

A patient is brought in for a mental health evaluation and while he’s a bit bigger than I am, he seems pretty harmless. He wants the usual comforts- a blanket and some juice, but other than that, he’s pretty low maintenance and follows directions. The nurse gives me a file with some pertinent information on what brought him in.

While on the way to a mental health facility, the kid decided he didn’t want to go – so he grabbed the wheel and punched his caregiver fifteen times in the face. I decided to use a little more caution in the care of this individual.

I take a patient to ct scan, it’s gonna be with contrast, so a dye is injected by the machine as the patient is undergoing the scan. The patient is on the table, in the machine when the contrast starts running. He calls out, “Miss, Miss!” I figure his iv is no good and it’s pumping into his arm- which can hurt. A half a second later- he proves me wrong.

This poor guy starts projectile vomiting. I’d never seen anything like it, lying on his back, vomit was shooting out of this guy like a geyser! Selfishly, I was happy that it didn’t hit the ER gurney, which meant there was nothing for me to clean up, just get him a new gown and get out of there. The ct machine, on the other hand, was soaked.

I really love being in the emergency room and sometimes it helps to remind myself why I came in the first place. I’ll be going offline for a bit soon when the baby is born. I’ll be sure to post a pic of the little guy when he debuts.

I’m working on a series of posts that will profile the different jobs of the emergency room. Stay tuned!

More Craziness….

mental health,crazy face, illness,mental illness

Before I worked in the emergency room, I didn’t realize just how many mental health patients come through our doors. We have teens who are suicidal, middle aged men with schizophrenia, and women that don’t fit any particular category- they’re just plane nuts!

Most of the time, I find this area of medicine interesting and fascinating- other times it can stressful, annoying, or boring.

The other day I had what we sometimes refer to as “psych row.” This consisted of three patients who were all in the emergency room for mental health reasons. One guy had a thick beard, and even though I was dreading spending time with him- I actually really enjoyed talking to him by the end of the day. He said some seriously funny things and was surprisingly intelligent over a wide range of subjects.

After eating his lunch tray, he starts putting all the garbage into a bag and I hear him mutter, “if I can’t give a tip, I can at least clean up this mess.”

Later, a guy who’s completely inconsoleable, having just smoked down some good ol’ spice comes rolling by.

“Don’t worry man, you’re gonna be ok!” Says my bearded friend to the arriving patient.

Later, we get in a patient who turns out to be a real handful- she’s totally psychotic, drunk, and was found wandering in traffic.

The medics say, “we could barely get her into our rig- good luck getting her into a gown.”

As I’m filling out some paperwork I can hear beardie talking to our new arrival.

“Hey sweetie,” he says in his best attempt at a calm, comforting voice,

“we’ve got this nice dress we need you to change into.

You’re really going to like it, it’s like a sun dress!

So can you go ahead and change into this dress for us?”

I didn’t realize that in the short time that this guy was in the emergency room for a mental health evaluation- he’d been hired on as a “patient care assistant.”

Even though he was completely sweet and spoke very kindly to this psychotic woman- she neglected to put the gown on- heck- she neglected to recognize any part of the reality that you and I know to be true.

Later though- she would prove that she still has an understanding of time and space- as she kicks me- pretty dang hard- right across the side of my head. I’m trying to help the nurse hold her down for a blood draw- since she’s been taken out of restraints- and she decides to swing her leg up and connect her shin bone to my jaw/temple- as fast and hard as she can.

I wasn’t expecting the strike and I’ll admit- she got me pretty good- oh well, doesn’t really bother me- not the first time I’ve been kicked in the head…just the first time outside of the ring.

She did warn me though- she told me she wanted me the eff out of her room- because I’m black…

The Impossible Illness

surprised face, crazy, wild, funnySpending some time with a restrained patient in the emergency room can quickly give you insight you never had and enlighten you with facts you wish you never learned.

The patient I was with was truly psychotic, not violent- towards me anyways, but so far out there that there was no way to guess what was coming next.

The patient was a female- that’s all I’ll say, and only because it’s important for the context of the story. I always try to disclose as little information about the patient without taking away from the pertinent info of the story. Many times I keep the patient gender-neutral when recounting the events of the day. This patient was female- and a live wire!

She would scream out name of one of our techs at the top of her lungs- apparently he hit it off well with her. She and I got along ok too.

She starts telling me about her medications.

“I take bi-polar meds so i can’t drink alcohol anymore.”

” I know what will happen if I drink on those meds- I’ll die when I’m fifty.”

“I’ll lose a kidney or get cancer.”

“I’ll friggin’ die from prostate cancer…I know things because I read and talk to my neighbors.”

Her poor neighbors- I wonder which one told her- she would die of prostate cancer

Brawl In the Hall

mounted, dropping punches

More than I’m allowed to do in the ER…

Two days ago, I had my first “real” brawl/wrestling match in the emergency room. This would mark twice in less than a week where someone would raise their hands to swing at me, and I’d have to employ my “special skills.” This most recent case was the craziest by far.

A patient checks in feeling suicidal- we have certain policies that are in place for the safety of patients and staff. Our policy states that all psych patients will change into a gown, and give blood and urine samples unless medically directed otherwise. This patient was aggressive and refusing to follow directions, right off the bat.

After finally convincing the patient to go the bathroom to change- there is another patient in the bathroom. “That’s divine,” says the patient. Hmm…I don’t think God is telling you to not go into the bathroom to change into a gown. I’m pretty sure He would be ok with this policy…

I explain that we will get blood and urine samples before the visit is over- a spring pops loose in the patients brain, and before I can blink- they have sprung from their bed and bowled through both their friend, and myself. This patient was on a mad dash for the door…and unfortunately for both of us- it’s my job to stop them.

Usually, re-directing someone back to their bed is no biggie, I’ve trained for years, grappling, wrestling- and I feel like I have pretty great body control. This patient was a bit of an exception. I never got the official weight of the patient, but they were over three hundred pounds- and closer to four than three if I had to guess. Don’t let the weight fool you, when they ran for the door- all of the athletic abilities that were pent up for the last thirty years or so -came out.

As the patient rounds the corner, I grab a wrist with both hands, hoping to slow them down, and have a second to reason with them. The patient turns on me, raises a fist, and when I let go to protect my face with one hand, drops the hammer of Zeus on my other hand- totally breaking my grip. Like a train with no brakes, the patient is rocketing towards the door.

As I run behind, thinking how to safely detain the patient, I realize I can’t just wrap up the legs like I would usually- on the mat. It’s too dangerous  the patient could be seriously injured in the fall because of their size. I wrap my arms around the patients waste (barely reaching, and sit. Right before we hit the floor, I spin- putting myself on top of the (now extremely angry and aggressive) patient. The patient is sitting and swinging and I quickly lock down “side control” on the patient- burying my head to avoid any potential damage.

Once I have a second of clarity- I yell “SECURITY!!!” It seems like forever until security is on scene, and I yell “SECURITY,” again- only to realize that there are ten or so people standing around. Things get a little fumbled in your head in a time like this.

What made me laugh was when the patient says to me, “Sir, I respect you, but can you please take some weight off of me?”

I’m only 180 lbs. but years on the mat have taught me how to be very “heavy” on top of someone, and I sure was doing all I could to pin this opponent to the floor. Into restraints and onto the gurney, the patient is wheeled into a private room and continues to go wild for the next few hours.

I end up with a red eye, a scratch over the other one, a scratched wrist and a couple of sore knees from wrestling on tile, but overall- I felt pretty good. Marking that one up in the “win” column.

anderson silva

Training with Anderson Silva

Anything you can do in your spare time to improve how you can defend yourself and protect others is a good thing. The more you practice, the higher the likelihood that you will be able to initiate your training under pressure.

It was good to have two days off after that ordeal. Never a dull moment in the emergency room. The patient did tearfully apologize for scratching me later…so- that was nice.

What’s in the Water?

water, bottled water, faucet,Dang…i swear the emergency room has become a mental hospital lately. The amount of people acting down right crazy has been overwhelming. The guy who I wrote about last- throwing a tuna sandwich- ended up getting thrown himself-by me. I’m sorry, when you’re screaming obsceneitites at me with your  hands poised to strike- I’m going to raise my hands to protect myself. When you slap my hands and lunge at me, I’m going to help you find your bed- judo style.

Today we had a patient who had multiple personas. First she channeled “Ramtha.” Not sure if Jay Z Knight know’s, but Ramtha is apparently possessing anyone he can get into these days. Fast forward a few, our patient emerges from the bathroom looking like a character from the Lion King! Mangled, tangled, badly colored hair sprouting out in every direction- her mane gyrating as she bounced up and down singing Nelly Furtado.

Another patient- rule out cva/poss. psych? First she cusses me, then she loves me.  I smell alcohol. I mention alcohol and a fuss arises- clearly alcohol is not to blame for this disaster that is steadily unfolding. Bloodwork comes back… blood alcohol level of .48…yeah, I’m thinking alcohol is completely to blame.

It doesn’t help when the waiting room is overflowing and you’ve got patients with genuine complaints in the next room over from someone yelling R rated slurrs at the top of their voice. I really do love my job. Sometimes I just have to remind myself.

Quote This!

quotes,funny,funny quotes,emergency,hilarious

Today was one of those days- extremely busy in the emergency room and a non-stop flow of new customers. More than usual- we got our dose of psych patients today.

It was a funny sight coming in this morning, psych patients lining the hallway- every one but one, with restraints hanging off of their beds. It must have been an eventful night!

What stood out to me today- besides the pace- was the things people said.

Psych issues…

“I don’t have long to live.”

“Sure ya do!”

“I’m foaming at the mouth, I think I have rabies!”

“No you don’t”

“You don’t know that!”

He was right, I didn’t know that, but I was making a guess.

“I had hepatitis once.”

“Ok…what kind of music do you like?

“Don’t try and get all personal on me”

“I’m not sir, just trying to make small talk.”

“Hmmm…well…I like the beatles.”

“Awesome, they were a great band.”

“Don’t drink my blood or you’ll die too.”

“I’m not going to drink your blood, I’m going to send it to the lab.”

I poke his arm for the blood draw.

Bastard…malpractice…” He mutters.

Another story I heard second hand made me laugh.

Psych row…time…unknown-

“Here, have a tuna sandwich and some juice.”

Moments later- flying tuna sandwich.

“Sir, you can’t throw your sandwich.”

“Well…I hate tuna….and women!”

Pretty great day- I was glad to clock out…and glad that I don’t have rabies.

Thanks People!

thanks, thank-you,typewriter,card,Life in the emergency room has been busy as usual. My inabillity to post as frequently in the last week has been due to my busyness outside of work. So much is going on, I want to take the time and thank-you for continuing to come back to read this blog.

Thanks to readers like you, the first month of being online showed some awesome feedback! We just passed 500 unique visitors, and over 3,500 page views! It’s been hard work getting the ball rolling- thanks to everyone who has helped get the word out! I’m working on a facebook page for the blog now- I’ve been spamming it through my personal page up till now. Look for that soon.

Wow, life has been busy.

My wife and I are expecting our first child in less than a month! On top of a new baby, we are moving into a new place. It’s been non-stop with baby showers, and trips back and forth- moving things to our new spot. As busy as life is- I love it. I like being challenged and love the exhausted pleasure of accomplishment.

Tomorrow I’ll post a “regular” post about the dysfunctional chaos of the emergency room. If there’s something you’d like to see changed about the site, or have a suggestion- feel free to comment or email me at charles@emtguy.com .

Power Tool

tools power tools emtguy Logically, when you go to the emergency room, you should end up cursing out the first person that helped you….

Guy checks into the emergency room, a bit grumpy- but he’s in pain, so I can understand a bit of an attitude. I take him back to his room, and get his vitals- trying to get him comfortable for the short time that he’s with us in the emergency room. I head back out to triage (where I’m stationed for the day,) and don’t see him again until he’s discharged.

He ends up with a set of crutches and emerges with his girlfriend- back into the emergency room waiting area.

“Where can I get something to drink?”

I tell duder that I’d be happy to bring him a glass of water (cause I can tell that he’s less than comfortable moving around on the crutches.) He displays his disgust at the idea of mere water, and has me direct him towards the vending machines. He’s quite a sorry sight, trying to get around on these crutches- but the thought of a corn-sugar infused bubble drink motivates him to get on the move.

Fast forward a few minutes and here he is again. He’s been outside with his girlfriend (where he left her) but now he’s halfway back in the waiting room (he has his crutch stuck in the automatic door.) I see him staring at me and sense his desire for me to answer his distress call.

When I approach, the door opens and he informs me that the door was crushing his hand. Hmm…I sense a much different demeanor than when he first checked in and I’m feeling a hint of hostility. He tells me that the ambulance service (that he’s using as a personal taxi,) won’t come get him unless I tell them that he’s been discharged. I’m a bit confused because this isn’t something I’d dealt with before.

“How long you been working here bud?”

“I’ve worked here a while.”

“Really? Cause it doesn’t seem to me like you’ve got your story straight.”

Oh boy…I head outside to see how I can help with his girlfriend and her transportation issue.

As we head out, he starts mumbling about how he’s being harassed because he doesn’t have good health insurance.

“First off sir, I’m not harassing you. Secondly, I don’t care what kind of insurance you do or don’t have.”

His girlfriend is clearly confused and he mutters “F&*#ing tool,” as he hops up on a planter.” I put my hand in his face (on the edge of losing it.)

“Sir, I don’t need to be talked to this way. Ma’am, can I help you with something?”

His girlfriend is clearly confused, as she’s just got off the phone with the ambulance people, saying thank-you, with a smile on her face. She says everything is good, and I head back inside. I can see the guy in the reflection of the glass as I walk off, talking crap and pointing at me.

What I wanted to say was…”sir, I don’t want to have to smash you!” It was worse that I was outside so it somehow felt more appropriate to issue this dude a beat-down. My restraint was for our mutual benefit…

Low Risk

When people check into the emergency room because they are suicidal, there is a process for assessing how serious of a risk they are to their safety. Part of that assessment is finding out if the patient has a plan to follow through with suicide.

 

Lowest risk- depressed with suicidal thoughts but no plan.

Higher risk- suicidal thoughts and specific plan of action.

Highest risk- suicidal thoughts, a plan of action, and an attempt to commit suicide.

When the nurse or social worker is interviewing a patient to find out about everything going on that’s led to the emergency room visit- they always ask about a plan.

I’ve heard some that sounded bizarre- I tried to swallow a battery…

I once, while sitting with a patient, asked if they were having any suicidal thoughts at the moment. They responded that yes they were, and that I should put up the railing of their bed because they were thinking about rolling off…

Patient is being interviewed and asked if they have a plan- yes, they are planning on starving themselves to death. I’m guessing they weren’t too serious about it, or had just made the decision because they were far overweight and stated that yes, they had eaten breakfast that morning…

Mental health is no joking matter and is an area where I have a lot of empathy for the patient. At the same time- it helps to take advantage of the comedic relief so we don’t become jaded…

Change-Up

It’s a busy monday in the emergency room and there’s a steady stream of patients coming through triage, and ambulances arriving in procession. Two ambulances are on their way in- both to be arriving at the same time.

One ambulance is bringing a patient who collapsed in a business, required CPR and is now intubated- I’m thinking this is gonna turn into a code. If I was to guess…I’d say we’d be doing CPR on said patient- upon arrival to the ER.

The other ambulance is bringing a patient complaining of chest pain. Vital signs are normal from what I understand (I never quite got the whole story.)

In come the two ambulances- one guy with a tube down his throat- the other one, sitting up, watching us as we work. I go into the intubated patients room and help get things started- there’s plenty of people in there to receive him and my presence is merely supplemental. I assist where I’m needed and walk out to see how the other patient is faring- and to see how I can help.

Hmm…CPR in progress- that’s a shocker. Apparently- while another tech was setting up for an EKG, the patient slumped and it was determined that he was without a pulse. The scene went crazy with all resources poured into a tiny room. Rounds of CPR and medications are having no affect on this patient- his heart just doesn’t want to beat.

Because of the size of the room, and the position of the crash cart- there’s no real way to make the drama that is unfolding private. Many of the ER patients and visitors are getting as much of a view as they can- as we pump on this guys chest- trying to restore life. In the end, our efforts are unsuccessful and the patient passes away.

How bizarre- two patients are brought in, an hour later- the one who appeared stable is dead- the one who appeared on the brink of death is showing signs of improvement. It’s strange to me that the patient could hang on to life and then nearly immediately after arriving in the ER, drop dead. You really never know what to expect. It helps me put things in perspective. Nothing is guaranteed in this life. I’m grateful for every moment.