ERNursey - An ER Nurse's Blog

Bad News California ER's

noreply@blogger.com (ERnursey) — Sat, 30 May 2009 02:03:00 +0000

The Governator's plan to tax the shit out of California citizens to balance the budget doesn't seem to be working so now he is proposing deep cuts. Unfortunately, the cuts are to things like dental services for Medi-cal patients, Healthy Families which provides medical care to kids that don't have insurance and funding to rural health clinics. Yes once again the government is attempting to balance the budget on the backs of the poorest people with the least to give.

I don't know about my other California colleagues but my ER is running at about 120% capacity with about 70% of the necessary resources. Now in addition we will be seeing all the people who can't get services anywhere else.

I can hardly wait.

noreply@blogger.com (ERnursey) — Sat, 23 May 2009 00:02:00 +0000

A little history lesson, Mr. President - We don't think you really need to apologize for America's actions and involvement in Europe

In alphabetical order -- Sacrifices Americans made just for Europe.

1. The American Cemetery at Aisne-Marne, France. A total of 2289 of our military dead.
We Apologize.

2. The American Cemetery at Ardennes, Belgium. A total of 5329 of our dead.
We are arrogant.

3. The American Cemetery at Brittany, France. A total of 4410 of our military dead.
Excuse us.

4. Brookwood, England American Cemetery. A total of 468 of our dead.

5. Cambridge, England. 3812 of our military dead.

6. Epinal, France American Cemetery. A total of 5525 of our Military dead.

7. Flanders Field, Belgium. A total of 368 of our military rest in peace here.

8. Florence, Italy. A total of 4402 of our military dead.

9. Henri-Chapelle, Belgium. A total of 7992 of our military dead.

10. Lorraine, France. A total of 10,489 of our military dead.

11. Luxembourg, Luxembourg. A total of 5076 of our military dead.

12. Meuse-Argonne. A total of 14246 of our military dead.

13. Netherlands. A total of 8301 of our military dead.

14. Normandy, France. A total of 9387 of our military dead.

15. Oise-Aisne, France. A total of 6012 of our military dead.

16. Rhone, France. A total of 861 of our military dead.

17. Sicily, Italy. A total of 7861 of our military dead.

18. Somme, France. A total of 1844 of our military dead.

19. St. Mihiel, France. A total of 4153 of our military dead.

20. Suresnes, France. a total of 1541 of our military dead.

Apologize to no one for our actions in Europe. Be proud of your heritage. At great expense of life and treasure,
we saved Europe during two World Wars. Remind them of our sacrifice and do not confuse arrogance with
leadership. As Americans, let's all look forward without forgetting the past.

IF I ADDED CORRECTLY, THE COUNT IS 104,366 Americans in Europe who will never come
home to the land they loved.

Always Ready

noreply@blogger.com (ERnursey) — Fri, 22 May 2009 23:59:00 +0000

noreply@blogger.com (ERnursey) — Fri, 22 May 2009 00:15:00 +0000

noreply@blogger.com (ERnursey) — Thu, 14 May 2009 03:59:00 +0000

ER visits by chronic drunks cost you billion's of dollars every year. I think I know why.

We have Joe. He is homeless and spends each day drinking until he passes out in puddles of his own bodily fluids. Often he is in a public place where some concerned citizen, fearing he is a corpse, calls 911. The jail nurses refuse to take drunks until they have the golden stamp of approval by an MD so that if the drunk croaks in a cell they can say they aren't liable.

Joe comes to our ER once or twice a week. Once he came three times in a 24-hour period because the jail was full and they kicked him out swiftly. He is filthy, aggressive and agitated since his nice stupor was so rudely interrupted. He kicks, he bites, he punches and spits. He has blackened a nurses eye, broken another ones glasses and broken a paramedics rib. Imagine how much fun it is to wrestle to restrain someone who is covered in urine, vomit and diarrhea.

Sometimes his visit basically consists of the doctor the doctor calling the cops and telling them to come make a pick up. But all too often it involves an IV, a banana bag, a head CT to make sure his mental status isn't from him falling and suffering a subdural hematoma, multiple labs and so on and so on.

In the meantime he is screaming obscenities and disrupting the entire ER. Taking up a gurney while someone ill has to sit in the lobby waiting for care. Often multiple staff members are involved in restraining him so that their own patients are neglected.

Why are we wasting resources on these people? They need to be institutionalized and cared for since they are incapable of caring for themselves. It would be much cheaper. And for those of you in the ACLU who think that the rights of one supersedes the rights of the rest of us I say:

BITE MY LILY WHITE ASS!

God Bless my Mom

noreply@blogger.com (ERnursey) — Mon, 11 May 2009 03:46:00 +0000

Since I have become the mother of a smart mouthed, moody, surly, sullen, eye-rolling teenager with the PMS from hell I just have to say:

Thanks mom for not killing me when i was that age!

Happy Mother's day to my wonderful mom who has always been there to prop me up and who amazingly took a smart-mouthed, moody, surly, sullen, eye-rolling teenager with the PMS from hell and somehow produced a reliable, responsible adult.

Happy Mother's day to all you mom's out there too. And if you didn't call your mom today and thank her for not killing you when you were a teenager........

Get on that damn phone right now!!!!

This is why we are failing

noreply@blogger.com (ERnursey) — Fri, 08 May 2009 17:17:00 +0000

last night we had 65 patients in the 12 hours I worked.

12 of them had chronic back pain
3 had migraines
7 dental pains
13 abdominal pains - 5 of which had more than one ER visit in the last 7 days
6 chest pains- one of these patients was a dialysis patient who had kidney failure d/t untreated HTN who would rather smoke crack than go to dialysis.
2 stroke symptoms
4 toddlers with fever, none of which were in any distress and none of which were given any tylenol or ibuprofen at home.
1 patient with new onset atrial fibrillation
4 senior citizens with pneumonia - one whose family wanted everything done despite the fact that she was severely demented - didn't recognize any of the family and was bed-ridden in a nursing home.
1 senior citizen with altered mental status d/t a UTI

the rest had various other complaints none of which needed an ER visit.

Out of 65 patients 12 were admitted. Of those twelve, 7 had severe chronic medical problems related to smoking, drug abuse or non-compliance with treatment.

At least 40 of them had no emergency medical condition at all. 27 of those visits were paid for by Med-i-cal - meaning you and me. Eight of those came in by ambulance - also paid for by you and me.

You can talk socialized medicine all you want - in my opinion we already have socialized medicine -EMTALA and Medi-Cal which has lead to rampant abuse of the ER. Socialized medicine will only make that worse unless something is done to fix the underlying problems, people need to be told NO sometimes.

NO, we are not going to continue paying for your dialysis since you chose to be non-compliant by not taking your med's or coming to your appointments.

NO, we are not going to provide millions of dollars of intensive care to treat a contracted, demented nursing home patient who has no cognitive abilities or quality of life. We are going to keep them pain free and let them die with some dignity.

NO, you can not come to the ER with your chronic pain. You can go to the clinic. Took your months worth of pain meds in two weeks? Too bad.

NO, we will not pay for anymore treatment for your smoking related problems as long as you continue to smoke.

NO, the government cannot cut any further mental health dollars and in fact - they shall be forced to fund a mental heath hospital with their own urgent care that is open 24 hours a day. There will be a clinic in every community of greater than 30,000 residents. Cutting funding to mental health has not saved a dollar. In fact it has cost us billions of dollars in repeated ER visits, increased drug abuse, incarcerations, homlessness and crime.

NO, drunks cannot come to the ER -they will go immediately to the drunk tank. BILLIONS of our tax dollars are spent every year on chronic drunks who drink themselves into a stupor daily then pass out on the sidewalk and end up in the ER. If you demonstrate a trend for this then you will be incarcerated since you obviously cannot take care of yourself.

NO, we will not pay for obesity related illnesses if you are doing nothing to help yourself. Trying to eat healthy and exercise OK otherwise you are on your own.

NO, you cannot call an ambulance for a non-urgent problem. It is ridiculous how many people come in by ambulance every day for non-emergencies.

Until we expect people to have some personal responsibility we will just continue bankrupting our country. Giving people unlimited access to free will just continue to allow them to have no responsibility for their actions. The government will continue to tax the hell out of those of us that work and are responsible to pay for those that are not. I don't know about you but I am getting a little tired of that.

What idiots are in charge?

noreply@blogger.com (ERnursey) — Thu, 07 May 2009 23:12:00 +0000

Today it was announced that to cut Med-i-cal costs there would be no more reimbursement for adult dental services.

So it is going to be cheaper to not pay a couple hundred dollars for dental care and instead spend thousands upon thousands for repeated ER visits to treat recurrent dental abscesses.

Brilliant.

Happy Nurses Week 2009

noreply@blogger.com (ERnursey) — Thu, 07 May 2009 22:54:00 +0000

This is why I am an ER nurse.

Today we had a visit from a very special person. She literally was brought back from the dead over 20 times.

The worst day of her life started on a routine trip to the local mall. She was found face down on the floor of the women's restroom -dead. The first person who found her immediately started CPR. There was an AED at the mall which was used and shocked her three times before EMS arrived. Thanks to the swift response of the EMS crew she was in our ER within 10 minutes of being found on the ground. She had CPR the entire time.

She had a pulse on arrival but when we moved her over to the gurney she went into pulseless v-tach and was shocked again. She spent thirteen minutes in the ER being resuscitated. The cardiologist was in the ER seeing another patient and made the decision to take her to the cath lab. She had a pulse when leaving the ER but went into v-fib in the elevator - one of the ER nurses climbed on top of the patient to perform chest compressions while the gurney was pushed swiftly into the cath lab.

The cath lab crew continued the resuscitation efforts while the cardiologist inserted a balloon pump. The patients hemodynamic status stabilized and she was taken to the cardio-pulmonary ICU in very critical condition. That evening she was taken to the cardiac OR where she underwent four vessel bypass.

Over the next couple of days her cardiac status continued to improve and she was weaned of the balloon pump and all her vaso-active and anti-arrhythmic drips. She began to wake up and show signs of neurologic improvement.

twelve days after she was found dead on the floor at the mall she walked out of our hospital unassisted on the way to a full recovery.

This is why I am an ER nurse.

Happy Nurse's Week everyone.

What the f#$% was she thinking?

noreply@blogger.com (ERnursey) — Tue, 05 May 2009 03:51:00 +0000

I just love Fail Blog. This is priceless.

Swine Flu

noreply@blogger.com (ERnursey) — Thu, 30 Apr 2009 16:20:00 +0000

I don't know about anyone else, I'm starting to feel a little concerned about the very real possibility of a pandemic and what the heck we will do to deal with it. Sure we've had panics before that have amounted to nothing, like bird flu, but this virus is hopping from country to county with frightening speed.

The hospital I work at is running at capacity. The beds are full, the staff is short and it is very common to be out of supplies like blood pressure cuffs or linen. What will we do if there is a surge in patients when we can't even handle our day to day load?

What about us, the caregivers. I am a single parent, as are many of my colleagues. Will I put my family at risk by exposing myself? Will they? Who will care for our families while we care for the sick.

I hope that this turns out to be another case of overblown media hype. But I have to say, I'm a little scared.

I LOVE Failblog

noreply@blogger.com (ERnursey) — Wed, 29 Apr 2009 03:07:00 +0000

see more pwn and owned pictures

noreply@blogger.com (ERnursey) — Wed, 22 Apr 2009 15:21:00 +0000

THIS is horrible, just horrible.

thanks to failblog.com

noreply@blogger.com (ERnursey) — Mon, 20 Apr 2009 03:57:00 +0000

Ahhh, spring in California. You need the heat and the AC both in 1 week. My house was 60 degrees when I woke up two days ago and it was 87 degrees when I got home from work today. Gotta love it.

Warning: A Political Post Follows

noreply@blogger.com (ERnursey) — Sun, 19 Apr 2009 04:00:00 +0000

some other right-wing conservative member of my family sent me this earlier this week. Read it carefully. If you think it is an exaggeration then read this report on where our president is and what he is doing. Where he is NOT is in AMERICA, What he is NOT doing is helping the AMERICAN PEOPLE. What he is doing is giving BILLIONS of dollars to countries that hate us a would laugh while standing on the shore and watching us drown. This has to STOP NOW!!!! Our country is going down the tubes, unemployment is approaching 15%, every neighborhood has been touched by the foreclosure mess and our President is in Venezuela - another country that hates us - making friends with their leftest leader. CHANGE? I don't see any change here. He's digging our financial hole deeper everyday and the only change is he is doing it with a much bigger shovel.

April 16, 2009

Tea Parties about Far More than Taxes

By Kyle-Anne Shiver

Many writers have dubbed the Tax Day Tea Parties as inconsequential, a fad that will die quickly, and of foolish origins that have nothing to do with the American patriots of revolutionary days. Patriots dumped a ship full of tea into Boston Harbor, these folks contend, to protest one thing: taxation without representation. We modern patriots have representation and are therefore insane to protest, or so this line of argument goes.

Folks who believe that the American Revolution was over nothing but taxation -- a penny more for a cup of tea or sugar or any of the other fees and taxes that the British were constantly adding to colonists' backs -- are as dimwitted as was King George in his day. The tea tax may have been the single match that started the fire, but the British had been soaking their American colonies in tyrannical kerosene for a long, long time.

Now, the Tea Parties occurring in the present day may indeed represent a brushfire that quickly extinguishes itself. Only time will tell.

But the message in grassroots Tea Parties today is of exactly the same character as its historical inspiration. The Tea Parties represent a growing anger against encroaching tyranny by a federal government that pays far more heed to billionaire financiers, union bosses, special interest lobbyists, and those on the bottom who pay no income taxes, than it does to all the folks in the middle, who work hard to pay their taxes and all their other bills.

The Tea Parties represent real citizens' anger over watching powerlessly for the past two months as a president, who ran as a moderate to get elected, has taken the fastest, boldest leap to the far left of any president to date. Not only has President Obama upped the ante on the failed policies of FDR and Lyndon Johnson, he has gone on an apology tour of Europe, bowed to a Saudi King, and promised billions more of our hard-earned money to global entities over which we have absolutely no control.

At a time when we Americans in the vast middle write checks to our federal government as we try to balance household budgets already stretched to the max, we read about the Obamas flying in a pizza chef and Michelle hiring her own full-time makeup artist to go with her already full-time hairstylist. We're stunned by a $150-million plus price tag on an inauguration carried out at the same time this president was telling the rest of us we needed to put our "own skin into the game" of saving America from the "worst financial crisis since the Great Depression." We're shocked to see a president using tax dollars to pay for cocktail parties, elaborate entertainment and $100/lb. Japanese steak as he continues his campaigning from the White House.

And we're stuck with a mainstream media complex so in bed with the new administration that they fête us to nonstop commentary on the Obamas' new dog, the swing set on the White House grounds, the organic garden of the new First Lady and the exploits of the first mother in-law. We get stories on Reggie Love, the personal gopher of the president, and how this closest-of-closest intimates to the Commander In Chief, always has Nicorette gum and mints and specialized water for the self-anointed one. We are treated to prime time press conferences galore that are nothing more than scripted campaign stops, complete with pre-selected questioners and not a word spoken by our President without a teleprompting device.

Yet, from these members of the fourth estate, we see next to no interest in this administration's fumbling, bumbling, giveaway foreign policy. We see only the lamest of excuses for the ever-increasing numbers of tax cheats and lobbyists -- handpicked by this "new kind of president" -- filling up the administration. We hear no cries of collusion, even though this president kowtows to labor bosses while he imperiously fires the CEO of GM.

We're told by this same media that we're selfish and rotten if we don't support national healthcare as a new entitlement, and that we're purely fanatical anti-science idiots if we don't support our tax dollars being used to kill babies in the womb and new wave Dr. Megele's experimenting on human beings at embryo stage.

This is the media complex who gives more coverage to a paltry little group of ACORN agitators bussed to an AIG exec's house than it has to the hundreds of genuine grassroots Tea Party protests preceding yesterday's national outpouring. And to top it all off, our own tax dollars go to support the agitating work of the ACORN folks and other leftwing, non-taxpaying groups who believe they are entitled to money they have not earned.

We, in the modern-day Tea Party movement, are being billed by the leftist press as greedy, insane, rightwing zealots who not only hate the poor, the minorities, the women and all the little children, but are now seen as a terrorist threat to homeland security.

Tax Day Tea Parties may merely be the tip of a growing-by-the-day iceberg of anger experienced by millions and millions of Americans who see the overreach of a federal government drunk on its own power. The American people know tyranny when they see it and they see it all around them now, threatening to finally extinguish what little liberty we have remaining.

Kyle-Anne Shiver is an independent journalist and a frequent contributor to American Thinker. She welcomes your comments at kyleanneshiver@gmail.com

It is NOT my job to get you home when you shouldn't have come in the first place.

noreply@blogger.com (ERnursey) — Tue, 14 Apr 2009 02:44:00 +0000

If you called an ambulance for your sniffles it is not my problem how you get home. No, the hospital will not comp you a cab. Sniffles are NOT an emergency and calling an ambulance for your non-emergency and taking the medics away from real emergencies should be punishable by a public flogging. So pardon me if I seem less than sympathetic while you whine about not having a ride and take your ass to the lobby and figure it out.

WTF?

noreply@blogger.com (ERnursey) — Mon, 06 Apr 2009 03:01:00 +0000

I had to look up the phase of the moon today because I could have sworn it was a full moon. I had a total of 18 patients today and, except for 2, they were (In the immortal words of Nurse K) CRAYZEE. Not just crazy but full on, bat-shit crazy. I should have known when the first patient's chief complaint was 'heart worms.' Yep, you got it. Heart worms, like a dog or cat gets. And she had been suffering from them for four years and no one would believe her. Um hum. Well, add us to the list of non-believers.

well, tomorrow is another day.

noreply@blogger.com (ERnursey) — Thu, 02 Apr 2009 03:31:00 +0000

OK, I have another question.

How do people that have never worked and exist on welfare manage to have $10,000 dollars worth of tattoos?

I hope they're kidding

noreply@blogger.com (ERnursey) — Mon, 30 Mar 2009 03:43:00 +0000

I was taking my sleeping pill this morning getting ready to go to bed when i happened to look at the side of the bottle and saw a warning sticker that read:

'CAUTION: MAY CAUSE DROWSINESS.'

May?

I would hope so, since it is a sleeping pill. What were they thinking when they pasted that label on the bottle?

Boarding Patients in the ER - another voice

noreply@blogger.com (ERnursey) — Thu, 26 Feb 2009 16:32:00 +0000

Last year I posted about the annual winter surge in patient volume that leads to us holding in-patients for hours or days in our ER which leads to longer and longer wait times for the ER patients due to reduced space to see them. I was frustrated at the lack of planning for the surge despite the fact that it happens without fail EVERY SINGLE YEAR.

Here's a comment from an anonymous reader on the same subject:

I have worked for the same system for nearly 15 years. Our census doubles in the winter time. This happens every year without fail. Come winter we are forced to hold anywhere from 15-30 admitted pt's in the er because "there are absolutely no beds upstairs, sorry". As a result, there becomes no place to see er pt's , pt's in the lobby wait hours (sometimes 9-10), ambulance offloads are extended 1-2 hour waits unless they are a priority 1, any ambulance that can go out to the lobby (even the ones I would normally not have sent to triage)will go out to the lobby. admitted pt's may or maynot get a hospital bed to lay on instead of a stretcher-let alone a tv or a phone for diversion, admitted pt may miss a couple of meals while they are there and hopefully all of their orders are being implemented cause as any ER nurse knows, It is very difficult to be in both modes of nursing at the same time. In the meantime, EMS shift commander is calling and screaming at me that their medics are still sitting in my ER waiting to offload-can't blame them- if all the medics are sitting in our ER's -how can they respond to 911 calls. Pt's and family members of the people sitting in the lobby are angry because their poor 91 year old mother can't sit out there for 6 hours-can't blame them either. I wouldn't wait 6 hours for anything.
So, I ask you this- if we know the hospital is inevitably going to explode like this at the same time every year-why doesn't the hospital ever plan ahead? Is it neccessary that somebody should die first and we should have some major lawsuits before it becomes a real issue? Oh wait , that's already happened and I don't think anybody cared. I have made suggestions in the past of things we can do in our ER to keep some of the flow going, but because they never have enough staff it is impossible to even do this. In my opinion, The problem starts with administration who is either really ignorant to the fact that this issue impacts everybody, the floors who are constantly at capacity, the ER who way over capacity and now very long waits to see a dr, the admitted pt's who are forced to stay in a very noisey environment and probably not being taken care of well as they could be,EMS who has no place to bring their pt's to and the community who can't seem to get any medical attention without spending an entire day at the hospital.
This will probably be my last year as the charge nurse. I want to be able to not care and be frustrated by this another year. I feel that if the hospital administrators put their heads together, they can come up with a solution. And yes it will have to cost money but if we are the only hospital in this county to serve the community, then they will have to suck it up and invest in itself.
On top of all this, the hospital just built a unit (approx 20 beds)to lease out to another company. Under the circumstances, that would have been a perfect place to board these pt's.

What Next?

noreply@blogger.com (ERnursey) — Thu, 19 Feb 2009 00:41:00 +0000

Hospital administration announced today that along with all our other duties in the ER we will now have to fill out a new form for the documentation of wounds as well as photograph any little ditzles that the patient may have.

Now I realize with the incredibly stupid new reg's that deny payment for wounds acquired while in the hospital it is necessary to do a thorough documentation of the patients skin BUT, since our ER sees approximately 200 patients a day and admits around 50 of them on average and since it takes about 1/2 hour to fill out the assessment form and photograph and print pictures it will take 25 hours of nursing time a day to do this on top of the job we are already doing that we are already understaffed to do.

Yesterday out of my assignment I admitted 8 patients, that would be close to 4 hours of wound assessment and documentation. That is 4 hours that I won't be starting IV's, doing EKG's, giving medications, drawing lab's or any of the other thousands of things I do every day. What is that going to do to the flow in our ER that is already functioning well over capacity. What will the effect be on the LWOBs as well as diversion times? Our average LOS for an admitted patient is already a ridiculous 5.34 hours - now we are going to add 30 more minutes on top of that? Ridiculous. On the other hand, the floor nurse may only get one or two admits during their shift. So who on earth would think it would make sense for the ER nurses to do this stuff?

Oh yeah, right. someone who has never worked in the ER. Duh.

What are your facilities doing?

The Answer to California's Budget Deficit

noreply@blogger.com (ERnursey) — Fri, 13 Feb 2009 00:39:00 +0000

Good news to all of us in California. The governator has come up with a plan to solve the budget crisis. He's gonna tax the shit out of us.

Seriously.

He is proposing an increase in personal state income taxes, sales taxes and gasoline taxes (our gas prices are already among the highest in the nation.)

He is forcing state workers to take two unpaid days a month.

AND, as a bonus, we get to look forward to an IOU instead of a state tax refund this year. Just fucking fabulous.

Maybe we'll get lucky and have that big earthquake and fall into the ocean.

Why ER nurses get burnout

noreply@blogger.com (ERnursey) — Tue, 20 Jan 2009 03:22:00 +0000

20 year old female with right lower quadrant abdominal pain arrives at 0852. She thinks she has a urinary tract infection. She is afebrile, denies nausea or vomiting, has normal BM's. Her other vital signs are normal and she rates her pain 5/10.

Patient is triaged, put in room, urine and labs obtained prior to the physician seeing the patient. The urinalysis is sent for testing and a pregnancy test per protocol.

MD sees the patient one hour after she is put in the room, the urine results have been on the chart for 30 minutes showing blood and leukocytes in the urine. The pregnancy test is negative.

MD takes 45 minutes to get around to putting orders in on the patient after coming out of the room, the patient has been in the department for almost 2 hours.

1 hour later the lab work is back and the chart is flagged for recheck.

45 minutes later after being asked several times the MD goes in to recheck the patient.

A pelvic US is ordered because the patient has a history of ovarian cysts and RLQ abdominal pain.

It is the weekend and the tech has to come in from home which takes around 40 minutes.

An hour later, after 4 calls by the nurse the radiologist has finally read the US and faxed the results to the ER. The US is negative. The chart is flagged for recheck.

The MD goes in to see the patient, comes out and orders a CT scan, appy protocol an IV, a bolus of NS, IV pain and nausea med's.

CT is backed up because of a trauma patient so it takes well over an hour for her to be taken to the test.

An hour later the CT results are back and the chart is once again flagged for recheck.

Ultimately the patient is discharged home after spending most of a twelve-hour shift in the ER. Diagnosis? Pyelonephritis, which is what she thought she had when she arrived.

Multiply this by 31 rooms and add in a waiting room full of angry, sick people who have been waiting for hours for a room - stir into that a couple traumas, a few mental health patients as well as angry patients and their family members and you can see why we get burned out.

noreply@blogger.com (ERnursey) — Mon, 19 Jan 2009 03:31:00 +0000

AHEM. Dr. Big Workup, in an effort to help you distinguish between the hopeless, chronic drunk who needs a night in the drunk tank and the patient that needs a CT, ECHO, multiple labs, cath urine, EKG, etc. etc. I present:

The Leap non-severity scale.

Please feel free to use it and quit wasting everyone's time!

noreply@blogger.com (ERnursey) — Sat, 17 Jan 2009 03:01:00 +0000

Stunning post by Aggravated Doc Surg:

The Four Horsemen of a Trauma Death