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The following statements were found on patient's charts during a recent review of medical records. These statements were written by various health care professionals:
"The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately."
"The skin was moist and dry."
"The patient had waffles for breakfast and anorexia for lunch."
"I saw your patient today, who is still under our car for physical therapy."
"The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week."
"The patient was to have a bowel resection. However, he took a job as stockbroker instead."
"When she fainted, her eyes rolled around the room."
"By the time he was admitted, his rapid heart had stopped and he was feeling better."
"Patient has chest pain if she lies on her left side for over a year."
"On the second day knee was better; on the third day it had completely disappeared."
"Patient was released to outpatient department without dressing."
"The patient is tearful and crying constantly. She also appears to be depressed."
"Discharge status: Alive but without permission. Patient needs disposition; therefore we will get Dr. Blank to dispose of him."
"Healthy-appearing, decrepit 69 year old male, mentally alert but forgetful."
"The patient refused an autopsy."
"The patient has no past history of suicides."
"The patient expired on the floor uneventfully."
"Patient has left his white blood cells at another hospital."
"Patient was seen in consultation by Dr. Blank, who felt we should sit on the abdomen and I agree."
"Patient has two teenage children, but no other abnormalities."
"Patient's history is insignificant with only a 40 pound weight gain in the past 3 days."
"The patient left the hospital feeling much better except for her original complaints."
"She is numb from her toes down."
"While in the ER, she was examined, X-rated and sent home."
"Occasional, constant, infrequent headaches."
"Patient was alert and unresponsive."
You Might Be an ER Nurse If.....
You consider a tongue depressor an eating utensil.
You have ever tried to identify what a patient ate last by examining the barf on your shoes.
You knock before entering a room, knowing full well the only patient in there is the one that just died!
You've ever basted your Thanksgiving turkey with a Toomey syringe!
You're at the grocery store, look down and notice you have at least 2 body fluids on you shoes and it doesn't bother you.
You refer to idiot patients as CNS-QNS [central nervous system - quantity not sufficient].
When asked, "Are you the nurse on tonight?" You want to respond, "No, I just like dressing up as a nurse and hanging around because I have nothing better to do!"
You've ever had a patient whose positive pregnancy test prompts her to call the next day and ask if you can tell who the father is?
You've ever rolled your eyes when the 14 year-old says, "No, I've never had sex"?
You've ever told a confused patient your name was that of your co-worker and to HOLLER if they need help?
You've ever passed on the green stuff at the buffet because you are certain you suctioned it from a patient earlier?
You know it's a full moon without having to look at the sky.
You've developed a crease between your brows from trying NOT to inhale the various human secretions you've encountered over the years.
Eating microwave popcorn out of a clean bedpan is perfectly natural.
You've been exposed to so many x-rays that you consider it a form of birth control.
Your bladder can expand to the same size as a Winnebago's water tank.
Your shoes have been seized and quarantined by either the Centers for Disease Control, OSHA, the EPA or the Nuclear Regulatory Commission.
You believe Tylenol, Advil, or Excedrin provides a large part of your daily calorie intake requirements.
You think that Prom tickets should have coupons good for one free gastric lavage.
If the hems of your scrub pants are held in with 3.0 suture, steri-strips or rubber bands.
You avoid unhealthy looking COPDers in the mall for fear that they'll drop near you and you'll have to do CPR on your day off.
You've ever pretended to sneeze and at the same time thrown KY jelly on a co-workers sleeve to make them think they got shot with a hocker.
You've ever held a 14-gauge needle over someone's vein and said, "Now your going to feel a little stick."
You've ever sworn your going to have "NO CODE" tattooed to your chest.
You can identify the 'PID Shuffle" and the "Kidney Stone Squirm" at 15 feet.
You've ever had to contend with someone who thinks constipation for 4 hours is an emergency.
You've ever listed a patient's chief complaint as "I'm drunk".
You refer to motorcyclists as organ donors.
You've ever had a patient with a nose ring, a brow ring and twelve ear rings say, "I'm afraid of shots."
You stare at someone in utter disbelief when they actually cover their mouth to cough.
You've ever thought, "As long as he's got a pulse, I don't care about the rhythm".
You've ever referred to a body bag as a "to go" bag.
Your personal triage categories are: Emergent, Urgent, Non-Emergent and Sleeping it Off.
You don't ask "frequent flyers" their history, you know it by heart.
You can keep a straight face when a patient responds, "Just two beers."
You develop Carpal Tunnel Syndrome from constantly locking and unlocking the Narcotic Cabinet.
You hold on to the bed rails during a defibrillation, just to have something to do on the night shift.
A trained physician can't recognize the proper anatomy of a female for a catheter, but you get it on the first try.
You believe that all bleeding stops...eventually.
You shock someone with an unrecognizable rhythm...until you get one you DO recognize.
Your idea of a meal break is finishing your coffee before it gets cold
You've ever bet on someone's blood alcohol level
Discussing dismemberment over a meal seems perfectly normal
You believe in the aerial spraying of Prozac
Your idea of comforting a child includes placing them in a papoose restraint
You have encouraged obnoxious patients to sign out AMA so you don't have to deal with them any longer
You believe the government should require a permit to reproduce
You plan your next meal while performing gastric lavage
You believe unspeakable evils will befall you if the word 'quiet' is uttered
You have used the phrase 'health care reform' to terrify your co-workers
You believe every waiting room should have a Valium salt lick
You know the local detox center number by heart
You have handled several 'lost condom' cases
You have had to leave the patient before you began to laugh uncontrollably
Your idea of fine dining is sitting down to eat
You believe chocolate is a food group
You believe a good tape job will fix anything
You get an almost irresistible urge to stand and wolf down your food, even in the nicest restaurants
Your idea of a good time is a Code Blue at shift change
You firmly believe that if Dilantin, Haldol and Librium were put in the water instead of fluoride, Dentists would be busier, but Nursing would grind to a halt
You don't believe 90% of what you're told, and 75% of what you see
You have your weekends off planned a year in advance
You believe that "shallow gene pool" should be a recognized medical diagnosis
You have discovered a new condition called "Hypo-Xanax-emia"
You take it as a compliment when someone calls you a dirty name
You say to yourself, "Great veins!" when looking at complete strangers at the grocery store
You refer to someone in severe respiratory distress as a "Smurf"
Your idea of a good time is dueling shock rooms
You've ever had a patient look you dead in the eye and say, "I don't know how that got stuck in there"
You have ever wanted to reply yes when someone calls the ER and asks "Is my (husband, wife, mother, etc....) there?"
You have ever restrained someone...and it wasn't a sexual experience
You believe a "Supreme Being" consult is your patient's only hope
You have ever had a patient say, "I'm not pregnant, I can't be pregnant! I can't be having a baby!"
You have ever had a patient control his seizures when offered food
Your feet are slightly fatter and tougher than Fred Flintstones
Your immune system is well developed that it has been know to attack and kill squirrels in the backyard
You have recurrent nightmares of being hit and run over by the portable x-ray machine
You call tell the difference between a Doctor's Order and the ground around a chicken farm
You call burn victims "crispy critters"
You call subcutaneous emphysema "Rice Krispies"
Your diet consists of food that has gone through more processing than most computers
You have referred to someone's death as a transfer to the eternal care unit
Your favorite hallucinogenic is exhaustion
You think caffeine should be available in I.V. form
Your most common assessment question is "what changed tonight to make it an emergency after 6 (hours, days, weeks, months, years)?"
You have witnessed the charge nurse muttering down the hallway, "Who's in charge of this mess anyway?"
DEALING WITH INSURANCE COMPANIES - OH THE WOES OF HMO'S!
Q. Do all diagnostic procedures require pre-certification?
A. No. Only those you need.
Q. Well, can I get coverage for my pre-existing conditions?
A. Certainly, as long as they don't require any treatment.
Q. What happens if I want to try alternative forms of medicine?
A. You'll need to find alternative forms of payment.
Emergency Medical Services
(Stupid) Frequently Asked Questions with Answers!
Q. Do you need to go to school for this or can anyone do it?
A. You have to go to school, it is long and hard, and most of the people involved like to abuse the hell out of you while you are doing it.
Q. Do you have anyone (like maybe a patient) in the in the back of your ambulance right now ?(asked while we are sitting in the unit eating lunch in the parking lot of Doug's Bar B Q)
A. No patients. Only the Paramedic Student; don't bug him, he's a stress case and might crack.
Q. Can I have bus fare to get to the hospital?
A. Yes, if it means you won't take an emergency rescue vehicle out of service so you can get to a routine appointment for your toothache and if you promise to quit bugging me.
Q. How long have you been doing this (asked by a recently hired rookie Paramedic)?
A. Let me figure it out. Since you were in second grade, partner.
Q. Can me and my four kids ride in the back with my boyfriend to the hospital?
Q. Can I ride up front on the way to hospital?
A. Maybe, if I like you and think you wont bug my partner in the back.
Q. How fast will your ambulance go?
A. I don't pay that close of attention, faster than my employer would be comfortable with, most likely.
Q. Is he going to make it?!! Is he going to make it?!! (asked in reference to a patient who puked after too many 40 ounce bottles of Old English 800 Malt Liquor).
A. Yes, I am sure that in spite of our best efforts, he will survive.
Q. Can I have a band-aid?
A. This is an ambulance, our band-aids are 8 inches x 6 inches. How many do you need?
Q. What happened? (at an minor fender-bender auto accident).
A. Plane crash!
Q. What happened? (outide of a house where a person was having shortness of breath).
A. Plane crash!
Q. What happened? (at a plane crash)
A. Shark attack!
Q. What does EMT stand for?
A. Every Menial Task, Eggcrate Mattress Technician
Q. What is the worst thing you have ever seen?
A. A 12 gauge shotgun blast to the left side of a woman's face that didn't kill her, so she was writhing on the floor and trying to scream through the blood running out of her mouth with a good part of her face missing. Either that or it was the 6 month old baby who died because his drugged out parents left him on the floor heater grate until he was so cooked that the flesh of his fingers split away from the bones. Now aren't you sorry you asked?
Q. Why did you bring the patient here?
A. I guess the sign out front that says "Emergency Department; Physician on duty" fooled me into thinking that this was a hospital that treated patients!
Q. Do you think the patient can be triaged to the lobby?
A. Since they demanded transport for a refill on their prescription I am sure that the lobby is more than an appropriate place for them to go. Unless you can triage them to the parking lot or the nearest bus stop.
Q. What are the patients bowel sounds? (On a critical 'auto vs. tree' patient).
A. Since we were on the side of the freeway and now are enroute to the hospital the bowel sounds pretty much resemble a diesel engine.
Q. What's the patient's name? What's the patient's name?!! (on a cardiac arrest victim).
A. I don't know, I asked him four times after he coded and he wouldn't answer me once!
Q. What are the vitals? (Different Nurse, same code).
A. If we're doing CPR right he should have a pulse rate of 80-100/min, 24 respirations/min, and a blood pressure of maybe 40 systolic.
Q. Can the patient sign the insurance and permission forms?
A. Only if they use your pen.
Q. (On the radio) Are you sure she's in ventricular tachycardia? The complexes are rapid and wide not narrow, right?
A. Uh, yeah I'm sure it's V-tach, we covered this rhythm in some detail in Paramedic school. Is this a pop quiz?
Q. Is he dead? (Fire Captian).
A. What tipped you off? The dependant lividity, the rigor mortis, or maybe the ants crawling in and out of his nose?
Q. Why can't you hold over for a few hours this morning? (Management).
A. Why not? I've only been awake for 26 hours straight and been puked on twice, I think it is safe to say I would rather floss my teeth with barbed wire.
Q. Can you guys hear the siren when it's on while you are in the cab of your ambulance?
A. What?! You will have to speak up I can't hear you from all the years of listening to the siren inside this ambulance.
EMS (Stupid) Frequently Asked Questions with Answers, copyright 1996 by Jerry Fandel.
Top Ten Reasons to Go to Nursing School
10. The Kreb's Citric Acid Cycle
9. Learn a little Greek and Latin
8. Body fluids
7. Practice self-diagnosis in psych class
6. Drug math
5. Get to know exotic microorganisms (that can kill you)
4. Meet your friend, the NCLEX
3. Find out how surprisingly well you do with very little sleep
2. Get to wear your favorite color: white
and the number one reason to go to nursing school...
1. Two words: Care Plans!
Martin Schiavenato, RN
Nursing At Clinical Speed
Thanks to Martin Schiavenato for this hilarious top 10 list! Check out Martin's publishing company, Bandido Books, for some of the best clinical guides on the market, including the Quick-E series of clinical pocket reference books by specialty (see our Book Shop for our review of the Quick-E Critical Care Clinical Nursing Reference Book).