Emergency Room- February 6th, 2015

Report

What were you're responsibilities or duties this week?

   My responsibilities this week included professionalism, soft skills, and knowing my boundaries. I was to assist the nurses and technicians I followed, without touching the patient and knowing my limit of knowledge in the hospital. I also was required to enforce federal law, even though it went against the nurse's opinion. 

What new knowledge or skill did you learn this week?

   I learned a lot about CPR, including by the third compression the ribs should be broken (if you're doing CPR right) and the depth of the compression will differ from body masses. I also learned medical terminology and new medical documenting.

What is the best thing that happened at the unpaid work-based learning site this week?

    I got to see a full code! The whole thing! One of the coolest things I've ever seen in my life, along with one of the most real things. It was definitely an eye opener. 

What was the worst thing that happened at the unpaid work-based learning site this week?

   For the first few minutes of the rotation, it was pretty slow, then my instructor came in and kind of got the staff aware that I wanted to learn. From there it was pretty minor stuff, like putting in an IV. It escalated as time went on. 

If the "worst" was a mistake, how was it corrected?

   I probably should have been more prominent with staff. Ask questions to the nurses and have more a voice in the beginning. 

This week was: GOOD. Why?

   The code blue was literally such an eye opener for me. I finally got see why these people do what the do. The rush. The need to help. It was a good change from not seeing much to seeing why medical professionals get that drive and passion to help. 

Record

Technology observed: The E.R. uses an electronic way of charting, where all the room numbers, patients, age, and C.C. is stated on a huge screen in front of the nurse's station. I'm guessing it's computerized because of how come and go the patients are in the E.R. 
Diagnostic Procedures observed: Vital signs for a stroke patient and the code patient were taken with a vitals machine. Triage of two patients, who were both elderly men, were also used.
Therapeutic Procedures observed: Soft skills were at an extreme high during the code blue because of the wife, kids, and brother freaking out, understandably. CPR, med distribution, ultrasound, and sanitation of equipment were observed as well.
Diseases/disorders observed: The code patient was have said to have a P.E. (Pulmonary Embolism), which is a clot in the lungs, so they tried to put "unblockers" in? I can't remember the exact same of the medicine, but it was used to help break up the clot because they thought it might help.
Medical terminology/abbreviations observed: I was introduced to P.E., which is a pulmonary embolism, as well as MONA, which is morphine, oxygen, nitrogen, and aspirin. Also, C.C. (Chief Complaint), DNR (Do Not Resuscitate) and CPR (cardiopulmonary resuscitation) was used.
Other: I got to see some of the EMT equipment including the full touch screen computer that is on the back of the bed, where the patients head would be which I thought was really neat. The surgeon who was in the room with the code was well was really informational as well. He explained a lot of what was going on and why they were doing certain things like unblocking the clot, shifting between compressions, and monitoring vitals.

Journal 

    The E.R. was surprisingly really quiet and calm and a lot of the staff was hanging out, making jokes. The equipment is very advanced with charting (they use a huge computerized screen) and med. cabinets and organization. The Emergency Room is very active because almost all the patients they receive are last minute, which means all the decisions the nurses and staff makes are last minute. When I was there, I got to see treatment of a women with chest pain in which they just treated with an IV, which to be honest, was sort of lame. Stroke of an elderly man who was said to be weaker on the right side of his body was handled. The man seemed very tense, very shaky, and very unaware of what was going on. A code blue patient was handled with CPR, ultrasound, soft skills, and triage. 

    The staff was super unresponsive for the first few minutes I was in there; they push me off with a technician, not a nurse, and she left within 30 seconds of me being with her. My instructor had to come in and give a little push to the staff, which made them kind of aware that I wasn't here to just stand around and sit in the nurse's station when I could be learning. I noticed they were kind of slow to respond... The stroke patient came in and literally waited with the EMTs for 5 minutes before any of the nurses did anything, which was super weird. Then when the code patient came in, the nurses had just cleared a room and like left the patient in the hallway which probably wasn't the best way to handle the situation, but I understand because of panic. All safety procedures were followed, gloves and all. Communication was astonishing, especially during the code. They were all talking to each other and made sure everyone knew what was going on. Red alarm kind of triggered in my mind when they then asked me to do compressions (which is against the law because I'm a minor in a hospital) but then went as far as calling my instructor. When told no, the nurse then got almost offended. 

    Another red flag was the casual conversation that was happening when the code came in. I kid you not these nurses were doing CPR and talking about what they were going to do later that weekend. This man is on the brink of dying and they were acting as if this was no big deal at all. It might be because they're almost used to it due to being in the E.R. and death is just a normal thing to see, but I would think they would at least be respectful of the idea that this man was a father and husband and his family was right outside of the room. The professionalism in that room was so sad. My instructor preaches about professionalism and how we act, but I swear if she were to see them in that room, she would have thought we were the walking epitome of professional.

    I learned more than I ever have in any other rotation while in the Emergency room. Morally, I learned that you have to be able to see other's stand points on decisions and reactions.  Families and friends of these patients are relying on you to help, at the end of the day, you're not the one whose about to lose a loved one; they are. I learned a lot about CPR skills with depth range and how you know if you're doing it correctly, along with that, I also learned the stubbornness of nurses is insane. I learned two new med terms; P.E. and MONA.. which was helpful. The terms gave me a better idea of what was happening in the E.R. 

    Favorite rotation; hands down. Who else gets to say that they watched a full code blue while in one of the highest rated hospitals in Texas? It made me realize why I want to be in the medical industry so bad. It's the rush and the passion and drive to help others. You become the patients number one supporter, and you're cheering them on every step of the way because it's their life in your hands. Professionally, the E.R. taught me what not to do. Example? Don't talk about wanting new shoes and how your boyfriend is being an idiot while a man is on his death bed. Don't call a student's instructor when the student has told you multiple times that they're strictly observational. DON'T ASK A STUDENT TO BREAK FEDERAL LAW BECAUSE YOU THINK IT WILL BE A GREAT LEARNING AND PRACTICE EXPERIENCE. I gain a ton of new information about last minute decisions while I was in E.R. which I think will help me a lot in athletic training and lifeguarding.