THis started out as a reply to a comment from the previous post…who covers the ER when I get called to a code (sorry about all the typos, I got a new keyboard that S U C K S):

Graham, It happened last night (weekend, night shift, floor codes, ER tanking). The senior FP resident is supposed to cover the ER when we get called away. last night I was finishing up a code in teh CCU, when the respiratory therapist got a phone call, informed me that there was a severe asthmatic in the Er needing treatment. Umm…hello, YOU are the therapist, shoudn’t you be running down there with me???

When I got downstairs, teh FP resident was sitting around the side where the resident’s admit from, nobody knew she was there, she didn’t ask if she could help, and the asthmatic patient was close to needing tubed herself.

i came close to givingg her epi just because the respiratory therapist was nowhere to be found. It was only because we have an incredible and motivated ER Technician, who is a paramedic STUDENT, who dug up albuterol from our ER and gave it to a brand new graduate nurse who is also a paramedic, and HE got the albuterol started.

There is otherwise no protocol in our ER for the nurse to start albuterol treatments.

It was a sucky night, my busiest night ever in terms of acuity. I think I saw about 36 patients, several critical, one flown out, one intubated, PLUS two codes on the floor. AT 6:20 AM I had another critical patient arrive. I mentioned ot the RT that he’d likely need BIPAP set up, and he actually said to me, “That will have to wait for morning shift.” I was apalled. All I would like to do is work in a place with competent staff. When the ER Technician/paramedic student is the most competent person I am working with, that’s really scarey. Someone could have easily died last night while my back was turned for just a second because we had only two nurses to cover all those patients.

My only savingg grace is that all my orders are timed…when the blood bank delivers blood before the nurse has even been back place an NG tube in teh GI bleeder, that’s scarey. It’s not the nurses fault, it’s the staffing. From 3-6AM the nurse supervisor actually worked in teh ER with us. it was great because she got to see us run a code, intubate a patient (with the student medic and the nurse-medic) and get her an ICU bed and out of the ER within about 30 minutes of her arrival. The Supervisor got to see how and why the ER can get overwhelmed in an instant.

BREATHE. <-- Perhaps it will be my epitaph.