Too Much Information, Too Little Time! (The First 90 Minutes of a Busy Afternoon) : Emergency Medicine News

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Too Much Information, Too Little Time! (The First 90 Minutes of a Busy Afternoon)

Leap, Edwin MD

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Emergency Medicine News 29(10):p 11-12, October 2007. | DOI: 10.1097/01.EEM.0000296565.26423.97

    Partner: Glad to see you! It's been a crazy day. Can I leave you a couple of patients? Great! In bed 5 is a lady from some nursing home who has COPD. She just got here by ambulance, and I started on her, but the nurses pulled me to 10 for the cardiac arrest. I'll finish the paperwork because we couldn't get him back. No family, not that we've seen yet. He was on the golf course when it happened, and his driver's license is out-of-state. Oh, bed 5, well, she may have pneumonia, but I'm not sure yet because X-ray hasn't done her film yet. And she was in the hospital last week with C. diff. She's vomiting now but no chest pain. Her family says her internist is out of town, so if you admit her she'll go to the hospitalist. Anyway, bed 19 is psychotic, or hyponatremic, but she's 88 years old and hallucinating and weak. Labs aren't back yet. Cool? Great, I'll finish the death certificate on 5. I mean 10. Five isn't dead yet, I hope! By the way, I haven't been to 18 yet. He has cellulitis, the nurses tell me. Couldn't get in there and finish up everything else.

    Nurse 1: Doc, listen, the kid in 12 just got here, and he's 18 months and puking, and seems a little short of breath to me. He was in the hospital last week with something; vomiting and diarrhea, I guess. His pediatrician called, and probably he'll be admitted, but he wanted you to check the kid out first. He's pretty dry. Mind if I slip a line in and order a nebulizer?

    Nurse 2: Hey, bed 5 is more short of breath, and needs another neb. And her sodium is 110. Fine, I'll give her a small saline bolus. You're coming now, right?

    Nurse 1: You need to see the kid, don't forget, but I'll get the line in and start the fluid.

    Charge nurse: Help! We're pretty full, and we can't get the supervisor to assign beds. Will you talk to her? And there's a lady on the phone who was here last night, and she's mad about the antibiotic she got because it costs too much. And she says you or somebody was rude to her. I tried, but she wants to talk to you! Oh, she's allergic to almost everything, but takes about 12 meds every day.

    Nurse 3: I know you're busy, but in 15 there's a guy with a kidney stone. He's allergic to morphine, but he can take Demerol. Can I give him something till you get there? I know him. He was here a few days ago with a stone. Or maybe with pyelo, I can't remember. But it was real. Thanks! I'll tell him you're on the way.

    Partner: All done. I'm out of here. I guess the coroner will contact that guy's family. Thanks!


    Medic, on radio: Doc, this is a 16-year-old girl with abdominal pain and a missed period. She's a little shocky, so I started some fluid. She hasn't had any pain meds, so we're coming lights and sirens. If her pressure gets up, can I give her some morphine? She's allergic to Demerol. Great. Medic 3 clear.

    Registration clerk: The wife of the cardiac arrest patient is here. She thinks he's had a heart attack, and wants to see him. The supervisor said to put her in the conference room. Can you talk to her?

    Nurse 1: Hey, there's a lady looking around for her husband, and I think he's the arrest. You need to talk to her now.

    Nurse 2: Listen, that sodium wasn't on bed 5; it was on bed 19. Bed 5 got more short of breath after the fluid you ordered. Yeah, I know you got the wrong labs. Sorry. I'm afraid she's getting wet. You want to check her?

    Nurse 3: I'm covering the sick child. His dad is really mad that you haven't seen him yet. Can you come for a minute?

    Medic, rolling through door: Doc, I need you here right now. This girl with the belly? She crashed at the door. Pale, diaphoretic, unconscious. I need you! Looks like she's having some vaginal bleeding!

    Nurse 3, in resuscitation room: Boss, chest pain just hit the door in 11! Looks pretty real. I know you're tied up, but as soon as you can get here, I need you. Wow! This one looks sick. You need surgery or something?

    Nurse 2: That baby is sicker. He's struggling. We called his doc because you're busy, but he says for you to see him because he's got office still, and isn't actually on call.

    Nurse 4: The lady in 18 with the cellulitis! She's seizing! Oh, yeah, the lady in 19 is seizing. You want her to have some saline? I guess it's because her sodium is 110. The guy with the cellulitis wants to sign out; he says he's waited too long. I'll tell him you're otherwise engaged, OK? Well, sure, I'll try to stall him till you get here.

    Charge nurse: You need to go to 5. She needs to be intubated. But she may have a DNR. Nobody knows for sure. I have a phone number for her son in Phoenix. Want to talk to him? We need you to talk to him if she's a true no code. And there's a new patient from a minor MVC in room 8. But I think he has a bad ankle. We ordered an x-ray. Can I give some pain medicine? He's allergic to morphine and Demerol but not Dilaudid.

    Unit secretary: You want an EKG in 11? The tech is here, but needs you to give a verbal. She won't believe me, and the guy isn't in the computer. Fine! You don't have to yell! Sure, I'll get gyn for you.

    Nurse 2: Hey, the wife of bed 10 just walked in and saw her dead husband. Did you ever talk to her? She passed out on the floor. She's pretty cool and clammy. I'm starting a line. Her daughter is on the phone and is really upset.

    Nurse 4: Kidney stone in 15 is having hives all over after the Demerol. He says maybe it was Dilaudid he was allergic to. His pain is still a 10. How about some Benadryl?

    Nurse 3: About your chest pain in 11, I know you're busy, but you need to come in here. He has tombstones all over his EKG. “No sir, I don't mean you need a tombstone. It's just an expression about your…just a minute!” Go see him, chop, chop!

    Secretary: Gyn is tied up in surgery. They want to know about the pregnancy test. You put it in, but it's not back. They say to call general surgery if you need someone right now. What? Cardiology? I'll get them now.

    Nurse 2: Stool is heme negative in 5. Also, incidentally in 12, the dad seems better now that you went in. I'll get a bed for him on peds if you want. He still looks pukey. Turns out he had Rotavirus recently, but was a really early preemie. Oh, his sodium is 155, and his CO2 is 12. Another bolus? Sure.

    Nurse 3: I'll get the TNK after you do the rectal. No, I didn't check stool. That was another patient that was heme negative, I guess. By the way, can this guy have some Stadol while we start the nitroglycerine? He's allergic to morphine, Demerol, and Dilaudid. Oh, and he's on Coumadin; you knew that, right?

    Altogether (it seems): He has chest pain, she has vomiting, she's seizing, he's struggling, she's dying, he's dead, they don't want anything done, they want everything done! Everyone's white count is 15. More abdominal pain, more syncope. Angry lady on the phone. Angry consultant on the phone. No beds, no time, no history, no information. Hurry to the next one, hurry to the last one. No one else can help, no one else is available. Surgeon is in surgery, family is in conference room, wrong allergy list, wrong medicine ordered on computer, pharmacist says he filled 200 Lortab yesterday! Daughter on the phone, son on the phone, wife on the phone…your wife, I mean!

    Kidney stone still hurts, hospitalist says don't get a bed yet, he may send her home. Child looks terrible, may need to be intubated. Dead man's wife needs to talk. Depressed man needs psychiatric help. MI has v-fib, so hurry! Doctor to room 10 stat, doctor to room 9 stat, doctor to phone stat, doctor to EMS radio stat. Multi-trauma to room 13, fall from height to room 7, ortho wants you to check on a patient, family doc wants you to pronounce one dead, urgent care sending you an asthma, student health sending you what may be malaria, wife still holding on the phone.

    Too much information, too little time, too little doctor.

    © 2007 Lippincott Williams & Wilkins, Inc.