My vagina has a fever?

Recently we had an 18 year old girl on our unit for a few days after her open-heart surgery. Long story short, she was mixing her drugs with some not-so-sanitary things (pond water, among other things...) and shooting those up. As anyone with a shred of foresight could imagine, pond water does not belong in the circulatory system, and she developed massive bacteremia. She ultimately became super septic and developed lots of fun things like septic emboli to her brain, spleen and lungs; vegetations on ALL FOUR of her heart valves; and acute kidney injury.

I met her after getting all of her valves fixed. Amazingly, she came through the surgery beautifully. Because she had all of her valves intervened upon (two repairs and two replacements), she was on pump quite a long time. The combination of her massive amounts of narcotics we had to give her and her probable pump head made her a little weird.

Her only complaint after surgery? "My vagina has a fever." Not kidding. She was afebrile, had no rashes or anything weird down there. But she was adament that her vagina was too hot. She insisted on laying in bed, spread eagle, with a fan pointed directly at her vagina. Pulling her gown down over her lap increased the temperature, so she kept it pulled up to her waist. And she had a basin of ice water that we had to keep refilling that she would dip a washcloth in and wet the area almost constantly.

It was a little awkward. She had a young, male nurse. He thought it was awkward. Her mother thought it was awkward. Her father thought it was really awkward. She did not think it was awkward.

This lasted for two days.

Facebook, you don't know me at all

You know how Facebook (and all sorts of other sites) tailors their ads to individuals? Like, you google "Hawaii" and then you start seeing ads for hotels on Waikiki? Well, Facebook loves to give me ads for nursing and EMS related things, probably because those are listed as my professions on my profile. Usually I get things like scrubs, stethoscopes, steel-toed boots, etc. Recently though, I've been getting a lot of ads for nursing/EMS clothing.

These clothes are so cutesy and obnoxious and unprofessional and frankly embarassing. So then I started googling to see if these kind of things were common. They are. 

A sample: 

 

 

I mean really... who wears this shit??  For future reference, Facebook and your advertisers, not me! 

 PS: The parents wearing "My daughter is a paramedic" thongs, we've progressed to a whole 'nother issue I think...

You never really had chest pain did you...?

Communications: "Medic 14, you're going to Restaurant-Across-The-Street-From-The-ER for 45 year old male with chest pain."

...drive, sirens, etc...

Me: "Hello sir, what's going on tonight?"

Mr. Iwannamorphine: "Oh honey, got some bad chest pain."

...dramatically get into the amubulance...

Me: "Tell me about this chest pain."

Mr. Iwannamorphine: "Well my tooth is killing me and it hurts so bad that it makes me have chest pain. Gotta give me some morphine, you gotta."

Me: "Here's some aspirin. For your 'chest pain.'"

Mr. Iwannamorphine: "Naw, don't need aspirin. That chest pain is gone now. It's the tooth. Teeth only respond to morphine."

Teeth only respond to morphine. I clearly skipped that day in nursing school AND medic class.

We go to the ER (less than 1 minute transport time). He went to triage, because well he had dental pain... And to my surprise, come to find out, he had walked out of the ER 3 minutes prior to calling 911, after waiting about 15 minutes and not being seen.

 They only offer ibuprofen in triage... Making this a great idea.
 

History, more important than physical exam

So I ran this lady with AMS. And by altered mental status I mean, she was totally unresponsive. But her vitals were all perfect, she was defending her airway beautifully, her lungs were clear, her EKG was better than mine and her blood glucose was normal. Baffling.

So then I decide to read her paperwork, since of course, the report I got from the SNF consisted of helpful comments like "I don't work with her usually" and "I'm calling her daughter, so I can't talk to you right now."

In there I discover that she's had multiple admissions for sepsis where she presented with AMS. Aha! Lightbulb! I check her lactate. It's 6.5. I start her IV and hang some fluid. And then I go back to reading.

And then, there is was. In the nurses notes: "Recently, patient has been playing in her feces more. She has been seen rubbing them in her vagina and licking her fingers. Also, this morning Ms. CNA found a ball of stool in her coffee, which she was drinking."

...

Guys, I think I found the problem.

Nope, didn't want those labs

Me: "Hey, I wanted to check on some pending labs for Mr. Imactivelydying."

Lab tech: "Sure, what are you looking for?"

Me: "That repeat CBC from around 2330."

Lab tech: "Oh, that was cancelled and thrown out."

Me: "WTF?! Why was it cancelled?"

Lab tech: "Well that patient had a CBC two hours prior and another two hours prior to that, so we didn't think you needed it."

Me: "Seriously?! For one, if I sent you the lab, we probably want it run. For two, how is that your decision to make?! And for three,  did you notice that those other CBCs were distinctly abnormal?? Which maybe would have prompted you to think that maybe we were actively doing things to fix his H/H of 2/12 and wanted to see a repeat?! No? None of those? Ok, please run the next one I send down. Thanks." click

Ugghhhhhhhhhh. Angry face.

We have different definitions of "code"

So I was working the other night when I heard the code bongs going off. The code was in the surgical observation unit, which I literally don't think I've ever heard before. (Basically overnight observation for routine procedures where you're expected to be discharged in the am. Things like biopsies, some laproscopic ortho and abdominal procedures, lots of plastics and ENT stuff, etc, etc...)

Much to my fortunate luck, I got a call a few hours later that I need to take that patient in my lonely one remaining ICU bed. Reasonable, I think... resuscitated codes should probably take the last ICU bed in the house.

And then I got report.

Obs RN: "So Mr. S is 83 years old, day of surgery from a lap hernia repair. No complications. He's voided after his foley out and all that good stuff. So I put him on his home CPAP and put him to bed at like 2100."

Me: "Mhmmm... yea... mhmmmm." Thinking: "I bet he got overnarc-ed and forgot to breathe for awhile. 

Obs RN: "Well then when I went to take his vitals at like 2330 his SBP was in the 70s!" pause for dramatic effect

Me: "Mhmmm... yea... mhmmmmm..."

Obs RN: "So then I called the code, of course."

Me: "Mhmm... wait, what?"

Obs RN: "He got hypotensive so I called the code."

Me: "Oh so that's when he arrested? It was like a hypotensive/PEA kind of arrest thing?"

Obs RN: "Oh no, just that one pressure of 70 systolic. The next one was 130/80 once I woke him up."

Me: "I'm sorry I'm confused. So he didn't stop breathing or anything?"

Obs RN: "Oh of course not. So anyway, neurologically he's a 15, moves everything, ambulatory, pupils equal and.........."

Apparently "code" doesn't mean pulseless/apneic to everyone...?

New rule

New rule.

If you squirrel my call, a stabbing that of course was the only interesting call of the night, you then have to also squirrel the next call I get toned for (which, by the way, should have been your call).

This second call, of course, will be a nice rectal bleed at the nursing home.

Not that this happened tonight or anything...