In A&E today...

I have good shifts this week. I've already worked one set of 12 hours today, and now I'm off until the weekend. Bonus.

All day in A&E on a Saturday and Sunday... imagine the thrills and spills...

Anyway, today was a good day. I think I'm beginning to find my feet within the department now.
At least I can actually find things for people now, although saying that, a few things went missing today which I had to undertake epic journeys to find.
When relatives ask for a cup of tea, they don't expect it to take 20 minutes, right? Well, as the ward had run out of cups, I had to go in search for more. After ransacking the kitchen, I realised I would have to look further afield for the bloomin' things.
Onwards to the canteen!
A rather miffed cafeteria lady met me at the canteen doors, and after explaining my predicament to her, she somewhat reluctantly led me into the main kitchen.
Tea cups galore!
But she had to ask the head cafeteria wifie if I could nick them first, whilst giving me a lecture on why we shouldn't be taking the kitchen items from them; it wasn't their job to hand them out, blah blah blah.
When in truth they'll only end up back on the wards anyway.
However, being a student (with some charm) has its advantages. Playing the "pity me, I'm a poor student sent on an errand I don't want to be on" role usually works in getting what the ward wants and needs.
I suspect that's why the nurses will send the students on errands; so other wards feel sorry for them and give them what they ask for.
However, other staff members just shoot the messenger. That's when the "I'm a student and I'm assertive" role kicks in. Well, generally. Either that or you just take the verbal beating and give them the finger as the ward doors swing shut behind you.
Not that I've ever done that, you understand.

Our second missing item - which was thankfully recovered - was one of the controlled drugs' (CDs) monitoring books. It actually cropped up in the most obvious place; on the receptionist's desk, yet everyone was too busy looking high and low to actually notice it.

So apart from this, I can now find the items which the nurses and doctors ask for.

Patient wise, we had a few varieties during the day, including two swine flu cases (one of which ended up being tonsillitis... how hard can it be to confuse the two?)

We also had a fractured clavicle (collar bone in non-medically-boney terms) and chest pains, an OD on paracetamol, a phantom pregnancy (yep, they do happen) and a little old lady who had fallen and hit her head, causing a lovely big bruise over her eye and a very bloody wound. The cut itself was relatively small and not exceptionally deep, yet the blood had poured from it; you could tell by her red, matted hair (I always find it strange that head/face wounds will bleed as though the injury is serious, when it can actually be a tiny cut.) Yet she was in good spirits and very sweet.
I always love how elderly people who really need help are immensely apologetic to you, every time you walk into the cubicle, even when you've just nipped in to get something out of the cupboards.
"I'm sorry to be such an inconvenience," or "I'm sorry for being such a nuisance," or "I'm sorry for taking up your time," and so forth.

When, on the other end of the scale, you have the time wasters sitting outside the door.

I triaged my first patient today, and for being so simple it was actually quite difficult.
His GP had referred him to A&E with fevers and sweats. Someone tell me which one it is, 'cos I honestly think it's neither an accident, nor an emergency.
And neither did the rest of the A&E staff.
With no other problems other than this presenting complaint, there really wasn't that much to ask or talk about. Hence why it was awkward.
Obs were all fine (no high temperature there then) and the patient appeared to be in good form.
Could the diagnosis be a case of the lazy GP?
The patient denied any recent colds/coughs/infections, as had the GP in the referral letter.
So what was the problem?
Well, we dipped his urine, and we found the answer. The guy had a urinary tract infection (UTI).
The doctor prescribed him antibiotics, and away he went - another happy customer.
Only he needn't have come to A&E and taken up our time.
He needn't have waited the hour he did to be triaged and treated.
The GP could have referred him to a practice nurse in the surgery, who would have tested the urine there and then. Hell, the GP could have even done it themselves. They could then have prescribed him the medication.
Standard procedure. Quick and easy. No fussing about with A&E waiting times.
It was inconvenient for the patient, and for the emergency staff.
Still, at least we got the guy sorted.

Aside from the emergency department, I also made a return trip to Ward 9 to visit my last mentor.
I don't think I'll get the chance to bond with another mentor like I did with her. Our constant excursions to every ward in the hospital brought us closer together, I think. Two nurses for the price of one, so to speak.
Now she's more of a friend, someone who I can still go to for advice and help in the nursing realms, and for a reference when it comes to getting a job - an added perk.
It was great to see her again, and I think she was pleased to see me too! I know now that if I ever have any issues whilst at DGH, I can always talk to her about them.
I'm sure we'll catch up again at some point, maybe before I head back to uni. But it would be nice to be able to keep in touch from time to time.

So overall? An interesting and varied day.
I just can't wait until my next few shifts, when I can see what the weekend will have in store for me.

Like Casualty off the telly...

Week 1 in A&E, and things have been going smoothly for the student nurses...

Yes, I have finished my first week's worth of shifts for placement - 3 consecutive stints in Dr Gray's A&E department.

Dr G's; it's like I can't get enough. I've even been back on ward 7 twice, just to say hello and to transfer a patient. I'll never get away now. I guess it's good to know I'm still remembered. Whether those memories are of a fond nature, well, that's yet to be said...

But A&E - that's right where I want to be!
In the midst of the quiet corridors, empty cubicles, abandoned resus rooms...
Not quite right, is it?
Yet that's what my three days have been like (for the mornings at least) until things pick up slightly towards the evening time. The time when, having already been on for almost 10 hours, you can't quite be bothered to deal with drunken patients, screeching kids, and what ever other trivial condition walks through the doors.

Saying that, A&E has not been entirely uneventful. In my opinion it's still better than a ward, because of the great variety that comes with the job.
In the past 3 shifts I have learnt quite a lot, and any confidence with some procedures or equipment is partly thanks to the RC experience. Already I have had to put someone in an arm sling and elevation sling, and help log roll someone off a spinal board and onto the bed. Surprisingly, you don't learn these basics in Uni.

Anyway, this is what I've witnessed/been involved in so far (not in any precise order of events as my memory isn't that good - patient confidentiality taken into account):

• An elderly lady who had fallen and hurt her shoulder, ?fracture.
• A paediatric resus alert, where a baby had lost consciousness - this turned out to be a false alarm, as when the baby arrived from the ambo it was crying its lungs out and fully awake and alert, and had apparently been this way since the call out. Phew...
  
• A burnt penis.
• A Myocardial Infarction (MI, or a.k.a. heart attack) and the protocol which comes with it - the patient was still alert and conscious by the way (prior to RC/nursing, I always used to think of MIs as collapsed/unconscious/dead, but obviously this isn't always true).
  
• A construction site worker whose circular saw thing (the spinny one with a serrated edge) had bounced off the metal he had been cutting, and had sliced back into him, cutting through his chest. Thankfully it hadn't quite reached the bone, and being rather stocky his thick fleshy layers had taken the blow. A very nice, deep laceration.
• Suspected CVA (a.k.a. stroke)
• A man who had jacked his van up to check on a tyre. The jack gave way, and the van fell, crushing the man underneath. He entered A&E with a ?spinal and a very sore ?broken shoulder. Apparently this incident is also classed as an RTC.
• A fractured femur.
• A variety of old breaks and torn ligaments/tendons, which were all plaster-casted. Myself and my fellow student even got the chance to practice plastering thanks to the very nice Orthopedic technicians of the A&E dept. Very good fun, and very funny.
• A patient with a head injury who was choking on his own saliva (very briefly, before he was whisked away to get a CT scan).

So far, so good!
Now one of the nurses has organised a day out for me and my friend with the ambulance crews, to observe the emergency work from a paramedic's point of view.
Obviously I am ecstatic over this, and can't wait until November when I get to join a crew for the day. I might try and pursuade my mentor for another day out. Thankfully she's very cool, hip and trendy, and if I ask nice enough she might just sort that out for me.

So yes, from the list it doesn't sound like a quiet stint, but it's very slow for Elgin A&E and even the nurses agree with me on that point!
Of course I have another 8 weeks to spend in the company of the emergency care workers, so there's plenty of time for things to pick up to full speed.
As one nurse commented on our first day, "it's just like Casualty off the telly."