Dusting

You want to know the best part about working in triage on a stupid busy night? One can theoretically spend the whole shift crop dusting the triage booth and every person thinks it was the patient before them. 

I'm not saying I did this. But I'm not saying I didn't, either.

NIHSS

So I'm doing my yearly renewal of the NIHSS certification, and I have to say - for practical, ER usage...it's kind of bullshit. I do my best to score patients appropriately, but when I'm watching the educational videos it's impressive how far off the test situations are from the reality of the ER.

For example: on the item where we're supposed to show patients a card and ask them to name certain objects. According to the video, "for the intubated patients, have them write down their answers on a notecard and then score them appropriately."

Riiiiiiiight. I can't even get patients to do the simplest of tasks correctly. Like put a thermometer under their tongue. Or take their shirt off before putting a gown on. Or not try and rip off all their cardiac leads because "they're itchy." Or even provide me a list of what surgeries they've had, because why should someone know what internal organ has been ripped from their insides? So with that in mind, do you realllly think I'm gonna have my newly stroked out intubated patient brought out from sedation long enough to try and draw me a pretty picture on a notecard? I think not.

It's more likely they'd bypass my NIHSS attempt, rip the ETT out with their one good arm, and then arrest a minute later because they're too gorked to maintain an airway. I guess they score a 3 on the aphasia part if they're dead?

Conversations in triage

Four AM in the triage window:

Young dude: I need to be seen by a doctor.
Me: Okay, have a seat here while I get some vitals on you. What brings you in to us tonight?
Young dude: I can't tell you.

Let me interject for a moment here. If ever a dude checks into the ER and says he can't tell you what the reason is, scientific polls have determined that 100% of the time it is because his man bits are a)dripping things it shouldn't be, b)swollen to sizes they shouldn't be, or c)a combination of both.

Now let's continue, shall we?

Me: That's fine. You can hang out in the waiting room until you're ready to tell me. Trust me buddy, there's no complaint you can think of that I haven't already heard and I hear a lot, so it doesn't really phase me. I'm here to help you, not judge you for whatever is going on.
Young dude: Okay. I'm here because...[voice gets real quiet]...my junk is, like, dripping out this nasty stuff and it burns.
Me: blah blah boring questions about symptom duration, unprotected sex, previous treatments.

Me: Alright man. Have a seat back in the waiting room and I'll call a tech up here to get you into fast track in a couple of minutes.
Young dude: Thanks, lady. Also, I do have a question. Would you ever go out with a patient? I mean, with me?

Seriously? If you're gonna ask me out, at least ask me out before you tell me your peen is malfunctioning. Because, EW. And also, HELL NO.