Warning information overload!

Today i have been on an educational day learning in depth the anatomy and physiology of the deteriorating child including the factors which are involved in the biological processes of the human body. My mind now feels totally bambozzled with information. Throughout the day i was requiring regular glucose boosts just to keep me going...So i am assuming my brain was hard at work trying to absorb all this information and store it somewhere up there.

Yesterday I thought it would be clever to do some overtime at work (Yes, on a sunday in the ED!) I am trying to utilise my skills learnt in my previous course undertaken thus need to spend more time in resus to improve my knowledge, clinical skills and my confidence. Yesterday resus became an extention to ITU. I spent the whole of my shift working together closely with the intensivists which must be said i quite enjoyed. I was able to give timely appropriate care and treatment to individuals. It gave me a warm fuzzy feeling inside and reminded why I entered the health profession. I find the intesivists great to work alongside and really helpful, which was reassuring for myself.


On a low we had a gentleman come in with septic shock, who was moderately unwell suffering with severe hypotension which was not responding to fluid resuscitation, hes BP was in his boots roughly 70 systolic on arrival. I suddenly felt quite out of my depth when i had orders thrown at me from all directions. I managed but was left feeling my whole focus was on the physical aspect of care rather than the nicities - such as communicating effectively with the patient and family, although this was carried out it was at such a minimal level because I was the only nurse in the mad panic of stabilizing the patient - god,what i would do to have 8 arms/legs/tentancles like an octopus! : )! On the other side of the coin the septic patient was only discharged from the ED less than 24 hours ago, one day discharged home next day admitted to ITU. It just reminds oneself of how quickly a patient can or will deteriorate and stop compensating over a short period of time - Could the initial management and presentation of the patient 24hours before have prevented an ITU admission - had we got it completely wrong? Was it a failure on our behalf? Was fate and destiny in play here, was the outcome just prolonged?

It is these kind of stories the media loves to write about and 'paint the NHS' in a bad light, sensationalize all the stories! Lets face it im sure the title ' ED saves anothers life' would not sell papers aswell as sensationalized stories. Once again you can see a businness stroke approach in full play! Although it is more apt to use a business approach in selling papers and less apt to use this when saving lives or at least attempting too!


It must be said though I had conformed to the standards of the 'new NHS' the bosses seemed happy. On a lighter note we should be soon be recieving a new influx of staff, which should help in these kind of situations, one can always wait in hope and anticipation!

I left the department feeling cheery but fatigued both physically and mentally.
Seemingly yesterday seems to have had a positive effect on my self esteem, self belief and confidence. It must be noted though I may have possibly being feeling fatigued more so from my saturday night shenanigans. It just reminds me how things are not as 'black and white' as they are sometimes seen or percieved to be.

Once again I left ED feeling glad to be alive and living life.

When hell hit the department.....devil style!!

Well, things did not seem to to get better, the night staff looked exhaused when i came on duty and you can tell from those looks - oh no..do i really want to be here...you convince yourself its not that bad and then become quite optimistic with regards to the situation....really how atrocious could it get...?

We had a GP in today who refused to see anything remotely emergency related with regards to minor injuries and would only see medical problems...which leaves oneself wondering the point behind this? The department is slowly sinking deeper and deeper under the sea of patients which seems to keep multiplying every 5-10 minutes, everytime you look out theres been an exponential growth, the sea of patients seems to be evolving and suddenly I feel a very diminutive part of the 'ED ocean'.

I felt like the vampire queen today rushing here there and everywhere, 'stealing' blood from individuals, never truly managing to get a grasp on anything or anyone, as you do. Supposadly stable patients placed in the observation wards prove not to be so stable in the morning after all. An elderly patient who presented to the department yesterday, late afternoon with falls/collapse, shoulder pain and acute confusion seems not to be so well after noting melina after her motions. This made me feel a little uneasy as the the patient was in my care yesterday and i did flag up with the doctor my concerns with regards to this patient and passed on my views on how i felt, in an attempt to be the patient's advocate as she was acutely confused. It left me wondering should i have really stuck to my point, listened to my sick sense and intuition and pushed my point further, in attempt to really ensure the patient recieved the timely pertinent care and treatment she deserved. It was noted the patient was left without review during the 'night rush hour' which to be fair is the way of emergency care, at times, but the patient was obliterated and left in the 'land of limbo', as they do, people view them as clinically stable. Although problem being, the patient was not stable and had a CRP of 165 and urea 9.2, tachycardiac, with a MEWS score of 5 and ended up in resus for a full new assessment, this left a certain stroke of unease about how i could or what i should have accomplished for the patient yesterday, I feel as if i am partially responsible for this individuals deterioration in health.

By 12.00pm there were patients all over-some deteriorating sat on chairs causing the panic station to flash at full speed,but there were no trolleys for them! ambos could not off load their patients and resus was full on within trauma's and the critically ill. Everyone looks very confuzzled - not knowing where to start, which way to go but the question still lies, where were the SHA today or last night for that matter....?