Sunday, July 3, 2011

A Good Day in Urgent Care

Yesterday evening was the perfect follow-up shift to a few days in the drunk tank. I was stationed in a separate little urgent care clinic where people come in for less medically serious reasons- small lacerations, broken fingers, muscle strain injuries, small abscesses, rabies shots, prescription refills, etc. The technician can help clean wounds, dress wounds, splint injuries, apply ace-wraps, knee immobilizers, sling and swaths, ice bags etc to an orthopedic injury, as well as a lot of the computer work.

Besides one aberration patient, the day flowed very smoothly and I got to hang out with some of my favorite nurse practitioners ever.

The drama-king came in screaming, my wrist, my wrist! he had it bent backwards with an ice-bag filled with hot water. For some reason, he was in a wheelchair. APRN took one look at him and said, take him to x-ray (and don't bring him back). "I need meds!," he yelled, "I'm in so much pain. Get the doctor here right now, I can't go without pain meds!" There was alcohol and who knows what else on his breath. I got him an ice pack, and he went off without meds to x-ray. He had 2 visitors come in soon after, a disheveled girl and a man with a gold grill in his teeth. I have never seen anything like it... it's like
But with this:
Why in the world would anybody do that? But anyway- there was something strange about this situation. When they heard he might be coming back to this clinic, the girl angrily said "I'm not playin' these games. He better get the meds over there. Let's go."
They're obviously still young and green in the drug-seeking game. Better luck next time...

Urgent care can be really hard to work in when there are a lot of patients sent to us, all of whom need x-rays or stitches, or abscesses lanced or a consult from orthopedics/podiatry/plastics/etc. There are just so many procedures and tasks to do for each patient.

It's hard on the physicians assistants/APRN's for different reasons; they were talking about the ones who couldn't take it anymore- the ones who had quit. A woman came in for thoracic back pain and was sent home with a followup appointment and pain meds; the next time she came in was for a massive pulmonary embolism, dead. The PA who treated her quit soon after.

You also get really weird/funny/stupid cases, like the cop who came in for a human bite.
Where did you get bitten, sir?
Here on my arm. Is it gonna get infected?
It looks like it didn't break skin. That means you're ok.
But there was saliva!
It didn't break skin, sir. It's ok.
Even with saliva?

Or the guy who came in for "genitourinary problems" who ended up with just a blackhead/ingrown hair on his pubis. It wasn't even remotely red or swollen. He made sure to call his wife a few times and leave messages to assure her he was ok, but that he was in the emergency room, not telling her what it was for and scaring her half to death.

Or the kid who had a giant abscess on his butt cheek who grunted the whole time we were lancing it. Just grunted- no yells of pain, per se.

I walked by the drunk tank to take a look; it was even worse than the night before. THANK GOODNESS I wasn't in there last night. If anything, being there every day is what is going to make me burn out.


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