I'm probably going to get some criticism for this, but here goes. Does anyone have information on a site that offers fillable PDF charts? I used SoapNote.org for a while, and it really helped me improve my charting skills, but that site is now disabled. I don’t use fillable PDFs very often, but I find them helpful from time to time.

First, I want to apologize if this isn't appropriate for this sub.

So, had a pretty unremarkable night. It actually went pretty well. Walking out of the ambulance bay to leave, a woman shouted at me from the adjacent patient parking lot while waving. I couldn't hear what she wanted so I picked up my pace and started a slow-run, but my mind immediately went to parking lot CPR (and memories of).

Well, she just wanted to know if she could park there (it's a very clearly labeled parking lot, but whatever). A very pleasant looking man exited the passenger seat and thanked me, I smiled and told them it's a great place to park, and wished them a nice day.

I'm okay, I have people I can talk to, this doesn't affect my day to day on the job. It's just the emotional toll afterward, but I find it hard to believe that pretty much every single coworker has gone through the same thing, and that we're all just PTSD blobs working together. I just didn't realize how much it affected me I guess, until this morning. Was kind of a rough drive home and walk to my car. I kept it together but you just kind of relive a lot of memories after such a small trigger as someone shouting to me from their car. Didn't expect that.

In the grand scheme I'm basically a newborn to the ED, a lot of you have tens of thousands more hours than I do in this setting and have seen endless worst thing possible. I don't want to talk about the shitty things we've seen but more how you get through the day to day with these little triggers that precede big events. Getting a really frantic EMS patch at 4 am or having a new coworker sprint down the hall for a warm blanket or a person shouting for help in the parking lot....

Do you folks go through this too? This is normal right, no human could deal with what we see and not be a bit traumatized? I would do my job for free 3 days a week if I won the lottery, this is not me being deterred, I'm just still a bit shocked at how much more affected I've been than I realized.

Thanks for reading and sorry if this is inappropriate and I just really want to reinforce that I don't want to talk about the worst things we've seen but more the fact that it's hard to let go of them.

Of course we always go after H’s & T’s plus the “must be warm and dead” protocols—but when a doctor has been out of ideas and says “any other suggestions before we call it?”, what last ditch effort caused you to get ROSC?

Hoping to get more ideas for codes as an ED nurse!

Enjoyed fighting a post-ictal seizure pt in meth psychosis yesterday while trying to keep the bipap on my old person flu pt simultaneously

My coworkers are fun, we'll see how long until we get in trouble for this

🇨🇦

The audacity.

People come in for the most nonsensical and nonemergent complaints. After the waiting/getting labs & scans, while sicker people are addressed it’s always wild to me that people are like “how much longer?” Or “I’m going to leave if I don’t get seen now”

Welp. That’s not how this works & sounds like you didn’t really have an emergency after all? 🫠😑

Ok, I have a general idea how it works on my end (MD), how does it work on their end, how do you get into this business. Is the hospital offering a certain rate to companies for the shifts to be covered. I ask questions, but feel I am purposely being left in the dark, obviously. TIA

Time to get the last minute tax write-offs and benefits ordered. Scrubs and a stethoscope for myself.

Anyone buying anything today? Any recommendations for handy things to have in the ED? (A pair of Leatherman Raptor shears is always nice).

Got noravirus from work along with the whole ed and now I have FLU A !!! mannn I’m sick of getting sick 😭😭

Anyone within 3 hours of my ER that has ICU and vascular surgery, including 4 major metropolitan areas, has no beds again. A hospital in a neighboring state accepted the patient but next we’re told helicopter’s aren’t flying due to fog and EMS can’t drive that far.

So I guess we’ll just hang out with our thumbs up our asses until a miracle happens or the patient dies.

Too bad he’s not rich or famous. Maybe I’m wrong but I bet if I told (university hospital) Senator Soandso or Tom Brady’s dad or Beyoncé was circling the drain a bed would magically appear 😩

Came in with inability to urinate greater than 24 hours. The nurse assigned to me was callous and obviously did not want to be there. I was in pure agony. I asked if she could ask the doctor for pain medicine. She said “He’s not giving you narcotics” and then shoved the foley up me. I yelped in pain and then screamed and cried for about thirty minutes straight afterwards. It was extremely traumatic of an experience. Doctor comes in to examine and sees me crying. He spoke to me with true compassion and gave me morphine for the pain.

I feel like it’s much too easy to be incorrectly judged as a drug seeker in the ER and people with true pain are treated terribly.

I get it. You’re overworked and overpaid and burnt out. But please remember there’s a real human being you’re taking care of. Please.

Thank you to you, Dr. Smith, for the only compassion I felt that night. I’m feeling so traumatized and can’t stop crying thinking about how I was treated like an animal when getting the foley placed (I have chronic urinary retention so this is not my first experience with foley but it was the first time I was ever treated so poorly during placement). Thank you for treating me with kindness and respect at 2am.

Hello everyone. I work in a hospital setting in a Pharamcy department. Recently Ed technician role came across me and I think I loved it I talked to the Ed manager she was willing to hire me I am not hired yet . The advice I need is there is a doctor in Ed who I think likes me never said a word to me , but I can feel it . He’s married but I think he just likes me or whatever I really feel anxious when he’s around me . I was thinking if I am hired how would I work with him 🥲 . I work for Pharamcy but I work in Ed with a pharmacist and when he’s there my heart beats fast I constantly check on my appearance. We don’t talk but if I get hired I would have to interact with him . The benefits of Ed tech job is better pay , better hours for me . What should I do should I take the job and I think I will adjust ??? I need to leave the Pharamcy job because pay is little and too much work . Please give honest advice!

RN of 2 years in a level one peds ED. We see a lot of DIB/asthma exacerbations that usually end up needing IV Magnesium sulfate over 20 minutes. Throughout my (admittedly short) career, it was common practice to have a bolus running with the infusion and a BP cuff cycling Q5min to prevent and monitor for hypotension. Over the last month, one of our head docs has released a statement that said something along the lines of, “hypotension is a common side effect of Iv Magnesium, but it is rare. Therefore, a NS bolus isn’t necessary to order with mag. If a patient does become hypotensive, please notify the provider so a bolus can be ordered at that time.” So now, we still monitor as previously mentioned but don’t bolus until the pt is actually hypotensive.. Is this becoming more of a common practice? I had a pt’s BP tank despite proper dilution/administration and they ended up needing a bolus w/ a pressure bag for correction. I’m just a little confused as to when the guidelines changed.

EMS is in a crisis in my (very rural) area. Barely enough personnel to cover primary duties of 911 response, and rarely is there enough resources to cover inter facility transfers... It it probably the worst it has ever been currently.

A county owned ambulance service where I work part time has no hospital in it's response area, or even in the counties we cover. We aren't responsible to anyone but the citizens of the counties we cover.

We, for a multitude of reasons, are actually overstaffed. So we do inter facility transfers between hospitals. There's a couple reasons for this... The first is because nobody else is doing them, the second is increased revenues. It's not uncommon to have three of our five trucks on the road on transfers.

However, in December, we noticed a huge uptick in sending facilities misrepresenting patient conditions or outright lying. So much so that we started a list of facilities that we won't accept transfer requests from any longer.

The most egregious was a couple nights ago... We had two trucks on the road. Both reporting terrible road conditions and visibility. A level 3 emergency department calls. This hospital has a very active cardiovascular lab. This hospital is also a two hour drive away from our station then a 3.5 hour drive to the receiving hospital plus a two hour drive back to our station... If the road condition was acceptable. The road condition was certainly not acceptable.

We were automatically declining requests due to dense freezing fog and treacherous road conditions. The state advised that they weren't planning to do anything about it until close to sunrise. In this situation we don't ask the patient status at all because if it is unsafe for us to go, it is unsafe for us to go no matter what is wrong with the patient. So I decline the transfer. The nurse on the phone persists. I again decline so she puts me on hold to talk to the physician. I wait on hold for a minute then I get paged for a 911 call... So I hang up.

The nurse calls back and leaves a nasty message, then calls my county's dispatch center to just have us sent to that hospital. The dispatchers contacted me instead and I advised them that we were declining the transfer because it was difficult to get my Ford Explorer across these roads, let alone drive hundreds of miles in a larger/heavier ambulance. Dispatch relayed this information to the nurse.

About 20 minutes later, a dispatcher calls me on my cell phone. They tell me that the hospital has called back numerous times and advised that the patient was going to pass away if we didn't take this transfer... No other details. A few minutes after that I get a call from one of the elected county board of supervisors who is appointed to oversee EMS. I tell him everything I know and my decision to not accept the transfer. Then I get a phone call from my medical director. My medical director asks if there is any way that we can take this transfer because the patient is in a 3rd degree AV block and is receiving transcutaneous pacing. The patient is intubated and on a ventilator and their cardiologist on call has declined this patient. I talk with my department head and we agree to give it a shot.

We run on a simple philosophy of risk nothing to save nothing... Risk a lot to save a lot. ALRIGHT... .Fine... Let's go... So we go. It was my turn in the barrel after a very active day of transfers so I went on this one myself. We arrive at the sending facility... I should have turned around and walked back out.

The patient was not intubated. The patient was not being paced. The patient is alert and oriented and up walking around. The patient does not have a 3rd degree AV block. The patient has a 1st degree AV block. This hospital's cardiologist declined this patient because he is a liver transplant recipient six years ago. When I arrive the patient isn't even on a cardiac monitor. The patient has perfect vitals and presented to the ED with abdominal pain.

I. Was. Pissed.

Of course, the nurse who badgered me all night had left because their shift change was 30 minutes before our arrival... So I told the charge nurse everything... She could not have cared less and defended that nurse. In no conceivable way was that patient safer in my ambulance than they were right there where they lay. We turned around and walked out, got back into our truck, and left. On the way out the doctor accosted us and ordered us to take that patient right now and he didn't care about dangerous road conditions and that was our job. That hospital called our county dispatch to the point where law enforcement had to get involved.

That facility is now on a short list of places that we will not even take a phone call from... But I don't get it... Why? Why intentionally and blatantly misrepresent the patient's status to put them in a far more dangerous position just to get them out the door? Their ED wasn't full... It was actually pretty empty. Of course, this is more the exception than the rule, but it's beginning to happen more and more often.

I work for TH under 1099. They keep denying my schedule “requests” when it’s 3 months ahead and reasonable not during a holiday. As far as I understand they are not allowed to dictate your schedule as an IC. How do you guys handle these situations as more of us are “IC”.

How do I get my physicians group to add more staffing for our physicians? When I come in at night we average 3-5.2 patients per hour with varied acuity. We are a stand-alone ER HOWEVER, we still get stabbings, chest tubes and many admits throughout the shift. I normally have about 3-4 pts that lwbs or AMA only becauseof the wait. All of our physicians hate it at my facility but leadership says we don't have the numbers because they use averages. Most of the census is front loaded b4 midnight and in the summer the census can be low. However we have days where our docs see 35 patients b4 midnight with an average acuity of 3. (Their shift starts at 5:30p) I'm so over it. Our physicians group is so smug, the medical directors work MAYBE one day shift a month then laugh at the newbies working grueling night shifts. I gotta do something. Im the night charge btw. I can't find standard Dr. staffing stuff online. None of the doctors have hope that anything will change. Im pissed. Im about ready to call the news or something. I just need something concrete to show these losers before I loose my sh*t. This staffing is unacceptable. We have no scribes, no mid levels not even a secretary to answer the phone... nothing. Please help 🙏

tl;dr I suck at this job.

I am just 6 months into my new job, and it's been so incredibly rough emotionally and mentally. I did super well in residency and had no issues. Currently working for a CMG in a somewhat big city.

As an attending, I find myself seconding guessing everything I do and doubting myself. I feel like I have mismanaged patients and need to be told what to do. I feel like I'm a dangerous physician who will and can harm patients. I was so good at procedures during residency and now, feel like I am botching them.

I've had a few bouncebacks who eventually got admitted.Working in an environment with very little support services, nursing and ancillary staff, and adequate physician coverage doesn't help either. I feel like I'm slow and sometimes either over work up or under work up patients.

I try to read and listen/watch EM:RAP to learn. Idk.I feel like an utter failure.

Sorry for the rant.

Anyone ever feel like quitting because you're just bad at this job?

Had my first case with this the other day, thought it was an interesting predicament. I ended up giving only 250cc NS bolus, 5 units SQ insulin regular and started on insulin drip and admitted to ICU to get dialysis.

For reference:

The pt had uri like symptoms for past few days, stable vitals, afebrile in ED. No leukocytosis, beta hydroxybutyrate of like 5, AG of 19, k of 5.3, co2 of 15. Ph of 7.3, only mildly ill appearing but otherwise not to dry.

The ER I am working at now, we do a lot of respiratory panel testing especially the very young and the elderly. Last month I noticed an increase cases of + norovirus, and since last week, a lot of flu and rsv +s. Not so much with covid..Anywhere else this is happening too?

Trying to get an idea of what’s competitive these days. My site hasn’t changed the pay in almost 15 years and is running around 260/hr total RVU based

Hi. I'm doing some research for work. Easiest way to explain what I'm after is by example.

(thank you in advance for being so generous with your time and expertise)

If you treated 7 opioid overdoses in 2 hours, would you conclude that an unusually potent and therefore dangerous synthetic opioid had just hit the street? And could/would that prompt you to give EMS and EDs a heads-up?

For gay pride, 15,000 condoms are distributed to bars and bathhouses, and on the day of the parade alonh the route itself. Two weeks later, could you work backwards from the number of new STI diagnoses to assess the effects of the condom campaign?

Last one: 21 cases of small pox are diagnosed over 2 days in your emergency department. Are you required to inform state health officials and the CDC within a certain time frame? After that, what ongoing role, if any, will emergency physicians play?

Took 40mg propranolol after a stim binge and my BP is somewhere between 235/75 and 150/100, while my heart rate is 85 BPM.

Normally, after a bender my heart rate is somewhere between 90 and 130 and my blood pressure is normal high.

I'm well fed, well hydrated (multi, potassium, magnesium, electrolytes, omega 3)

So I'm guessing Unopposed alpha-stimulation.

Cant find any treatments on the internet.

That’s it.

I'm a bioengineering student at a private university that has a strong medical program. I've only toured the ICU and tele-ICU of my university hospital (which is definitely state of the art in US), so my question might sound a bit odd. I noticed that doctors and nurses see lots of vitals on patients monitors. I am curious why there's multiple monitors screens instead of just having a singular monitor with the just the important information. I can imagine how mentally taxing it must be for all the hospital staff. So for efficiency purposes, would it help you guys if us engineers collaborated with doctors to revamp which vitals are displayed specifically for emergency room purposes? Or would it help if doctors can decide what patient vitals are displayed?

This is pretty much the best supplement for sleep I've found. Except I wake up in five or six hours wired as fuck with zero chance of being able to go back to sleep. This happens regardless of dosage.

I'm sure that isn't great for my brain long term. Is there some kind of adjunct I can use to actually get eight hours of sleep here?