CLEVELAND, OH – Initial news feeds are reporting that an acute GI bleed patient is being transferred up from the ER to the ICU within the next 10 minutes.  Report was called and mentioned that the patient has a 22g IV in the right AC with ½ NS trickling in at 50 ml/hr.  Vitals include a BP of 70/palpable and a HR of 129.

IV catheter
I think a 22g or even a 24g IV will work

“ER special again,” said ICU nurse Kim Williamson.  “If we are lucky the IV will be dangling in the AC, just one small tug away from coming out.  Oh, and I wonder if it will kink every time the patient bends his arm more than 10 degrees.  My money is on it kinking big time.”

No type and cross either!  Perfect!” exclaimed ICU attending Dr. Angela Phillips.  “Break out the MAC central line kit and some pink top tubes AGAIN.”

The ED paperwork, with a bunch of useless scribbles and circles, will likely be lost on the way up and it was just reported that the patient sticker machine is still broken at admissions.  All 3 copies of blood paperwork forms and consent forms, which weren’t filled out, will need to be hand printed.

The icing on the cake in regards to filling out the forms is that the patient’s name is Michael Klobstopilewskiviller-Deederviller, one of the longest last names in the community.  Admissions’ computer registry was not able to add the patient to the EHR yet, and have indicated that all orders will need to be written on paper as well.

Gastroenterology was notified by the ED, but the GI doctor on call decided that the patient wasn’t acute enough to scope today since it was after 4 p.m., despite the fact the patient was pale, diaphoretic, tachycardic, hypotensive, and had a hematocrit of 18.

“Just tank him with some blood and I’ll scope him in the morning,” was the response from the GI doc on call.  (GomerBlog inquires, how does GI always get away with this?)

“Yeah, I think a 22g IV should do the trick here,” Dr. Phillips sarcastically said to the charge nurse.  “Let’s hook up the Belmont and save a life!”

Meanwhile down in the ED, high fives were occurring and it is being reported that the movie Rudy was being played in the break room.

Veteran ED Nurse Bryan Meaters explained the difficulty in obtaining even a 22g IV.  “This vasculopath had nothing and was volume down coming in.  We were lucky to even get a 22g IV in, but the ICU nurses will of course never be happy with what we do.”

EM physician, Dr. Rubins, told GomerBlog the honest truth: “It’s all about placement.  No matter what you do or don’t do in the ED, every service is going to complain and moan.   If we DO something, than we get chastised for being too aggressive and acting like a cowboy.  If we DON’T do something than we get reprimanded for being idiots.  The ED is a big dumping ground for negative comments from patients, doctors, and nurses.  Seriously, when was the last time anyone every said, ‘Great job, ER’?  Never.”

“Knowing that, why bother.  Placement first and then move on to the next patient.  I’m going home at the end of my shift either way.  You guys sort it out, I’ve got 30 deep waiting in the lobby so I’ve already moved on by the time I call you.”

Well played, ED.  Well played.