A few notes on ER staff

Non-medical staff in the ER works a bit differently. No techs: we have some support staff that are called just that: ER support. They function rather as traditional orderlies: stocking, patient transport, physical tasks, but nothing like our techs with wound care, IV's etc. I really miss our paramedics who are so good at all those technical patient care things like splints, IV's, wound prep, etc.

Nursing roles are much more limited also. Ranging from being less forward in requesting/reminding the docs of patient needs (Doc, the guy in 12 needs pain meds, etc.). No ability to pre-order x-rays, labs - best that seems accepted, is to hand you the order slips with a sticky label on it already.

IV starts require certification for nurses, and some seem to choose not to do so - so some RN's don't start IV's. RN's don't start nurses on little kids - gotta be a Doc, don't do male urinary catheters, or little kid urinary catheters, etc.

RN staffing faces the same sorts of shortages as the Docs: including no sick-call backup. Last night we were overloaded with patients - especially borders, and short on nurses so poor Matt had 13 patients stacked 2 to a room and in the hallway. He looked pretty downtrodden until I met him outside on my way home where he was smoking a cigarette - can't say I blamed him a little nicotine before going back in to face that mob.

Weird case of the day was the 8 year old boy with urinary retention (821 ml with the bladder scan) from a fecal impaction. When we get this with old men, I like to put in a foley catheter first (since the over-distended bladder is the most painful issue), then work on the underlying constipation/impaction. Couldn't get even a 5 French feeding tube into the kids' bladder, so decide to work the impaction next (and save a suprapubic drain as last option). So, with a finger up the kids butt, digging away, he was able to pee ('wee' in Australian) as soon as I got the first couple grams out - firing all 821 ml against the far wall - much to the relief of all. I think the interns should have gotten that case, but all the fun was over by the time one of them was free.