Observations in ED

Wednesday
I worked with nurses Cosmina and Annie today. Building positive relationships with staff is starting to go well - some of the nurses seem to be very fond of Jason and mentioned his name all day and when he paid a visit, you couldn't wipe the smile off their faces as he rehearsed counting 1-10 with them and attempted mini conversations!

The morning was slow which is a recent pattern but this afternoon I heard nothing but "ekargie, ekargie", and 'time for another cannulation' and 'please help' with all kinds of things like catheterization. I think I like the yellow room (Immediate Care) best as you can count on a lot of action. It's a challenge to start in on my own but when I receive a pat on the back after a few hrs I know persevering and showing lots of initiative pays off.
Today we observed: at least 3 hospital staff who 'gave themselves the "perfusion"' - and left the tell-tale sign of a cannula in their arm. The most amusing case was a roguish guy we call Hoony who has the role of something equivalent to an Enrolled Nurse in Australia - he cannulated, attached a bag of fluid to himself and stood texting on his phone with the other hand; all of a sudden a new patient is being rushed into the red room for resus and Huni's involvement is necessary; he jumps up to help running around still with one arm held high in the air squeezing the fluid bag. So it's no worries if we have a big night on the town because we'll just stumble into SMURD and it surely won't be long before someone saves us with 'the perfusion'. Golden rule of this hospital seems to be that perfusion is the universal remedy.

I've also observed that omeprazole is given for every second person - 'to protect the stomach' and that hypertension (one case of 218/199) is not uncommon. I was horrified as captopril, frusemide were given all with little noticeable effect. Part of me wonders how these patients are actually living and breathing still!

Amanda was on the ambulance and had 2 1/2 callouts. One patient in a pneumonia clinic was surprised to be swamped with 10 red suits when his mild shortness of breath required only a supervised transport! Other cases were for chest paint and a patient who swallowed his dentures. Tori had a great victory with performing her first cannulation successfully today. In the Red room Jason's been unravelling the complexities of the interdependent diseased body and how to chart a course of treatment. Midway through the day we saw SMURD's simulation room. It's really fantastic, and like at Monash at home, has an 'apartment' where jobs can be practised, a car crash simulation area and lots of manikins.

Ambulance in the car crash simulation area

SMURD's Ebola protection kit

SMURD simulation & practice room

Thursday

Had a RDO again but Jason and I decided to go into the hospital anyway because that's why we're here. Even though it was a 'quiet' day we studied patient cases in the resus room and found ourselves randomly assigned to jobs like taking 12-lead ECG's on a few different patients. The resus room ended up providing some educational experience as we witnessed an intubation procedure and then I spotted something which I was sure was not normal - and turned out to be regurgitation which the Dr quickly rectified. A lot of different drugs to what I'm familiar with are used here and so some time was spent looking these up in the super-heated hospital library where you have to fight off the urge to sleep as if you're in a field of poppies! All the drama happened in the last hour of the day when a large very sick patient became physically aggressive and I found myself exerting all my strength along with a couple others to try and pin him down while intravenous sedation was repetitively attempted. Meanwhile the patient beside him had his sedation wear off and poor skinny Jason found himself single-handedly doing all he could to restrain a large agitated patient and stop him pulling out his cannula and spurting blood everywhere! There's a first time for everything. Tonight we definitely all had to wash our white scrubs!
We had drinks after dinner with Attila the Hun. Well, most Hungarians don't shorten their name to hun, but close enough! This triage nurse, unlike his predecessor, was very pleasant company for a relaxed night on the town :)

Myself, Amanda, Jason, James, Hannah, Attila (thanks to Tori for the photo!)

At dinner James, Amanda and I discussed how every day you learn something and have a cultural experience even on a day off. I think I have a false perception of my level of control... until I step out the door and begin another day as a foreigner in Romania!