FAIL

1.  we get this admit from ED.  now i know that the ED is crazy, and i'm not one of those nurses who needs every little detail that i can find for myself in the computer in report, but i do expect the basics.  like the diagnosis.  so this kid is apparently a fall off a balcony.  the report was as follows: "mmm ahh,  2 IVs in...i think 2 IVs...chest tube on the left (not correct).  i think he fell.  (yells to coworker in background) DID HE FALL??  ok, yeah. and mmmmmm, yeah we're sending him up".  the patient arrives with a chest tube that's supposed to be to suction but is not.  he apparently has a C-spine fracture, which was not mentioned at all in report.  he's for some reason still attached to the ED's TRAM monitor, but not the actual monitoring screen, just a brick with some outlets.  and the first words out of his mouth when i asked him what happened?  "I jumped, because IT WAS THE WILL OF GOD!!!".  um, yeah...you are clearly a suicide risk and therefore a sitter patient.  upon further investigation, the patient was not supposed to be transferred to the floor until his sitter arrived.  when we called the team and asked where the patient's orders were, we learned that the team wasn't aware he was coming to the floor either.  they told the ED to hold him.  once again, i know the ED is crazy, but if you're going to dump a patient on us, would it be too much to ask that you actually tell us what's wrong with him?  you know, before we leave him alone and God tells him he needs to strangle himself with his oxygen tubing.  transfer FAIL, ED.

2.  we get this transfer out of the ICU.  little old man with rib fractures.  i'm headed across the hall to my patient's room when i hear a noise.  like a train.  puff puff puff puff puff puff puff.  so i follow the sound, and find the little old man in his bed breathing at 50 a minute.  that noise?  is the sound of Jesus coming for the little old man who is (naturally) a full code.  oh, but not to worry!!  upon transfer, the ICU nurse said that the patient had "been like this".  well this?  is not ok.  ever.  because little old man can't breathe at 50 a minute forever.  and soon he will stop.  breathing, that is.  and then he will be dead.  so after a rapid response, some nebs, a little IV lasix, and some prayers that he wouldn't code, we 'return to sender'-ed him to the ICU, only 3 hours after he came out.  shame on you, ICU nurse, for allowing him to be transferred to the floor in the first place.  and for that, you get a FAIL.

3.  a patient was brought to us after hitting a tree with her face.  clearly after such a trauma, the patient was knocked unconscious.  in an attempt to help, a bystander began to administer CPR.  unfortunately the patient was still breathing with a pulse, and the attempts to resuscitate her only stopped when she opened her eyes and croaked "i'm alive".  so now it addition to her facial trauma, she has rib fractures and a cracked sternum.  note: if when giving CPR, your victim is watching you and trying to talk, STOP COMPRESSIONS.  kudos for having good intentions and trying to help, but ultimately that's a CPR FAIL.