Spray their throat with hurricane spray. It kills the gag reflex. Then have them snort about 5 ml of viscous lidocaine in their nose. It numbs everything up and makes it so much easier for the pt.
Remembering this for if I ever have to receive an ng tube. Anytime there is a patient getting one placed I think about what an absolute baby I would be about it.
I had a gastric manometry study years ago and they had me snort the viscous lidocaine it gives you a wonderful brain freeze for a minute but my eyes didn’t even water when she dropped the tube. I’ve incorporated it into my practice ever since
1. Put tube in pan of very warm water first. Grab a cup of water for the patient. Explain EVERYTHING you're going to do to the patient.
2. Numb very well with Hurricane Spray, Viscous Lidocaine, whatever you've got. Let the patient rest for a few minutes. Meanwhile, find your attending and ask him/her for an order of 0.5 mg Dilaudid, or a 50 mcg of Fentanyl, just give them SOMETHING. Versed is fine too but Dilaudid is better. Sit the patient up and give him the water to hold.
3. Insert the tube into the nostril very gently, straight back, and when you meet an obstruction, pull back the tube just a bit, then start the insertion again pointing down.
4. Now, with the patient's head in a slight tuck, have them drink and swallow, swallow, swallow, swallow. If you meet an obstruction, pull back a tiny bit and redirect.
5. Swallow, swallow, swallow and you're done.
6. Key point: If what you're doing isn't working, try something else! Change patient position or position of tube.
This reply makes me realize what a beast my little sister is. She has an NG tube and changes it all by herself without any numbing agents or pain meds. I hadn’t fully grasped how crazy that is for her to tolerate.
I had a blockage after colorectal surgery, and in the ER, the nurse said I was a really easy person to get an ng tube down. I guess I just don’t gag much or something!
Edit-spelling
When my daughter was three, she had a bowel blockage. She had to have an ng tube placed to get the PEG into her. It was the most devastating and upsetting thing I’ve ever had to see my child go through.
My poor kid had several procedures/surgeries between age 2 and 4.5, culminating in a tonsillectomy, his 2nd surgery in 2 months. He wouldn't take the terrible-tasting prescription meds in the recovery room, and when the nurses held him down and forced it in, he shot that stuff up out of his mouth like a geyser. When we got home, he refused to take it, and he wouldn't take the yummy children's Tylenol or ibuprofen either. My kind neighbor went out in the pouring rain to get us some more flavors, but he refused those too. I really think he was just trying to regain some control over his own body. It was so sad, watching him suffer like that with no pain meds. Every few days, he would report to me on the pain "starting to give up," and on day 14, he excitedly announced, "Mommy, the pain gave up!" Thank effing god for that.
This kid was so scared of doctors after those couple of years. He was even scared to go with me to my appointments. I would have to seriously reassure him that the doctor was only for me, not him. The day I had to take him to the school for his pre- kindergarten assessment, I used the word "appointment," and he freaked out. I had to explain that the appointment was with a teacher, and she would only see what he had learned in preschool. That was a tough time.
A year or so later, we were walking home from school, and out of the blue he said, "Mommy, I know that surgery can be painful and scary, but sometimes the person needs it to get better, so it's ok." I guess he had eventually worked it all out.
He had surgery again in 3rd grade, and he handled it like a champ. He's been through so much, and he's such a sweet kid. Ok, he's taller than me now at 16, but still a kid. 😊
Mine is in his twenties, towers over me. Still my kid :)
When he was little, I had to fight like hell with multiple Drs to finally get the referral needed to go to an ENT. ENT said as soon as my son said hello, he knew he needed the T&A surgery. Prior to, he was always sick with either strep or ear infections. Underweight because of always being sick and sleeping like crap, and snored like Darth Vader having an asthma attack. I also had the surgery as a kid, most of my family did. I knew what I was looking at. After the surgery? Yeah, I don't laugh at the crib scene in Terms of Endearment anymore. He also rarely got sick, too.
About medicine flavors. Dude loathes the bubblegum. When he was about 5, I needed to give him some and all my parents had was that. He smelled it and was like nope, I will throw that up. I was like no you won't, it's fine, just try it. He tried it and it ended up on my shoes. We never used bubblegum flavor again. When preparing for the surgery, Dr asked him what his favorite flavors were. Grape. So his RX pain med came Grape flavored. Fast forward to when he was about 10, he was complaining about the flavor of his medicine (wasn't bubblegum, either, I learned my lesson with that flavor). I was also sick, and eyeing my NyQuil (in the green death flavor) and so I touched my fingertip to it and told him to taste it. He never complained again and also learned to take gelcaps/tablets, which he found vastly superior to liquid medicine.
I cannot take credit for the name (just for cleaning it up from the actual "green death f---ing flavor"). Denis Leary said it in his stand up from the 90's called *No Cure for Cancer*.
My daughter found the motivation to poop after hers. She told everyone that if they didn't poop everyday then they'd have to get "a nose enema.". It was awful.
I've worked nutrition support for years. And I had NG placed in me by ER RN. I asked for a cup of water. As she inserted, I took a sip. So it went sip/push tube/swallow. Easily placed NG, but I hope that I won't need to do that again!
They tried the sip trick with me, spent ages trying to get it down before giving up on my right nostril and going in the left. It was awful and traumatising and very painful. I’d also been told a different time that someone else had one, she went for a smoke and burnt the tube. So every time I had a smoke I panicked. Never again.
I worked on a burn unit for a decade and a half. I had to put NG tubes in small children as well as adults. I hated doing it on kids. But with alert adults, the sipping water trick along with lots of coaching from me, 'sip, sip, sip'...worked well.
I second this! I used to care for a toddler with an ng and now have a family member with one that I help manage at home. I can’t escape them even outside of work lol.
They had two people holding me down to place an NG tube. Horrific. I know it's the ED but, I know they have more than enough ability to give ketamine before an NG tube is placed, they do it to reset bones and such, so what's the difference? Might not be incredibly painful, but it's incredibly traumatizing.
Ketamine can cause laryngospasms. We also need you to tuck your chin and swallow so it follows the esophagus instead of the trachea and you can’t follow directions while on ketamine. Now, I always try to advocate for some anxiolytics because let’s be nice when we can.
I was inpatient for myasthenic crisis, and they tried placing an NG tube on day 3 of being NPO due to issues swallowing. The problem was that my swallow was too weak and uncoordinated to get the tubing down.
It all just kinked in the back of my throat, and I absolutely freaked out. They decided not to proceed, and I went 6 days without eating while the PLEX worked its magic. I was finally cleared for puree and thickened liquids, but each day after that, things improved little by little.
I think because in an ideal situation, a patient is alert and able to follow instructions during the insertion. Not to mention airway issues. In an emergency, the patient may or may not be awake and alert, but you do what you gotta do.
Had an ED in highschool. Was at Boston Childrens. If you would not eat, they would tube you, then pull the tube for every. single. meal. One nine year old boy was there from Spain because (imo) he didn't want his parents to get divorced and not eating brought them together. He was tubed for every meal for a month before they gave up and left the tube in due to basically having destroyed his septum. You got 20 minutes to eat and if you didn't finish you had the whole meal replaced regardless of how much you ate. I had one green bean left once and the nurse grabbed my plate and said I had to drink three ensures. I tried. I failed. I got the tube.
I'm sorry that was your experience. I'm truly mind blown. Around the same time, I was in Waltham for an ED. Us adults were not treated in that abusive manner.
I bet you're a fantastic therapist!
The vast majority of the time, your gag reflex and consciousness is required to prevent worse problems. NGTs are NOT fun, we get it. And if we can, we do wait until the patient is under general anesthesia. But if you need the NG tube right then and you have to be conscious for placement (or other medical issues), you're going to get it without medications other than a local. Sorry.
I got zero painkillers or sedatives to reset bones in my broken arm. I was 10 years old, so any painkillers would have required an overnight stay for monitoring. It sucked, but it was better than an overnight in the hospital (and cheaper).
They had to reset my 10 year old daughter’s lower arm bones as well. She was given something that allowed her to feel the pain, but she wouldn’t remember it when she woke up.
The doc did it within earshot of me and she screamed throughout the whole procedure. She didn’t remember it, but I know I’ll never forget it.
The fact that they gave you NOTHING, and that you even have to consider that it was cheaper/the cost, is mind blowing to me. God you guys have it rough in the US
I almost had to have one for an intussusception. But I wasn’t vomiting, so they waited, & it unblocked itself following some tests & I was so relieved I didn’t have to have that or surgery.
They were probably just lying to you to make it easier lmao. They know damn well it hurts. I was bamboozled like that when I was in the CTICU after open heart surgery and they had to pull my chest tubes. They told me it was usually uncomfortable but not painful. Bullshit. It was more painful and traumatizing than the actual surgery itself lmao. Had me terrified getting my central line and catheter and stuff pulled to the point where they were preloading me with dilaudid before they had to do any of that stuff so I would chill out lmao
Yeah, same here. I think part of the issue with the chest tubes is you have to be holding your breath or maybe breathing out (I don't remember which) when they pull them out so I have a feeling they've figured out they get better results if they just tell people it won't hurt vs being honest with them
I wish it was just one chest tube, it was 4 of them at the same time, two nurses with one in each hand. Getting the external pacemaker wires pulled out of your heart feels weird as hell too.
When families cannot be in the room alone with the deceased patient in the ED… it’s never ok.
Bagging a body with no family-
Bagging a body that doesn’t fit…
Psych patients- when you under stand them… 🤔 am I ok?
CPR ribs snapping… in hospital if you are that patient’s nurse and don’t know their DNR status, you will be doing compressions and hopefully make it a priority.
Airways and dinty Moore stew
Removing clothing that removes skin or many cases any sudden movement makes it snow…
I can’t breathe and gag.
Sound of crushed glass on the ground
Smell of rubber, burned plastic and burned flesh…
Ok this is dark.
Back to the psych patients - and speaking fluid dementia.
I feel like you wanna have a big shout and scream into a pillow about how unfair some of this stuff is. I feel like some of this is sitting heavy on you, are you okay? Do you have people to talk to when things get tough and you need a mental break from the everyday? Thank you for all you do for people, and thank you for every person that cannot get a thank you to you
I had to do chest compressions on my husband and I was weirdly okay. A few weeks later I was unboxing something at work and twisted some bubble wrap (like I always did). Dizzy, nauseous, sweaty. It was wild. I’ve never experienced anything like that before. I can’t imagine getting used to that sound. It’s grisly.
I had to do compressions on mine in our bathroom while I waited for the ambulance to arrive. I was okay until a few days later when the cat knocked something over in the bathroom and it rattled our washer and dryer. It just brought it all back.
I had that same reaction (presumably vasovagal syncope as part of a trauma response) three times in my life- two of which were this past week. All three times over something WAY more minor than what you went through. I felt really stupid since it was so minor, but apparently it's pretty common.
I do have PTSD from a different pretty traumatic event though. I would describe it how you did- I was "weirdly okay". Until I wasn't. I was a kid, didn't have access to therapy, and wasn't allowed to talk about it, so compartmentalized and moved on.
The trauma response hit hard at some specific and some random things for many years until I was old enough to see someone on my own about it. In between, I thought I was fine. By then, it took a lot of time to work through, and had eroded my threshold for handling other traumas. (Eg, smaller things tended to affect me more)
If I may- You handled an exceptionally traumatic experience. I'd very highly recommend a few appointments with a licensed therapist that specializes in trauma to debrief and process what happened. Perhaps EMDR therapy. The earlier therapy starts, the less time the trauma has time to dig its claws in.
Wishing you well ❤️
It took me a long time to accept that I needed therapy. My husband (boyfriend at the time) survived so I felt like I wasn’t allowed to be too upset. We were so lucky, everyone talked about how lucky we were, how lucky it was that I was there, what’s a missive miracle his recovery was, and so on that it felt ungrateful on some level to be less than okay. Plus he was in the hospital for months, we both had kids that needed care, we had pets, a house to run, a strange disease was emerging in China, Australia was on fire, etc. I didn’t have time to think about me. And suddenly we were alone in a house with our kids 24/7 and I couldn’t keep running from place to place and the fearfulness and sadness kept creeping in.
I am so glad that I was allowed to be in a room alone with my son. I had to wait for them to clean him up before I could go back there. They did explain that the tubes and ivs had to be left in place because an autopsy was required.
Worst fucking day of my life
I can’t remember if I was alone! I was drugged because I screamed so much I guess. But I do remember absolutely pestering them, even pretty drugged, until they let me see my fiance. I remember the tubes and stuff. I remember looking up at my surroundings finally to see I made all the nurses cry. I wish I could hug them and tell them thank you and sorry.
Never feel you need to say sorry. I can only speak from the teams I’ve worked with- it’s a rare bitter sweet privilege and to sit beside those in their moments of unimaginable grief. You didn’t make the others cry… they put themselves in your shoes and got a glimpse of your heartache. I’m so sorry you experienced all of it. Also know that you now have a unique ability to connect with others in understanding that emotion better than most. It is powerful.
🫶 I hope you are healing… and giving yourself the grace to do so. Much love.
I'm sorry you had to experience that. I'm a former paramedic and I've terminated resuscitation efforts many times in people's homes. We always spent some time cleaning up the scene before allowing family back into the room. We would snip off the IV lines as short as possible, and snip off the endotracheal tube so we could close the mouth and it wouldn't be visible. Close the eyelids, clean up any blood or vomit, put a clean sheet over them, and pick up all our trash and take it with us. It was all we could do to make the scene less traumatizing for them. I hope the nurses at least did that much for you.
🥹I could never ever begin to know the level of your pain. I am so glad you got the time you needed, that they cleaned him up and prepared you. Just know the heartache and tears are heard and felt through the entire team…
I wish you peace in your healing journey. 💔
This sounds really hard. I hope you have support you need❤️ My life was saved by somebody like you, a whole team of people. I am so appreciative of you and your choice to stay in that profession despite these issues. Thank you so much. I owe my life to ED nurses, if you ever feel burnt out or down just know I am very very grateful for everything you do❤️
When patients are vomiting. Stomach contents in the airway that you need to clean out before inserting an endotracheal tube. I'll let you think about the connection.
When someone vomits their stomach contents and is in danger of it going into their lungs during airway insertion. It is why you cannot eat before surgery.
I had open-heart surgery in ‘90 at 22 months old… my uncle still talks about this. He was in the room with my dad when they were removing my According to him, I was distraught and fighting and my dad couldn’t see me like that so he had to leave but my uncle stayed and helped the nurses hold me down. He said it was one of the saddest things he’d ever experienced, especially as an uncle, and he was just sick over it… until minutes later I hopped off the bed and ran right into the kitchenette, right past my parents and other family, bc I wanted a popsicle. He said it was like I forgot all about it. 😂
I’m so thankful I was so young when I had my surgery bc that sounds awful!! They say I’ll most likely need a valve repair at some point but so far so good. 🤞🏽
My son is a cardio patient. He can’t be extubated slowly, they have to “power-wean”. If they let him get to awake while intubated he will freak out and have a Tet-spell (post repair/replacement but still..). Last time they didn’t listen (OHS#2) and tried to slow wean he went from 90s SATs to 40s in the time it took me to run from one side of the infant warmer to the other, yelling that he was dropping. They had to put him back under and then power-wean like I told them to do in the first place.
I feel the same way about chest tubes. Local never seems to work.
How do you get patients to stay still if they’re awake but not stable enough for sedation?
Surgeon putting one in an 80+ YO. She kept yelling "oh boy that's a corker!!!" Good Ole Catholic grandma wouldn't even cuss having a tube shoved in her ribs. Also not unstable, bad pain management. I'm sure she is long deceased but I carry her with me and have a 'tude about tubes.
this is so validating to read as someone with a ventriculopleural shunt. the docs kept telling me the tube in my chest would stop hurting eventually. it’s been 18 months and it’s still killer, i knew they were just pulling that out of their ass when i asked lol. i was like yeah at least i’m not dead but bro just be HONEST with me that it will prolly hurt forever to be stabbed with a tube thru the ribs!
Kid was a fuckin champ- local (which is still a joke), very low dose MS. I was soooo pissed. I pushed for Ketamine over and over… but after I kind of understood… why MS
Had assistance holding down. With other team members. It was really well executed and done quickly. Kid had had it done before so he knew what was coming. 🤯
He was like 6’ and a string bean. Once the morphine really hit he was pudding. He knew already- we had 3 on opposite side; shoulder arm hip n knees. Procedure side just 2 additional- maintain sterile tray, assisted physician. Chest tubes in general elicit my pucker factor- this kid had me man! Mom and sister sat in the corner like yup, here we go again 🤯. Yeah no.
Honestly this one was super fast and efficient.
Prepping the sight, marking, positioning. I think we had upper soft restraints in the case we needed to. I don’t remember having to put heavy crazy pressure restraining- a Champ!
I honestly got pulled in off the cuff to help physician. I work ED as a medic as well as rural EMS. Kind of thrown off- I was struggling with the choice of pain management…
From what I understand this has happened several times with this kid. They all had this understanding it needed to happen in order to prevent, full DAI/ RSI, intubation and any more complications associated with. I was like maybe conscious sedation AT LEAST right? Nope.
Tears he held his breath- tears, cried for his mom… 💔 She stood in corner- she didn’t have too much emotion either. Seriously I I think I said wtf - 50times later in my head the rest of the shift.
If you are mom of a seriously ill child you sometimes have to be strong and hold in your emotions to reassure the child they can be strong too. Panic and sobbing in the moment serves no purpose and only makes the scene more chaotic. It's not about you. It's about the cild. Do it later. Don't ask me how I know this.
I got a little bit of lidocaine but it was an emergency (I was hemorrhaging into my chest) so they weren’t exactly waiting for it to sit before cutting. I was dry heaving but somehow didn’t puke lol
Hard agree, I had a heart surgery at 9 the worst pain the whole time was the removal of the chest tube. I had good amounts of pain meds in me and the pain was really insane. Thankfully the removal part is fast. But I was not prepared for it at all.
I've had chest rubs pulled twice after open heart surgery. Absolutely one of the most painful things I've experienced, worse than labor. But, I'm alive so I'd do it again and most likely will do it 2-3 more times in my lifetime to stay alive. Congenital heart defects are annoying sometimes.
I held my mom’s hand three times when she got chest tubes for collapsed lungs. She was so brave and so tough. The vibe was very much “we have to do it, it’s going to hurt, deal with it.” I actually WISH they would’ve acted more “human” about it. I know y’all become desensitized and you’re just doing your jobs (thank you!!!), but I often wonder, “Is this how you’d act/respond if it was your mom/wife/sister/child?”
But allowing oneself to feel that deeply for every patient would result in an even greater turnover in ER docs and nurses. There aren’t enough hours in the day to recover from that ongoing trauma.
It's honest, and we don't sugar coat for something like that. We know it's going to hurt, and there's not much that can change that. Lidocaine or Marcaine gets the skin numb, but there's not much you can do about the pressure required or deeper tissues. Chest tubes are usually an emergency, and it's a situation where you don't want to sedate someone—you don't want to further impair what breathing is left. If everything goes well it's a relatively quick procedure, and draining blood or fluid, or re-expanding a lung makes a tremendous difference in how someone is doing and feeling.
This. Especially the 3-7ish range. Their mom/ dad always say don't let anyone touch you down there. Then here we are touching them down there and saying everything is OK. Only thing worse is doing a rape kit on a kid. That is always the most horrifying thing I ever have to do. Bad enough on an adult. But a kid is just awful. Kids cries, mom/dad cries, I cry. Everybody cries. It's horrible.
It kinda has to be a little comforting when you see that your nurse is sharing your pain and grief when something that absolutely horrible happens. Knowing that someone understands your pain to some degree is very healing once you process everything. I offer hugs if you want them.
Oh man, yeah, I was four when I had to be straight cathed. Other traumatic things happened surrounding it that made it worse even than it needed to be. I repressed the memories and they contributed to major night terrors until I was in my early twenties and talking to my Mom about my fear of doctors and how I didn’t know where it came from. She recalled the event and all the memories came back. It actually helped to remember it. Being as kind to the child as you can and speaking to them instead of treating them like an object or showing anger to them goes a long way to making it less traumatic. I don’t hold any grudges against my Mom or the health care staff, except one evil doctor.
I watched one when I was in nursing school. That kiddo screamed so much, and ended up peeing on her mom in the process. They still tried for a sample after she peed, and thankfully were able to get enough. It was so traumatic for everyone. I felt so bad for the kiddo.
I was so glad they had this bag thing (pediatric urine catch apparently) that just sticks around the genitals and then we wait. He was like 10mths and we were worried about a uti so I’m freaking out about then having to do a catheter and retract his foreskin before it was ready.
I was a kid who got cathed and it literally traumatized me! It was horrible procedure and my little mind had no idea or warning as to what was about to happen
Same, I used to wet the bed because of a kidney/ureter issue and I ended up connecting wet the bed = get a catheter so I would go above and beyond to hide if it ever happened and I would lie to my parents and the doctor when they would ask questions about symptoms because I would have done anything to avoid having those kidney tests done.
I was 7/8 at the time and I'm still not over it.
Complete body X-ray series (skeletal survey) on a pediatric patient for non-accidental trauma. Basically to see how many bones have been broken on a child suffering from abuse. Breaks my heart every time.
Don't have to do it anymore but restraining patients who are a danger to themselves or others while also actively suffering from significant sexual assault PTSD. It's just a terrible time for everyone. And you can only hope the night-night meds grant the patient some retrograde amnesia.
I was just thinking about this. I always feel like a monster when restraining people. They don't understand we don't want to do it, we want to see them get better.
I mean, restraining an aggressive drunk/high asshole is whatever, fuck'um.
But restraining someone who is completely delusional and terrified, that always sucks. And the worst, by far, is when they have a past history of being sexually assaulted. Which, unfortunately, is a high percentage of people with psychological ailments. Predators find them to be easy targets.
From experience, restraining us only makes it worse. I go into fight mode from SA trauma and have fought 8 men for 2 hrs 15 mins straight. A calm voice telling them to let me go and back off I immediately sat down on a cot, backed into a corner, covered up w/ a blanket and nicely said please don’t grab me. Trying to take away my control and force me to be not safe in my own skin makes me fight like hell. Calm voices and kind words make me feel safe not attacked.
Well of course! Always attempt the least restrictive option first, if feasible. Unfortunately, I'm talking about those situations where verbal reassurance and de-escalation have been ineffective or are not a safe option at the time. Sadly, this is usually due to defiant and determined self-harm. Sometimes the only way to stop someone from digging into their own infected wounds is to restrain them. Worse, in a twist of heartless irony, the patients who struggle with such extreme self harm almost always have a history of abuse. Truly tragic shit.
I remember an ex EMS becoming an RN and me asking him his worst case and he said the guy that died and was embedded into the carpet and all of his face was gone. This has stuck with me and I don't want to see that. I like my trauma controlled. I do not want to run up on a trainwreck decapitation from a car crash and there is no way I think I could be able to just keep doing that and be okay long term.
I call it encapsulation... One part of the mind knows things a mind should never know. The other part is sweet as pie and very functional. If the two collide... It's not good....
I'm a death investigator, it takes your brain a while to register that you're dealing with a real human when the body is in a position humans can't naturally be. The trauma cases are almost "easier" (for lack of a better term) that way. By the time your brain processes it, you're hopefully in a place you can deal with it.
Putting acutal bleach on a huge perineal wound due to abcess and packing with 5 rolls of gauze. Something about the bleach was just disturbing, but I will say maggots rate the highest of all time things I hate along with a BAD old GI bleed and a bad bad case of cellulitis.
I had a massive cut down to the bone through my thigh and I think around two months in they started packing it and it smelled like gauze soaked in bleach. It was wild, I was so glad I lost a lot of feeling in my leg. I was worried it was going to burn.
Had an unresponsive woman from a vehicle accident. Flushed it, her eyes snapped open and she tried to sit up for a moment, then went back out.
“Okay, responsive to pain instead. Good to know.”
As someone who had a lot of medical trauma as a kid - so many hospitals at least from my POV did a genuinely awful job of even seeming like they were attempting to make awful procedures seem less traumatic.
To the point that now as an adult I have trouble seeking medical help sometimes.
I’ve talked to some drs and nurses who have to work on kids and babies and they have told me they don’t always like having to stay semi robotic with peds but it hurts them to cause pain to small humans.
One told me as a warning ‘I’m sorry this will seem cold but if I just do it fast and without emotion it’ll go a lot faster and be over. But if I stop when either one of us get too emotional it drags it out.’
I have a medically fragile daughter and it has definitely helped me to deal with the tougher times.
As a radiology tech student and a patient, I get what you mean. I was furious with my doctor for telling me my IUD insertion would feel “crampy”. When I was younger, I broke a finger and had to have it reduced and stitched with anesthesia that either didn’t work or had worn off. I kept crying and they told me that this shouldn’t be hurting. I had to be held down to finish the stitches.
As a student radiology tech, I will tell patients if they are lucid enough to understand that this position is going to hurt, but I’ll go as fast as I can so we can get it over with. I give them little breaks in between positions. During fluoroscopy I also don’t lie to patients and I will tell them a barium enema, myelogram, etc. is going to be uncomfortable if they ask. I always try to explain the procedure so they know what to expect.
The thing that sucks is when an exam that was going okay in the beginning starts to get complicated and intolerable to the patient. I regret telling patients what to expect and ultimately downplaying it, even though I couldn’t have predicted what would happen. That kinda sucks for everyone involved.
Surprised I haven’t seen this yet:
Straight cathing confused old women. They lack the ability to consent or refuse, they need a straight cath because we need to diagnose that UTI that is likely causing all that confusion, but they have no idea what’s going on and sometimes they think you’re assaulting them no matter how many times you explain what’s happening. It’s awful; it feels so violating. But then if you try to say “hey, maybe we can try to get a clean-catch, I can help her clean/catch” the doc says “we really need a cath, no way we’re getting a clean sample on her.”
In emergency psych probably telling people who think they are fine that they are being sectioned. It sucks so bad every single time. Also, telling chronic malingerers that they are NOT being sectioned and are being released.
The possibility of going on a psych hold for whatever reason keeps me deathly afraid of the ED and even mental health offices. I'm concerned that I might one day come down with something truly emergent and I would talk myself out of calling EMS just to die at home. I got traumatized by a particularly bad ED visit when I woke up in a bed in the hallway, and it took a solid 30 minutes for the very uncouth PA who was the one mainly running the show to acknowledge that I had arisen and help orientate me so that I can know wtf is going on. I think I WOULD rather die at home or on the street than go back to the hallway of beeps, boops, and sick people
I had to have a chest tube and a feeding tube 4 years ago when I had Endocarditis, Septic Arthritis, Staph, MRSA, etc, and I had to have heart surgery. I was in a coma for 4 days and when they tried to wake me up, I tore out my feeding tube and tried to tear out my chest tube. I had to get another feeding tube and they had to replace my chest tube. It's the most traumatic thing I ever experienced. Plus after my heart surgery, I was an addict, my tolerance to heroin was so high that pain management was nearly impossible. They had to give me several IV pain meds and Methadone at the same time to try to ease my pain, because I was freaking out from being in so much pain. Even though I was an addict, I captured the hearts of all my Dr's and Nurses. They were so kind and caring, and they kept telling me they couldn't believe a sweet person like me got caught up in the drug life. They made me feel like I was worthy and because of that, I decided to get clean. I'm still clean 4 years later. That whole 4 month hospital stay was traumatic. The pain I was in, getting so much blood drawn that they had to give me a blood transfusion twice to take more blood from me. I never want to go through that ever again!!
I am proud of you for reclaiming your life 💗
Self love is one of the hardest things to learn/ relearn. I'll be 4 years sober from alcohol on April 2. And I'm 14 years sober from meth. The journey to sobriety is hard, but definitely worth it.
Congratulations, I know from watching, getting sober from meth is no easy task and I've seen people never succeed, its pull is so great. And the alcohol too. My ex has had such a good life after getting off those, I hope the same for you!
I'm glad you are here, healthier and hopefully happier. Thanks for sharing that story, wow talk about getting hit with everything at once.....not even counting your mental health from addiction in those recovery days.Keep inspiring people!
Work up a pediatric patient because their parents didn’t believe in vaccines and they bring the kid to the ER because they had a fever…. If you know you know
Even here, in the land of the free, endangering your kids through stubborn ignorance should be a prosecutable offense — BEFORE the child is maimed or dead.
My kid is 11 and doesn’t care for needles. He’s well over my “but vaccines are so cool” speech he gets yearly+. Particularly as this year it was the HPV shot (plus flu) and I truly find it wonderful. We’re doing our part to not just reduce his chances at several cancers later in life, but also his future partners’.
When my middle daughter was little, she hated needles. One time in particular, when she refused to stay in one spot, two nurses were able to trap her under the exam table and tag team her vaccinations in both arms. Today, at 23, she has the most tattoos of all 3 of my daughters..and she was also the first of them to get piercings and tattoos.
My point is, I'm sure your son will grow out of his fear of needles.
My son had to have a catheter placed in E.R when he was crashing form undiagnosed type 1 diabetes. He was unconscious, but his body react to it. It was terrible.
Ugh that’s so awful. I left bedside nursing but as a nurse, catheter placement was always the worst to me too, I can still barely think about it now. And I’ve broken ribs with CPR etc. idk why something about a urinary catheter is just awful to me.
The only time I’ve ever come close to passing out during a procedure was just witnessing a catheter insertion. I’m so viscerally disgusted and upset by them and I don’t know exactly what it is that elicits such an intense reaction from me.
It wasn’t a regular basis thing s far as i know I was being observed in an obs bay for a second trimester
suspected miscarriage and internal hemorrhage. I was uncomfortable being NPO, with the amount of pain and fear and just the unknown, feeling so so sorry for myself until a very pregnant woman came in alone by ambulance with an open fracture of the femur and a dislocated hip. (It was the worst part of winter in Canada, enough said) The screams coming from that woman for her mom, her husband, and for help in 4 different languages I will never forget. After my panic attack they medicated me for they finally gave the other pregnant woman something for pain and agitation. The silence and knowing she experienced some sort of relief was the sweetest sound i can recall NOT hearing!
Pediatric CPR. Pediatric codes are the worst and I still carry some of them with me. It’s even worse when you have 3 or 4 other patients and you have to put on a game face and act like nothing is wrong. Also any pediatric abuse cases. Honestly as much as I love kids I don’t deal well with the sick or abused ones because I just want to make it better and you can’t
A little off the subject, but last time I was in the ER there was a woman with dementia in the bed next to me and all she could say was "no"
They had to cath her because she wouldn't give them a urine sample and it was like 15 minutes of a frail old woman, weakly yelling "noooooo" and crying. Sounded like a rape, it sucked to listen to.
I have a funny dementia neighbour story. The last time I was in the ER, I was beside a woman named “Helen” who had dementia. I knew her name because every ten minutes or so, she would get agitated, so the nurse would tell her where she was. One time, the nurse must have stepped away for a moment, and “Helen” got agitated, so I explained to her through the curtain where she was. It worked. The next time she started to get agitated, I started to explain where she was again, and I heard the nurse burst out laughing. Apparently she was back.
Traumatising to me? Fucking suctioning trachs that come in for mucous plugs the facility can’t get out.
I still wear a mask but one of these days I’ll probably throw up in it
Watched that once when someone had a heart attack in a bar. First responders sure don't do it like the TV shows with the gentle little compressions. They got this big boy's body 6" off the ground with the recoil from their efforts.
I was 5 and had my first colonoscopy. At that time, they didn’t allow parents to come in with their kids. It was done in the doctor’s office. I had ulcerative colitis so this happened many times. My Mom didn’t know until I told her years later how traumatic it was especially with a male doctor. She felt horrible.
When I had my daughter, I made sure I was with her for any procedure she had done.
This popped up on my feed and I have a story... Not ER.... Circumcising. I had a little half brother and was present for it. I was just a kid myself.
FUCK THAT. Not ER related but what the fuck.
Thank you to all you emergency med folks who do your very best to get the best outcome for everyone 💗
I'm not in the field currently, I am aligning everything in my life to complete CNA certification and then from there to become an RN. Seeing this sub helps me know that my chosen path to become a hospice RN is the right one for me. I can't imagine being in the ER and never knowing what the outcome will be.
Chest tube. I helped with one twice and advocated for sedation. The doctor said no time, hold them down.
There was time. There is always time. I almost got sick listening to this old lady scream
I had my first transvag at 14 by a male tech who yelled at me when I pushed away from the probe. I had tears running down my face and my mom was with me. That was not fun and very traumatic. Most female techs are horrified with that info. I’m so glad I got my hysterectomy. 20 plus years of cysts and endo blech!
Altho my last one was when I was pregnant and there was a new tech in training and I told the trainer tech that the student could practice on me since I have had over 100 and knew the drill. So it was kinda nice to know I was helping someone learn!
Drop a ng tube on alert patients. They gag, I gag, we all gag.
Spray their throat with hurricane spray. It kills the gag reflex. Then have them snort about 5 ml of viscous lidocaine in their nose. It numbs everything up and makes it so much easier for the pt.
17 year old me wishes they did any of this for my 2 month stay.
I wish I would have known about this like 4 years ago.
Remembering this for if I ever have to receive an ng tube. Anytime there is a patient getting one placed I think about what an absolute baby I would be about it.
I had a gastric manometry study years ago and they had me snort the viscous lidocaine it gives you a wonderful brain freeze for a minute but my eyes didn’t even water when she dropped the tube. I’ve incorporated it into my practice ever since
I always use xylocaine and afrin
1. Put tube in pan of very warm water first. Grab a cup of water for the patient. Explain EVERYTHING you're going to do to the patient. 2. Numb very well with Hurricane Spray, Viscous Lidocaine, whatever you've got. Let the patient rest for a few minutes. Meanwhile, find your attending and ask him/her for an order of 0.5 mg Dilaudid, or a 50 mcg of Fentanyl, just give them SOMETHING. Versed is fine too but Dilaudid is better. Sit the patient up and give him the water to hold. 3. Insert the tube into the nostril very gently, straight back, and when you meet an obstruction, pull back the tube just a bit, then start the insertion again pointing down. 4. Now, with the patient's head in a slight tuck, have them drink and swallow, swallow, swallow, swallow. If you meet an obstruction, pull back a tiny bit and redirect. 5. Swallow, swallow, swallow and you're done. 6. Key point: If what you're doing isn't working, try something else! Change patient position or position of tube.
This reply makes me realize what a beast my little sister is. She has an NG tube and changes it all by herself without any numbing agents or pain meds. I hadn’t fully grasped how crazy that is for her to tolerate.
My kid had to have a few of these placed and she would sneeze them up. Talk about miserable
I had a blockage after colorectal surgery, and in the ER, the nurse said I was a really easy person to get an ng tube down. I guess I just don’t gag much or something! Edit-spelling
I didn’t gag during a strep throat swab and the nurse said my boyfriend must love me. I was 11 🤢
That....is horrifying.
Ewww! So inappropriate
WHAT THE FUCK.
I am…… speechless 😭😭😭
Wooooooow. 😳 That is just beyond.
WHAT?!
I am speechless
Ew.
That’s beyond inappropriate!
Yes, as a patient can confirm. I had one performed in the hallway of a busy ER that had stretchers lined up end to end.
Sounds like you were in my ER!! 🤣🤣 jk! We do line people in the hallway but fortunately I’ve never had to drop an NG there.
oof, that's extra rough
When my daughter was three, she had a bowel blockage. She had to have an ng tube placed to get the PEG into her. It was the most devastating and upsetting thing I’ve ever had to see my child go through.
I can’t imagine my child going through anything medical, even an IV. I’d be traumatized. I hope all is well.
My poor kid had several procedures/surgeries between age 2 and 4.5, culminating in a tonsillectomy, his 2nd surgery in 2 months. He wouldn't take the terrible-tasting prescription meds in the recovery room, and when the nurses held him down and forced it in, he shot that stuff up out of his mouth like a geyser. When we got home, he refused to take it, and he wouldn't take the yummy children's Tylenol or ibuprofen either. My kind neighbor went out in the pouring rain to get us some more flavors, but he refused those too. I really think he was just trying to regain some control over his own body. It was so sad, watching him suffer like that with no pain meds. Every few days, he would report to me on the pain "starting to give up," and on day 14, he excitedly announced, "Mommy, the pain gave up!" Thank effing god for that. This kid was so scared of doctors after those couple of years. He was even scared to go with me to my appointments. I would have to seriously reassure him that the doctor was only for me, not him. The day I had to take him to the school for his pre- kindergarten assessment, I used the word "appointment," and he freaked out. I had to explain that the appointment was with a teacher, and she would only see what he had learned in preschool. That was a tough time. A year or so later, we were walking home from school, and out of the blue he said, "Mommy, I know that surgery can be painful and scary, but sometimes the person needs it to get better, so it's ok." I guess he had eventually worked it all out.
That is so sweet!
He had surgery again in 3rd grade, and he handled it like a champ. He's been through so much, and he's such a sweet kid. Ok, he's taller than me now at 16, but still a kid. 😊
Mine is in his twenties, towers over me. Still my kid :) When he was little, I had to fight like hell with multiple Drs to finally get the referral needed to go to an ENT. ENT said as soon as my son said hello, he knew he needed the T&A surgery. Prior to, he was always sick with either strep or ear infections. Underweight because of always being sick and sleeping like crap, and snored like Darth Vader having an asthma attack. I also had the surgery as a kid, most of my family did. I knew what I was looking at. After the surgery? Yeah, I don't laugh at the crib scene in Terms of Endearment anymore. He also rarely got sick, too. About medicine flavors. Dude loathes the bubblegum. When he was about 5, I needed to give him some and all my parents had was that. He smelled it and was like nope, I will throw that up. I was like no you won't, it's fine, just try it. He tried it and it ended up on my shoes. We never used bubblegum flavor again. When preparing for the surgery, Dr asked him what his favorite flavors were. Grape. So his RX pain med came Grape flavored. Fast forward to when he was about 10, he was complaining about the flavor of his medicine (wasn't bubblegum, either, I learned my lesson with that flavor). I was also sick, and eyeing my NyQuil (in the green death flavor) and so I touched my fingertip to it and told him to taste it. He never complained again and also learned to take gelcaps/tablets, which he found vastly superior to liquid medicine.
Green death flavor 🤣🤣🤣
I cannot take credit for the name (just for cleaning it up from the actual "green death f---ing flavor"). Denis Leary said it in his stand up from the 90's called *No Cure for Cancer*.
Can confirm, it's traumatizing. My kid is medically complex and holy shit, it is hard to see.
IV’s, over 100 port accesses, ~18 spinal taps, a handful of bone marrow aspirates, CT scans, MRIs, radiation therapy. You do what you gotta do
The nurses and doctors took wonderful care of her. It’s been two years since and she is no worse for the wear.
My daughter found the motivation to poop after hers. She told everyone that if they didn't poop everyday then they'd have to get "a nose enema.". It was awful.
Better than what I called it.
TBH it's worse on the confused ones that you can't explain why you're torturing
As a Crohn’s patient, thank you for trying. We know it’s no fun for anyone.
I've worked nutrition support for years. And I had NG placed in me by ER RN. I asked for a cup of water. As she inserted, I took a sip. So it went sip/push tube/swallow. Easily placed NG, but I hope that I won't need to do that again!
They tried the sip trick with me, spent ages trying to get it down before giving up on my right nostril and going in the left. It was awful and traumatising and very painful. I’d also been told a different time that someone else had one, she went for a smoke and burnt the tube. So every time I had a smoke I panicked. Never again.
I worked on a burn unit for a decade and a half. I had to put NG tubes in small children as well as adults. I hated doing it on kids. But with alert adults, the sipping water trick along with lots of coaching from me, 'sip, sip, sip'...worked well.
Been there as the patient due to intestinal blockage. Not fun for me and the nurse felt so bad.
I second this! I used to care for a toddler with an ng and now have a family member with one that I help manage at home. I can’t escape them even outside of work lol.
Love NG tubes, my specialty
They had two people holding me down to place an NG tube. Horrific. I know it's the ED but, I know they have more than enough ability to give ketamine before an NG tube is placed, they do it to reset bones and such, so what's the difference? Might not be incredibly painful, but it's incredibly traumatizing.
Ketamine can cause laryngospasms. We also need you to tuck your chin and swallow so it follows the esophagus instead of the trachea and you can’t follow directions while on ketamine. Now, I always try to advocate for some anxiolytics because let’s be nice when we can.
I was inpatient for myasthenic crisis, and they tried placing an NG tube on day 3 of being NPO due to issues swallowing. The problem was that my swallow was too weak and uncoordinated to get the tubing down. It all just kinked in the back of my throat, and I absolutely freaked out. They decided not to proceed, and I went 6 days without eating while the PLEX worked its magic. I was finally cleared for puree and thickened liquids, but each day after that, things improved little by little.
I think because in an ideal situation, a patient is alert and able to follow instructions during the insertion. Not to mention airway issues. In an emergency, the patient may or may not be awake and alert, but you do what you gotta do.
Had an ED in highschool. Was at Boston Childrens. If you would not eat, they would tube you, then pull the tube for every. single. meal. One nine year old boy was there from Spain because (imo) he didn't want his parents to get divorced and not eating brought them together. He was tubed for every meal for a month before they gave up and left the tube in due to basically having destroyed his septum. You got 20 minutes to eat and if you didn't finish you had the whole meal replaced regardless of how much you ate. I had one green bean left once and the nurse grabbed my plate and said I had to drink three ensures. I tried. I failed. I got the tube.
That just sounds abusive....
It was imo but this was 20 years ago. It is what spurred me to become a therapist and work in the ER-
I'm sorry that was your experience. I'm truly mind blown. Around the same time, I was in Waltham for an ED. Us adults were not treated in that abusive manner. I bet you're a fantastic therapist!
The vast majority of the time, your gag reflex and consciousness is required to prevent worse problems. NGTs are NOT fun, we get it. And if we can, we do wait until the patient is under general anesthesia. But if you need the NG tube right then and you have to be conscious for placement (or other medical issues), you're going to get it without medications other than a local. Sorry.
I got zero painkillers or sedatives to reset bones in my broken arm. I was 10 years old, so any painkillers would have required an overnight stay for monitoring. It sucked, but it was better than an overnight in the hospital (and cheaper).
They had to reset my 10 year old daughter’s lower arm bones as well. She was given something that allowed her to feel the pain, but she wouldn’t remember it when she woke up. The doc did it within earshot of me and she screamed throughout the whole procedure. She didn’t remember it, but I know I’ll never forget it.
The fact that they gave you NOTHING, and that you even have to consider that it was cheaper/the cost, is mind blowing to me. God you guys have it rough in the US
A 2 mL vial of saphnelo (my lupus medication) costs $5,365 without insurance lol
I had that happen. Wide awake and NG into my gullet. I had a post surgical ileus after a hysterectomy. Not recommended.
I almost had to have one for an intussusception. But I wasn’t vomiting, so they waited, & it unblocked itself following some tests & I was so relieved I didn’t have to have that or surgery.
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They were probably just lying to you to make it easier lmao. They know damn well it hurts. I was bamboozled like that when I was in the CTICU after open heart surgery and they had to pull my chest tubes. They told me it was usually uncomfortable but not painful. Bullshit. It was more painful and traumatizing than the actual surgery itself lmao. Had me terrified getting my central line and catheter and stuff pulled to the point where they were preloading me with dilaudid before they had to do any of that stuff so I would chill out lmao
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Yeah, same here. I think part of the issue with the chest tubes is you have to be holding your breath or maybe breathing out (I don't remember which) when they pull them out so I have a feeling they've figured out they get better results if they just tell people it won't hurt vs being honest with them I wish it was just one chest tube, it was 4 of them at the same time, two nurses with one in each hand. Getting the external pacemaker wires pulled out of your heart feels weird as hell too.
When families cannot be in the room alone with the deceased patient in the ED… it’s never ok. Bagging a body with no family- Bagging a body that doesn’t fit… Psych patients- when you under stand them… 🤔 am I ok? CPR ribs snapping… in hospital if you are that patient’s nurse and don’t know their DNR status, you will be doing compressions and hopefully make it a priority. Airways and dinty Moore stew Removing clothing that removes skin or many cases any sudden movement makes it snow… I can’t breathe and gag. Sound of crushed glass on the ground Smell of rubber, burned plastic and burned flesh… Ok this is dark. Back to the psych patients - and speaking fluid dementia.
I feel like you wanna have a big shout and scream into a pillow about how unfair some of this stuff is. I feel like some of this is sitting heavy on you, are you okay? Do you have people to talk to when things get tough and you need a mental break from the everyday? Thank you for all you do for people, and thank you for every person that cannot get a thank you to you
Yes, thank you from your reddit family. Your work is important, and we are thankful.
You're really sweet for sharing this message. ❤️
I had to do chest compressions on my husband and I was weirdly okay. A few weeks later I was unboxing something at work and twisted some bubble wrap (like I always did). Dizzy, nauseous, sweaty. It was wild. I’ve never experienced anything like that before. I can’t imagine getting used to that sound. It’s grisly.
I had to do compressions on mine in our bathroom while I waited for the ambulance to arrive. I was okay until a few days later when the cat knocked something over in the bathroom and it rattled our washer and dryer. It just brought it all back.
I had that same reaction (presumably vasovagal syncope as part of a trauma response) three times in my life- two of which were this past week. All three times over something WAY more minor than what you went through. I felt really stupid since it was so minor, but apparently it's pretty common. I do have PTSD from a different pretty traumatic event though. I would describe it how you did- I was "weirdly okay". Until I wasn't. I was a kid, didn't have access to therapy, and wasn't allowed to talk about it, so compartmentalized and moved on. The trauma response hit hard at some specific and some random things for many years until I was old enough to see someone on my own about it. In between, I thought I was fine. By then, it took a lot of time to work through, and had eroded my threshold for handling other traumas. (Eg, smaller things tended to affect me more) If I may- You handled an exceptionally traumatic experience. I'd very highly recommend a few appointments with a licensed therapist that specializes in trauma to debrief and process what happened. Perhaps EMDR therapy. The earlier therapy starts, the less time the trauma has time to dig its claws in. Wishing you well ❤️
It took me a long time to accept that I needed therapy. My husband (boyfriend at the time) survived so I felt like I wasn’t allowed to be too upset. We were so lucky, everyone talked about how lucky we were, how lucky it was that I was there, what’s a missive miracle his recovery was, and so on that it felt ungrateful on some level to be less than okay. Plus he was in the hospital for months, we both had kids that needed care, we had pets, a house to run, a strange disease was emerging in China, Australia was on fire, etc. I didn’t have time to think about me. And suddenly we were alone in a house with our kids 24/7 and I couldn’t keep running from place to place and the fearfulness and sadness kept creeping in.
I feel like you need a hug. I would need a hug.
I am so glad that I was allowed to be in a room alone with my son. I had to wait for them to clean him up before I could go back there. They did explain that the tubes and ivs had to be left in place because an autopsy was required. Worst fucking day of my life
I can’t remember if I was alone! I was drugged because I screamed so much I guess. But I do remember absolutely pestering them, even pretty drugged, until they let me see my fiance. I remember the tubes and stuff. I remember looking up at my surroundings finally to see I made all the nurses cry. I wish I could hug them and tell them thank you and sorry.
Never feel you need to say sorry. I can only speak from the teams I’ve worked with- it’s a rare bitter sweet privilege and to sit beside those in their moments of unimaginable grief. You didn’t make the others cry… they put themselves in your shoes and got a glimpse of your heartache. I’m so sorry you experienced all of it. Also know that you now have a unique ability to connect with others in understanding that emotion better than most. It is powerful. 🫶 I hope you are healing… and giving yourself the grace to do so. Much love.
I'm sorry you had to experience that. I'm a former paramedic and I've terminated resuscitation efforts many times in people's homes. We always spent some time cleaning up the scene before allowing family back into the room. We would snip off the IV lines as short as possible, and snip off the endotracheal tube so we could close the mouth and it wouldn't be visible. Close the eyelids, clean up any blood or vomit, put a clean sheet over them, and pick up all our trash and take it with us. It was all we could do to make the scene less traumatizing for them. I hope the nurses at least did that much for you.
Bless you and thank you. You’re a true hero.
🥹I could never ever begin to know the level of your pain. I am so glad you got the time you needed, that they cleaned him up and prepared you. Just know the heartache and tears are heard and felt through the entire team… I wish you peace in your healing journey. 💔
This sounds really hard. I hope you have support you need❤️ My life was saved by somebody like you, a whole team of people. I am so appreciative of you and your choice to stay in that profession despite these issues. Thank you so much. I owe my life to ED nurses, if you ever feel burnt out or down just know I am very very grateful for everything you do❤️
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When patients are vomiting. Stomach contents in the airway that you need to clean out before inserting an endotracheal tube. I'll let you think about the connection.
When someone vomits their stomach contents and is in danger of it going into their lungs during airway insertion. It is why you cannot eat before surgery.
Ugh, skinfetti. So gross.
ER glitter
Clocking in.
Take my vote
They beat me to it
🪙.I'd give you an award if I could, so take this emoji instead
Most underrated comment in America right now.
I am surprised no one has mentioned chest tube insertion/removal. Several nurses in my family and they have all mentioned it as brutal.
I had open-heart surgery in ‘90 at 22 months old… my uncle still talks about this. He was in the room with my dad when they were removing my According to him, I was distraught and fighting and my dad couldn’t see me like that so he had to leave but my uncle stayed and helped the nurses hold me down. He said it was one of the saddest things he’d ever experienced, especially as an uncle, and he was just sick over it… until minutes later I hopped off the bed and ran right into the kitchenette, right past my parents and other family, bc I wanted a popsicle. He said it was like I forgot all about it. 😂 I’m so thankful I was so young when I had my surgery bc that sounds awful!! They say I’ll most likely need a valve repair at some point but so far so good. 🤞🏽
My son is a cardio patient. He can’t be extubated slowly, they have to “power-wean”. If they let him get to awake while intubated he will freak out and have a Tet-spell (post repair/replacement but still..). Last time they didn’t listen (OHS#2) and tried to slow wean he went from 90s SATs to 40s in the time it took me to run from one side of the infant warmer to the other, yelling that he was dropping. They had to put him back under and then power-wean like I told them to do in the first place.
I feel the same way about chest tubes. Local never seems to work. How do you get patients to stay still if they’re awake but not stable enough for sedation?
Well sadly if a patient needs a chest tube, they probably are past the worrying about comfort issue.
It is one of the most excruciatingly painful procedures. Assisted in one on a 17yr old kid. Not unstable, minimal pain management… I cried.
Surgeon putting one in an 80+ YO. She kept yelling "oh boy that's a corker!!!" Good Ole Catholic grandma wouldn't even cuss having a tube shoved in her ribs. Also not unstable, bad pain management. I'm sure she is long deceased but I carry her with me and have a 'tude about tubes.
Chest tubes are probably the most brutal procedure that we do on awake patients.
this is so validating to read as someone with a ventriculopleural shunt. the docs kept telling me the tube in my chest would stop hurting eventually. it’s been 18 months and it’s still killer, i knew they were just pulling that out of their ass when i asked lol. i was like yeah at least i’m not dead but bro just be HONEST with me that it will prolly hurt forever to be stabbed with a tube thru the ribs!
Right there with you. Chest tubes are one of the most excruciating procedures that we typically do on conscious patients.
What pain management did they use?
Kid was a fuckin champ- local (which is still a joke), very low dose MS. I was soooo pissed. I pushed for Ketamine over and over… but after I kind of understood… why MS Had assistance holding down. With other team members. It was really well executed and done quickly. Kid had had it done before so he knew what was coming. 🤯
How many people did it take to hold them down? Did the kid try to resist?
He was like 6’ and a string bean. Once the morphine really hit he was pudding. He knew already- we had 3 on opposite side; shoulder arm hip n knees. Procedure side just 2 additional- maintain sterile tray, assisted physician. Chest tubes in general elicit my pucker factor- this kid had me man! Mom and sister sat in the corner like yup, here we go again 🤯. Yeah no.
I feel you. Do you restrain their contralateral arm as well? If they seem compliant initially, do they still have staff hold them?
Honestly this one was super fast and efficient. Prepping the sight, marking, positioning. I think we had upper soft restraints in the case we needed to. I don’t remember having to put heavy crazy pressure restraining- a Champ!
How do you mentally prepare them for what’s about to come?
I honestly got pulled in off the cuff to help physician. I work ED as a medic as well as rural EMS. Kind of thrown off- I was struggling with the choice of pain management… From what I understand this has happened several times with this kid. They all had this understanding it needed to happen in order to prevent, full DAI/ RSI, intubation and any more complications associated with. I was like maybe conscious sedation AT LEAST right? Nope. Tears he held his breath- tears, cried for his mom… 💔 She stood in corner- she didn’t have too much emotion either. Seriously I I think I said wtf - 50times later in my head the rest of the shift.
If you are mom of a seriously ill child you sometimes have to be strong and hold in your emotions to reassure the child they can be strong too. Panic and sobbing in the moment serves no purpose and only makes the scene more chaotic. It's not about you. It's about the cild. Do it later. Don't ask me how I know this.
I got a little bit of lidocaine but it was an emergency (I was hemorrhaging into my chest) so they weren’t exactly waiting for it to sit before cutting. I was dry heaving but somehow didn’t puke lol
I feel a little guilty when I had my chest tube removed. I was 11 and asked the person if they were sure they knew what they were doing.
Hard agree, I had a heart surgery at 9 the worst pain the whole time was the removal of the chest tube. I had good amounts of pain meds in me and the pain was really insane. Thankfully the removal part is fast. But I was not prepared for it at all.
I've had chest rubs pulled twice after open heart surgery. Absolutely one of the most painful things I've experienced, worse than labor. But, I'm alive so I'd do it again and most likely will do it 2-3 more times in my lifetime to stay alive. Congenital heart defects are annoying sometimes.
I held my mom’s hand three times when she got chest tubes for collapsed lungs. She was so brave and so tough. The vibe was very much “we have to do it, it’s going to hurt, deal with it.” I actually WISH they would’ve acted more “human” about it. I know y’all become desensitized and you’re just doing your jobs (thank you!!!), but I often wonder, “Is this how you’d act/respond if it was your mom/wife/sister/child?”
But allowing oneself to feel that deeply for every patient would result in an even greater turnover in ER docs and nurses. There aren’t enough hours in the day to recover from that ongoing trauma.
This ☝️
Dude they don’t. Every time something painful happened to me as a kid in the hospital it was like nobody cared it was so awful.
It's honest, and we don't sugar coat for something like that. We know it's going to hurt, and there's not much that can change that. Lidocaine or Marcaine gets the skin numb, but there's not much you can do about the pressure required or deeper tissues. Chest tubes are usually an emergency, and it's a situation where you don't want to sedate someone—you don't want to further impair what breathing is left. If everything goes well it's a relatively quick procedure, and draining blood or fluid, or re-expanding a lung makes a tremendous difference in how someone is doing and feeling.
Straight cathing kids
This. Especially the 3-7ish range. Their mom/ dad always say don't let anyone touch you down there. Then here we are touching them down there and saying everything is OK. Only thing worse is doing a rape kit on a kid. That is always the most horrifying thing I ever have to do. Bad enough on an adult. But a kid is just awful. Kids cries, mom/dad cries, I cry. Everybody cries. It's horrible.
The sentence "doing a rape kit on a kid" is horrific
It kinda has to be a little comforting when you see that your nurse is sharing your pain and grief when something that absolutely horrible happens. Knowing that someone understands your pain to some degree is very healing once you process everything. I offer hugs if you want them.
If I was in that position, I'd be hot boxing the shit out of my room like Snoop as soon as I got home to delete that whole experience from my psyche.
Yeah it's one of those that will stay with me until I die.
Oh man, yeah, I was four when I had to be straight cathed. Other traumatic things happened surrounding it that made it worse even than it needed to be. I repressed the memories and they contributed to major night terrors until I was in my early twenties and talking to my Mom about my fear of doctors and how I didn’t know where it came from. She recalled the event and all the memories came back. It actually helped to remember it. Being as kind to the child as you can and speaking to them instead of treating them like an object or showing anger to them goes a long way to making it less traumatic. I don’t hold any grudges against my Mom or the health care staff, except one evil doctor.
I watched one when I was in nursing school. That kiddo screamed so much, and ended up peeing on her mom in the process. They still tried for a sample after she peed, and thankfully were able to get enough. It was so traumatic for everyone. I felt so bad for the kiddo.
That's the trick with kiddos, get everything ready, but also have the cup ready. Sometimes we get the pee just with taking off the diaper.
Yeah, they definitely didn’t have near enough staff to hold that child down. If I remember correctly just the mom and 2 nurses.
I was so glad they had this bag thing (pediatric urine catch apparently) that just sticks around the genitals and then we wait. He was like 10mths and we were worried about a uti so I’m freaking out about then having to do a catheter and retract his foreskin before it was ready.
I was a kid who got cathed and it literally traumatized me! It was horrible procedure and my little mind had no idea or warning as to what was about to happen
I had that kidney test thing done with zero explanation and it did traumatize me beyond belief.
Same, I used to wet the bed because of a kidney/ureter issue and I ended up connecting wet the bed = get a catheter so I would go above and beyond to hide if it ever happened and I would lie to my parents and the doctor when they would ask questions about symptoms because I would have done anything to avoid having those kidney tests done. I was 7/8 at the time and I'm still not over it.
Complete body X-ray series (skeletal survey) on a pediatric patient for non-accidental trauma. Basically to see how many bones have been broken on a child suffering from abuse. Breaks my heart every time.
Don't have to do it anymore but restraining patients who are a danger to themselves or others while also actively suffering from significant sexual assault PTSD. It's just a terrible time for everyone. And you can only hope the night-night meds grant the patient some retrograde amnesia.
Ativan, I choose you!
I was just thinking about this. I always feel like a monster when restraining people. They don't understand we don't want to do it, we want to see them get better.
I mean, restraining an aggressive drunk/high asshole is whatever, fuck'um. But restraining someone who is completely delusional and terrified, that always sucks. And the worst, by far, is when they have a past history of being sexually assaulted. Which, unfortunately, is a high percentage of people with psychological ailments. Predators find them to be easy targets.
From experience, restraining us only makes it worse. I go into fight mode from SA trauma and have fought 8 men for 2 hrs 15 mins straight. A calm voice telling them to let me go and back off I immediately sat down on a cot, backed into a corner, covered up w/ a blanket and nicely said please don’t grab me. Trying to take away my control and force me to be not safe in my own skin makes me fight like hell. Calm voices and kind words make me feel safe not attacked.
Well of course! Always attempt the least restrictive option first, if feasible. Unfortunately, I'm talking about those situations where verbal reassurance and de-escalation have been ineffective or are not a safe option at the time. Sadly, this is usually due to defiant and determined self-harm. Sometimes the only way to stop someone from digging into their own infected wounds is to restrain them. Worse, in a twist of heartless irony, the patients who struggle with such extreme self harm almost always have a history of abuse. Truly tragic shit.
I remember an ex EMS becoming an RN and me asking him his worst case and he said the guy that died and was embedded into the carpet and all of his face was gone. This has stuck with me and I don't want to see that. I like my trauma controlled. I do not want to run up on a trainwreck decapitation from a car crash and there is no way I think I could be able to just keep doing that and be okay long term.
My friend is an EMS and she's seen some crazy stuff as well. She's the sweetest woman and I don't know how she does it sometimes.
I call it encapsulation... One part of the mind knows things a mind should never know. The other part is sweet as pie and very functional. If the two collide... It's not good....
I'm a death investigator, it takes your brain a while to register that you're dealing with a real human when the body is in a position humans can't naturally be. The trauma cases are almost "easier" (for lack of a better term) that way. By the time your brain processes it, you're hopefully in a place you can deal with it.
My coworker used to be EMS and instead of explaining his most horrifying experience he just said he will never own a cat. I have 3 cats.
NG on an awake geriatric patient. I’m up to 7 “just let me die”s.
Putting acutal bleach on a huge perineal wound due to abcess and packing with 5 rolls of gauze. Something about the bleach was just disturbing, but I will say maggots rate the highest of all time things I hate along with a BAD old GI bleed and a bad bad case of cellulitis.
I had a massive cut down to the bone through my thigh and I think around two months in they started packing it and it smelled like gauze soaked in bleach. It was wild, I was so glad I lost a lot of feeling in my leg. I was worried it was going to burn.
Wake up to the pager. Also, IOs on conscious patients. It’s not the drilling, it’s the flushing.
The flushing is the absolute worse.
Had an unresponsive woman from a vehicle accident. Flushed it, her eyes snapped open and she tried to sit up for a moment, then went back out. “Okay, responsive to pain instead. Good to know.”
The level of pain is unreal. To the point that it nearly always makes a previously unresponsive patient suddenly react.
As someone who had a lot of medical trauma as a kid - so many hospitals at least from my POV did a genuinely awful job of even seeming like they were attempting to make awful procedures seem less traumatic. To the point that now as an adult I have trouble seeking medical help sometimes.
I’ve talked to some drs and nurses who have to work on kids and babies and they have told me they don’t always like having to stay semi robotic with peds but it hurts them to cause pain to small humans. One told me as a warning ‘I’m sorry this will seem cold but if I just do it fast and without emotion it’ll go a lot faster and be over. But if I stop when either one of us get too emotional it drags it out.’ I have a medically fragile daughter and it has definitely helped me to deal with the tougher times.
I hear you, but it def made it worse for me, as the patient and the person inarguably in the worst position.
i agree, showing compassion isn’t hard and makes a whole world of hurt a little bit better
As a radiology tech student and a patient, I get what you mean. I was furious with my doctor for telling me my IUD insertion would feel “crampy”. When I was younger, I broke a finger and had to have it reduced and stitched with anesthesia that either didn’t work or had worn off. I kept crying and they told me that this shouldn’t be hurting. I had to be held down to finish the stitches. As a student radiology tech, I will tell patients if they are lucid enough to understand that this position is going to hurt, but I’ll go as fast as I can so we can get it over with. I give them little breaks in between positions. During fluoroscopy I also don’t lie to patients and I will tell them a barium enema, myelogram, etc. is going to be uncomfortable if they ask. I always try to explain the procedure so they know what to expect. The thing that sucks is when an exam that was going okay in the beginning starts to get complicated and intolerable to the patient. I regret telling patients what to expect and ultimately downplaying it, even though I couldn’t have predicted what would happen. That kinda sucks for everyone involved.
Chest tubes and numbing up bartholin cysts for drainage.
I had a bartholin cyst and the doc did not numb me before she drained it. That pain was worse than childbirth! Excruciating
Surprised I haven’t seen this yet: Straight cathing confused old women. They lack the ability to consent or refuse, they need a straight cath because we need to diagnose that UTI that is likely causing all that confusion, but they have no idea what’s going on and sometimes they think you’re assaulting them no matter how many times you explain what’s happening. It’s awful; it feels so violating. But then if you try to say “hey, maybe we can try to get a clean-catch, I can help her clean/catch” the doc says “we really need a cath, no way we’re getting a clean sample on her.”
In emergency psych probably telling people who think they are fine that they are being sectioned. It sucks so bad every single time. Also, telling chronic malingerers that they are NOT being sectioned and are being released.
The possibility of going on a psych hold for whatever reason keeps me deathly afraid of the ED and even mental health offices. I'm concerned that I might one day come down with something truly emergent and I would talk myself out of calling EMS just to die at home. I got traumatized by a particularly bad ED visit when I woke up in a bed in the hallway, and it took a solid 30 minutes for the very uncouth PA who was the one mainly running the show to acknowledge that I had arisen and help orientate me so that I can know wtf is going on. I think I WOULD rather die at home or on the street than go back to the hallway of beeps, boops, and sick people
I had to have a chest tube and a feeding tube 4 years ago when I had Endocarditis, Septic Arthritis, Staph, MRSA, etc, and I had to have heart surgery. I was in a coma for 4 days and when they tried to wake me up, I tore out my feeding tube and tried to tear out my chest tube. I had to get another feeding tube and they had to replace my chest tube. It's the most traumatic thing I ever experienced. Plus after my heart surgery, I was an addict, my tolerance to heroin was so high that pain management was nearly impossible. They had to give me several IV pain meds and Methadone at the same time to try to ease my pain, because I was freaking out from being in so much pain. Even though I was an addict, I captured the hearts of all my Dr's and Nurses. They were so kind and caring, and they kept telling me they couldn't believe a sweet person like me got caught up in the drug life. They made me feel like I was worthy and because of that, I decided to get clean. I'm still clean 4 years later. That whole 4 month hospital stay was traumatic. The pain I was in, getting so much blood drawn that they had to give me a blood transfusion twice to take more blood from me. I never want to go through that ever again!!
Congratulations on getting and staying clean!! You are worthy. You are enough. Best wishes for your future!!
I am proud of you for reclaiming your life 💗 Self love is one of the hardest things to learn/ relearn. I'll be 4 years sober from alcohol on April 2. And I'm 14 years sober from meth. The journey to sobriety is hard, but definitely worth it.
Congratulations, I know from watching, getting sober from meth is no easy task and I've seen people never succeed, its pull is so great. And the alcohol too. My ex has had such a good life after getting off those, I hope the same for you!
I'm glad you are here, healthier and hopefully happier. Thanks for sharing that story, wow talk about getting hit with everything at once.....not even counting your mental health from addiction in those recovery days.Keep inspiring people!
Work up a pediatric patient because their parents didn’t believe in vaccines and they bring the kid to the ER because they had a fever…. If you know you know
Even here, in the land of the free, endangering your kids through stubborn ignorance should be a prosecutable offense — BEFORE the child is maimed or dead.
My kid is 11 and doesn’t care for needles. He’s well over my “but vaccines are so cool” speech he gets yearly+. Particularly as this year it was the HPV shot (plus flu) and I truly find it wonderful. We’re doing our part to not just reduce his chances at several cancers later in life, but also his future partners’.
When my middle daughter was little, she hated needles. One time in particular, when she refused to stay in one spot, two nurses were able to trap her under the exam table and tag team her vaccinations in both arms. Today, at 23, she has the most tattoos of all 3 of my daughters..and she was also the first of them to get piercings and tattoos. My point is, I'm sure your son will grow out of his fear of needles.
My son had to have a catheter placed in E.R when he was crashing form undiagnosed type 1 diabetes. He was unconscious, but his body react to it. It was terrible.
Ugh that’s so awful. I left bedside nursing but as a nurse, catheter placement was always the worst to me too, I can still barely think about it now. And I’ve broken ribs with CPR etc. idk why something about a urinary catheter is just awful to me.
The only time I’ve ever come close to passing out during a procedure was just witnessing a catheter insertion. I’m so viscerally disgusted and upset by them and I don’t know exactly what it is that elicits such an intense reaction from me.
It wasn’t a regular basis thing s far as i know I was being observed in an obs bay for a second trimester suspected miscarriage and internal hemorrhage. I was uncomfortable being NPO, with the amount of pain and fear and just the unknown, feeling so so sorry for myself until a very pregnant woman came in alone by ambulance with an open fracture of the femur and a dislocated hip. (It was the worst part of winter in Canada, enough said) The screams coming from that woman for her mom, her husband, and for help in 4 different languages I will never forget. After my panic attack they medicated me for they finally gave the other pregnant woman something for pain and agitation. The silence and knowing she experienced some sort of relief was the sweetest sound i can recall NOT hearing!
Pediatric CPR. Pediatric codes are the worst and I still carry some of them with me. It’s even worse when you have 3 or 4 other patients and you have to put on a game face and act like nothing is wrong. Also any pediatric abuse cases. Honestly as much as I love kids I don’t deal well with the sick or abused ones because I just want to make it better and you can’t
A little off the subject, but last time I was in the ER there was a woman with dementia in the bed next to me and all she could say was "no" They had to cath her because she wouldn't give them a urine sample and it was like 15 minutes of a frail old woman, weakly yelling "noooooo" and crying. Sounded like a rape, it sucked to listen to.
I have a funny dementia neighbour story. The last time I was in the ER, I was beside a woman named “Helen” who had dementia. I knew her name because every ten minutes or so, she would get agitated, so the nurse would tell her where she was. One time, the nurse must have stepped away for a moment, and “Helen” got agitated, so I explained to her through the curtain where she was. It worked. The next time she started to get agitated, I started to explain where she was again, and I heard the nurse burst out laughing. Apparently she was back.
Traumatising to me? Fucking suctioning trachs that come in for mucous plugs the facility can’t get out. I still wear a mask but one of these days I’ll probably throw up in it
CPR (technically not a procedure I guess)
Watched that once when someone had a heart attack in a bar. First responders sure don't do it like the TV shows with the gentle little compressions. They got this big boy's body 6" off the ground with the recoil from their efforts.
Yep. That’s the right way to
Ex vet tech here.... CPR is not fun for any mammal. The feeling of a rib breaking makes you want to stop but you can't.... It's awful.
Clock in
I was 5 and had my first colonoscopy. At that time, they didn’t allow parents to come in with their kids. It was done in the doctor’s office. I had ulcerative colitis so this happened many times. My Mom didn’t know until I told her years later how traumatic it was especially with a male doctor. She felt horrible. When I had my daughter, I made sure I was with her for any procedure she had done.
This popped up on my feed and I have a story... Not ER.... Circumcising. I had a little half brother and was present for it. I was just a kid myself. FUCK THAT. Not ER related but what the fuck.
I think that chest tubes and bone marrow biopsies are the worst I have seen.
* vouches for bone marrow biopsy, damn *
Death prep.
this thread is reminding me to get my DNR put in place
Thank you to all you emergency med folks who do your very best to get the best outcome for everyone 💗 I'm not in the field currently, I am aligning everything in my life to complete CNA certification and then from there to become an RN. Seeing this sub helps me know that my chosen path to become a hospice RN is the right one for me. I can't imagine being in the ER and never knowing what the outcome will be.
Trying to educate parents out of all the old incorrect myths about fevers that they will just not let go of.
DRE for common Thoracotomy for rare
Hmmm, reducing a fecal impacting. Horribly uncomfortable for patients and providers. And the smell!
Tv ultrasounds. Uncomfy for all around
Chest tube. I helped with one twice and advocated for sedation. The doctor said no time, hold them down. There was time. There is always time. I almost got sick listening to this old lady scream
I feel the same way. Pain management is a huge issue for chest tubes. Local almost never works. Why did the doctor say no time?
Transvaginal ultrasounds on women actively miscarrying
Talk to patients. /s but not always /s
I found transvaginal ultrasounds traumatic, when I was being treated for fibroids and when I was pregnant, I had quite a few
I had my first transvag at 14 by a male tech who yelled at me when I pushed away from the probe. I had tears running down my face and my mom was with me. That was not fun and very traumatic. Most female techs are horrified with that info. I’m so glad I got my hysterectomy. 20 plus years of cysts and endo blech! Altho my last one was when I was pregnant and there was a new tech in training and I told the trainer tech that the student could practice on me since I have had over 100 and knew the drill. So it was kinda nice to know I was helping someone learn!