Sunday, April 25, 2010

That's Just Unsanitary!

Friday was another 12 hour shift in Midsize Non-Trauma Center's ED, and while there were only two people I would actually be able to label "True Emergencies" all shift, there were some VERY interesting cases in other ways, which was impressive given that when I walked in at 645, there were NO PATIENTS IN THE DEPARTMENT. I curled up on one of the swivelly chairs and DIDNT SAY ANYTHING for fear of jinxing it, but as predicted, the "quiet" (oh no! i typed it!) only lasted about half an hour.

The first truly bizarre/awful case of the day was a 500 some-odd pound man, brought in for, ironically "failure to thrive". This MUST only be a social designation, since in neonates "failure to thrive" means they're LITTLE...not this particular gentleman's problem. His problem was bilateral cellulitis of the lower legs. REALLY GROSS cellulitis of the lower legs. They were wrapped in biohazard bags by the medics, who promptly ran outside and started shaking their clothes off on arrival...which is NEVER a good sign. Apparently this gentleman had ROACHES LIVING IN HIS SKIN FOLDS.

The truly odd thing about this large man was that he was COMPLETELY LUCID, and convinced that we were "making a big deal out of nothing!". He was caked in dirt, apparently from "pulling himself across the floor" which he didn't seem to think was a problem in and of itself, and was FURIOUS that he'd been taken out of his house. It took us (me, my partner and three Real Nurses) almost an hour to get him all cleaned up. He was really quite polite, and seemed lucid, albiet with a HUGE blind spot about how bad his house and hygeine really were. He was admitted to med-surg, for placement in assisted living, and may lose both his legs to gangrene.

I learned that the smell of gangrene actually does not upset me nearly as much as I had originally thought. Good to know! On the other hand, I have also learned that I will be itching for the rest of any day when a patient has bugs.

Its tough to know how to feel about a patient like this- on one hand, you KNOW they cannot take care of themselves, because...well...he was dragging himself across the FLOOR in a filthy house! But on the other hand, now we're taking away all his perceived independence. Tough call.


the observer said...

Oh, I so wanted to tell you how to make the redirection stop! I couldn't figure out how (I thought leaving a note for you on Dr. Grumpy's blog might be more than he could stand). I had the same thing happen to one of my blogs.

I really enjoy your blog. I am an RN in the midwest who has a very similar background to yours and I have really enjoyed your blog!

Go forth and pass boards--I'll be cheering you on!

John @ cellulitis infection said...

Cellulitis infection can be very unpleasant and very serious if treatment not begin on time (immediately). Recurrence of this infection is to 50%. Just to know.

The Future Missy Prissy RN said...

OMG, that is awful..I am sure you helped him as best as you could. Sorry to say, but that is just gross. So sorry he has to live like that.

The Future Missy Prissy RN said...

Can I post this post on my site to get feedback of how others in the field would have reacted and/or cared for him? I'll give you the credit and link back to your page? I just believe for us newbies entering the field, we need to be aware of all aspects of the field..


little d, S.N. said...

sure, go ahead Charissa, I think this sort of case combines a LOT of different disciplines, and i'm always looking to learn new things!

The Future Missy Prissy RN said...

Thank you! It is just so horrible, how you never really know how others have to live or the environment they are placed into. I guess we all just make it as conducive as possible with our surroundings..