Under an hour

Today began like any other day. Or so thought... until I got to work.

It was a Monday on the acute side of the ER — my least favorite shift. Not because of the chaos or the patients, but because it’s the only shift where scribes don’t have a real workspace. Instead, we’re exiled to the corner with a COW (Computer on Wheels), tucked behind a wall and a sheet of glass like some weird ER aquarium exhibit. We hear muffled voices through the glass, occasionally make eye contact with a provider, and spend most of our shift wondering whether we’re about to get called to a patient… or if we’re just slowly dissolving into the floor.

Anyway, I arrived on time, debriefed with the scribe before me, logged into the EMR, and had just sat down when—boom—red trauma alert. No warm-up. No stretch. Just straight into the fire.

The patient was a transfer from an outside hospital with a large laceration to the back of his knee, a popliteal artery injury. Blood had soaked through the blanket he came in with, and a tourniquet was cinched above his knee. It was my first time seeing a vascular injury like that. The thigh looked like an overinflated water balloon, like it might pop at any second and turn the trauma bay into a Tarantino film set.

The wound wasn’t fully exposed (for good reason), and after a rapid physical exam, the patient was whisked away to imaging. I finally sat down to finish the note, only to be immediately summoned for the next patient. Code Stroke-

Scribe Pro Tip #90000:

Always carry a small notepad when working acute shifts. Code Stroke patients go straight to CT, and there’s usually a human conga line trailing behind the gurney — EMS, nurses, neurology, your provider, and sometimes an extra random person who just really likes CT, I guess.
Trying to wedge your COW into that party? Awkward. Bring the notebook. Jot it down. Type it up later. Your shins and your dignity will thank you.

-So off to CT we go. The wet read didn’t show a stroke, but the patient had the red-flag symptoms: central visual field deficit, dizziness, and an unsteady gait. Labs were totally normal: glucose, troponin, coagulation, all squeaky clean. So… what was going on? A classic ER mystery.

I was typing up my notes when a ripple of commotion passed behind me. I turned around to see a naked patient confidently strolling down the hallway. A nurse called out, “Sir, you need to get back in your room… you’re not wearing any clothes.” He didn’t stop. Just kept walking, gown flapping uselessly in his hand, heading toward other patients’ rooms with the determination of someone who had somewhere to be. Eventually, the streaking ended, and we all went back to charting like nothing happened. 

All in an hour's work in the ED!

Lessons from the Shift:

1. Tourniquet Times Matter. A Lot.
If you're documenting a trauma involving a tourniquet, always write down the exact time it was placed, especially if EMS calls it out. Tourniquets save lives, but they’re not meant to stay on forever — 2 hours max is the general rule. Beyond that, you risk nerve damage, muscle death, or even limb loss.
💡 Bonus tip from my EMT training: If you’re the one placing the tourniquet, write the placement time directly on the patient’s skin or on the tourniquet itself. And as the scribe, be sure to note any reassessments or reapplications in the trauma documentation.

2. Be prepared for anything and never go into a shift with expectations. You will almost always be wrong. There is no predicting what a particular day or shift or time will bring, and there is almost no pattern to the influx of patients into the ED. They come in all the time, everyday, no matter the weather or the season, no matter if it's the weekend or a weekday, no matter if it is 3 o'clock in the morning or 3 in the afternoon. And if you go into a shift thinking: it's a Monday afternoon during the summer on a beautiful day, with barely a cloud in sight, what's the worst that can happen? Prepare to be amazed...

2. Never Expect Anything, not Even the Unexpected.
Never walk into a shift thinking, “It’s a sunny Monday afternoon in July. It’ll probably be quiet.”
The ER laughs at your optimism.
There is no predicting the rhythm of the department. Patients show up at 3 AM, 3 PM, during tornadoes, during fireworks, and during lunch breaks. Sometimes all at once. So keep your notebook handy, your shoes comfortable, and your expectations very, very non-existent.

If you’re new to scribing: buckle up, take notes (literally), and never underestimate how weird and wonderful the ED can be. Some days, you leave with a killer case write-up. Other days, you leave with a story about a naked man and a fascinating tourniquet.

Either way… it’s a win. Or at least a mildly concerning dinner story.