I need to screen print this...

I need this on a shirt so badly....


more cat pictures

They're just words...

I don't know why I have such a problem with certain forms of medical-speak...

I think part of it is I always want to talk so that anyone listening can understand me. I think using all that medical jargon is just trying to "show off" a little. And part of it is my general desire to be difficult...

I get report the other night . First patient presents with "Extreme cephalgia with photophobia"... (So, they have a bad headache, and the light hurts their eyes, huh?).

Second patient is "Status post assault... Bilateral peri-orbital ecchimosis with a large hematoma to their occiput, but no underlying fractures" (Wow!!! You got a couple of shiners going there... I bet that lump on the back of your head, hurts, too... Let me get you an ice bag!)

And so the report goes... Now keep in mind, I have no problem hearing these words. I usually consider it my job to be in the room when the doctor is talking to the patient, and, when the doctor leaves, asking, "Is there anything they said that you would like to hear in plain English?"... And I think that's why I hate the medical jargon so much; it is almost an attempt to avoid having to answer questions, or explaining what's going on... It's like we are trying to show off by speaking in a foreign tongue

Other words I dislike...

Anasarca -

Angioedema -

Urticaria -

Any words that drive you nuts?

Our first "drive in" trauma

Had a crazy night the other night, with a new "first"...

Being a trauma center, one of the things that happens every so often is what we call a "walk-in trauma"...

Usually a gun shot wound, or a stabbing, where the person walks in the front door, or, in the case of some gun shot woulnds, is simply dumped at the front door by a car that speeds off into the night... Doesn't happen often, but it does happen...

It makes for a crazy few minutes; while 4-5 minutes warning doesn't seem like much, in the world of getting ready for a trauma, it is a lifetime. People can get to the trauma bay, X-Ray, lab, respiratory, trauma anesthesia and so on all have to come from different areas. The nurses can get the room "started up" (We always have it stocked and ready, but we can turn the monitors on, and just "fine tune" things.) So these "walk-in" traumas always make for an interesting few moments of rushing...

We have four "trauma bays" It is very rare we get more than three at once (three trauams stretches our resources pretty tight) four can be done, but we will usually "divert" from trauma when we hit three...

There was a huge wreck close to us, with six victims. We were getting four, two others were under age 14, and were stable enough to go to a pediatric trauma center a little farther away. So we were already stretching. I wasn't working trauma that night, but, with four coming, I was pulled into one of them. We knew we were on divert, so when the ambulance door flew open and paramedics come running in with a bloody patient on a backboard saying, "We have another trauma here" we were sort of shocked... The charge nurse said, "Why did you come here without calling, we're on divert"... They just pointed outside....

The patient was a drunk driver who must have seen all the flashing lights and freaked out, floored it, and hit the brick wall around the ambulance entrance to our trauma bay! (at about 40 mph). Luckily, the wall sits up against an elevated dirt area, or the patient might have actually "driven in" instead of being stopped by the wall.

They never even put him in the ambulance; the medics who had unloaded the last four traumas just walked down, extricated him, and wheeled him up the ramp...

So, we got to do a fifth trauma at the same time. Luckily, two of the first four where labeled traumas due to the mechanism of injury, and were able to be moved out of the trauma bay to a regular room, so we had room to take care of number 5...

It was a busy hour, with our first drive-in trauma ever!

A dirty, dripping, slimy disgusting night...

I thought tonight would never end...

I have not seen so many disgusting, slimy, purulent (because we can't chart "pus-sy") wounds!!!

I saw abcesses in two armpits, two forearms, one butt cheek, a thigh and a labia tonight. As a side note, shaving was a major factor in several of these abcesses (shooting up drugs was a close second). One or two I&D's a night is noormal... Tonight I lost count tonight!!!

Add to that a self-inflicted arterial wrist bleed, a (probably weel-deserved) assault on a quite drunk and obnoxious person, and a really gross infected toenail removal, and you have the makings for a totally bloody, kinda gross, but totally cool at the same time night!

It was one of those nights where you want to go hose yourself off before getting in the car for the drive home... sadly, showers was the one thing we didn't put in our new ED locker rooms...

I'm home safe and sound, and the clothes didn't make it more than two-three steps into the house (glad everyone was still asleep!) and the shower was the first order of business, even before I signed in to do some early morning blog-checking...

I hate losing...

I have come to the conclusion that I hate losing.

I know we can't save them all, and some probably are suffering far less once they are gone, but it still pisses me off..

Younger patient this weekend (well, too young to be as sick as they were). Once everything was calmed down, and I could talk with the family, I found out they had started drinking heavily in their teens, and continued on most of their life, until their body started falling apart...

Had just signed on to a hospice service that morning! Had signed DNR paperwork literally less than 12 hours prior to coming in. Patient had end stage liver disease from cirrhosis.

Patient started vomiting bright red blood, and the family called 911. EMS found the patient with a very low blood pressure (like 70's/30's). Got an IV in and started a bolus as they headed in to us...

In rolls a patient the color of a banana, with eyes that glowed yellow. Opened their eyes when you spoke to them, but never really answered any questions. One of those patients you look at, and go, "It's going to be a long, busy night..."

Family didn't come in with the patient. I think they felt guilty for calling 911 (since hospice had told them to call them for any problems) but, obviously, if someone I cared about started spewing blood everywhere, I would have, too...

Long story short, labs showed we were in for a fight, if we were going to fight... Hemoglobin less than 5. Crit less than 17. Bilirubin more than 15. Ammonia over 300, INR over 8...

And, of course, the patient is circling... The doc's call the family and do a great job of explaining the choices... keep them pain-free and provide supportive care, or do the whole shebang. Either way, life expectancy isn't very long...

Family wants everything except surgical intervention and CPR/shocks... So, off to the races we go. Blood up, boluses up, platelets up, lots of IV's... Patient has obvious esophageal bleeding, and we can't keep up... I have dopamine up maxed out, vasopressin up... and I'm still not catching up...

Finally the doctor called the family and said, "If you want to be here when they pass, you need to come now... we're talking minutes, not hours..."

I'm still working, but the pressure is still dropping... Patient still opens their eyes to voice at 50/30, but no pain apparent thank goodness. At 40/20, they are unresponsive... At 30 systolic, I can see an arterial waveform, but can't hear a heartbeat, and they go into agonal breathing... I wonder where the family is... I'm watching the Art line...28..25..20... The ECG becomes erratic, into an escape rhythm, and finally stops... I record the time of death, and let the doc know. He verifies... 4 minutes after time of death, the family comes running in...

I spent quite a while with them, answering questions, telling them there was no pain... After a while, they thank me, and slowly leave, and I get the patient cleaned up and off to the mortuary...

I know the patient is finally free from pain. I know their death was rather peaceful, as far as dying goes...

But I still hate losing...

Received in an Email...

I don't have anything exciting, or even interesting to post... I've been reading the world's dryest textbook all day for school...

But, this made me smile...

A first-grade teacher, Ms. Brooks, was having trouble with one of her students. The teacher asked, "Harry, what's your problem?" Harry answered, "I'm too smart for the 1st grade. My sister is in the 3rd grade and I'm smarter than she is! I think I should be in the 3rd grade too!"

Ms. Brooks had had enough. She took Harry to the principal's office. While Harry waited in the outer office, the teacher explained to the principal what the situation was. The principal told Ms. Brooks he would give the boy a test. If he failed to answer any of his questions he was to go back to the 1st grade and behave. She agreed.

Harry was brought in and the conditions were explained to him and he agreed to take the test.

Principal: "What is 3 x 3?"
Harry: "9."

Principal: "What is 6 x 6? "
Harry: "36."

And so it went with every question the principal thought a 3rd grader should know. The principal looks at Ms. Brooks and tells her, "I think Harry can go to the 3rd grade."

Ms. Brooks says to the principal, "Let me ask him some questions." The principal and Harry both agreed.

Ms. Brooks asks, "What does a cow have four of that I have only two of?"
Harry, after a moment: "Legs."

Ms Brooks: "What is in your pants that you have but I do not have?" The principal wondered why would she ask such a question!
Harry replied: "Pockets."

Ms. Brooks: "What does a dog do that a man steps into?"
Harry: "Pants."

Ms. Brooks: "What goes in hard and pink then comes out soft and sticky?"
The principal's eyes opened really wide and before he could stop the answer, Harry replied, "Bubble gum."

Ms. Brooks: "What does a man do standing up, a woman does sitting down and a dog does on three legs?"
Harry: "Shake hands."

The principal was trembling. Ms. Brooks: "What word starts with an 'F' and ends in 'K' that means a lot of heat and excitement?"
Harry: "Firetruck."

The principal breathed a sigh of relief and told the teacher, "Put Harry in the fifth-grade, I got the last six questions wrong....."

Could this night get any longer???

Oh, what a night!!!

Busy as all get out, but no really sick people...

Were getting them in, working them up, and sending them home... but then it hits a snag...

We have a few doctors that are, for lack of a better word... methodical... They do full workups, horde the charts, take their time making decisions... I try not to say they are purposefully slowing down the care, perhaps they are being careful to make sure they aren't missing anything..

All is well and good on an average evening, when we are thinning out, and enough people are still moving...

Last night we had a methodical doctor working with a mover and shaker... a doc that gets things done... We were crazy busy, like I said, but no really sick people...'

Then our mover and shaker started getting fed up... He was seeing a substantial portion of the patients, and it was becoming obvious... so the mover and shaker stopped picking up charts... When the methodical doc picked up a chart, the mover would pick up a chart...

The rapid result was gridlock... at one point, we had 11 charts waiting to be seen by a doc... The mover looked briefly at each chart, and made sure they weren't "seriously sick". In his defense, he did pick up and see a patient that probably needed to be seen quickly... but I also had another patient, who needed a workup for abdominal pain, that I had drawn and sent labs on a full 90 minutes before a doc (in this case, the methodical one) finally saw the patient and ordered the labs I had drawn way earlier...

Our doc's change shift at 7am just like we do, and to top things off, the "do not see zone" started at 5:45 am... Every chart that hit the rack after that time was left for the day shift docs...

They weren't happy walking in to a overflowing "to be seen" pile... I'm sure the patients weren't too happy, either...

The happy ones were us, for surviving one of the longest nights on record!

Wow... A depressing look at my future...

I am hard at work on my first class leading towards my Master's degree..

It is your basic entry class into a masters program, basically having us all look at the different roles a masters-prepared nurse can take, and getting us to further define our desires for our education.

I am in a learning track leading to a emphasis on Nursing Education. I have felt a desire to get into nursing education in some form as I continue in my career. I have always loved training and education. Probably the job I loved the most in my previous careers was as a "Development Advisor" for a convenience store company, where I was in essence a corporate trainer. I taught classes at a regional training center, developed curriculum for the management training program, and loved every moment. (sadly, the position was eliminated in a "cost-cutting" move)

Combine that with the love I have for nursing, and an overwhelming desire to "give back" to the profession that in a few short years has given so much to me, and the desire for a career in nursing education seems a natural.

As I was doing research for a paper on the history and current challenges in nursing education, I came upon the following statistic:

"In 2003, the average pay rate for a master's-prepared nurse practitioner was $94,213. The same year, the average pay rate for a master's-prepared nursing instructor was $63,916."

I want to get into nursing education for a lot of personal reasons. I have preached many times about money not being important to being happy (I have had many jobs that paid well... I hated most of them.) Ultimately, I do not want to spend a lot of time and money on an education to take a huge step back in pay, however...

While I still have a huge desire in my heart to get into nursing education, it pains me to see how much "dis-incentive" (is that a word?) there is to get into that field. No wonder there is such a shortage of nursing instructors... The same time spent in getting a degree can be so much more lucrative in other fields of nursing...