Triage nurse: Hi , what brings you in today?

BP(brilliant patient) My doctor called, didn’t you get the message?

TN: I didn’t, but we can still get the information from you. Did you see your doc today?

BP: No, I called him, he says I need a Cat scan.

TN: OK, so what’s hurting you ?

BP: My belly

TN: Where does it hurt?

BP: (points to her obese abdomen)

TN: When did it start?

BP:Last night. Oh and I have these sores on my mouth and on my ear too. Could you check it out too?

TN: Let’s stick with the belly for now, What type of pain are you having?

BP: I don’t know it’s just pain

TN: How bad is it on a 1-10 scale?

BP: I don’t know, now it’s zero but last night it was a 10. Are you guys going to do a pregnancy test?

TN: Yes. (tries hard not to roll eyes)

BP: I also want to let the doctor know that I fell in the shower 2 weeks ago and hit my head

TN: Did you lose consciousness?

BP: Yes

TN: Why didn’t you come in then?

BP: I don’t know, I was busy.

TN: (WTF?) I will let the doctor know (who will also roll his eyes). I am going to give you pain medication through your IV now, it may make you sleepy. Were you ever nauseated for the past 24 hours?

BP: Yes

TN: (Why did I ask?I feel like I am putting words into my patient’s mouth because she obviously has nothing better to do than to suck the life out of my cells not to mention tax money on bogus work-ups for NOTHING.Oh, she did get a pregnancy test. Negative, with a collective sigh of relief. My god this chick sucks.)

3 hours, 0.9NS 1 liter bolus, 2 mg Dilaudid, 4 of zofran, and a GI cocktail later:

BP: My neck hurts and I have a headache

TN (I am not the triage nurse anymore, I was moved to the ER and got stuck with BP) I am thinking “Oh no you don’t, not now after 3 hours of your whining and not getting your lard-ass up to the bathroom, you have to use a bedpan.” Did I mention she was 21? She must have walked in here. So I say, “I will let the doctor know, by the way how’s your BELLY pain?”

BP: (in her most “I am going to die breathless voice”) It’s…like…a…three now.

TN: Good, then she informes me that the doctor just came in and ordered a CT scan of her abdomen. D’OH! I am going to bang my head against the wall 100 times, as that would feel better than taking care of this succubus. At least he’s not scanning her head and doing an LP. Thank god for small victories.

Unable to finish her oral contrast for her belly scan she says breathlessly,” I..can’t…drink…anymore.” I say “Fine, you wouldn’t want to make yourself more nauseated” At which point she tells me she’s still nauseated.

Hear that? It’s the banging of my head upon the wall….

It’s like every symptom I end or begin a sentence with, she tells me she has it. This type of patient is not sick. It’s like she’s bored with her life… at 21. I wanted to tell her to go to a coffee shop and read. Go to the mall or take a road trip if you are bored. Hang out with friends. How about go to school? Maybe study once in a while. Learn something and become productive instead of a burden.

2 and 1/2 hours later, she’s discharged with a script for Protonix and Zofran. The total time spent sucking resources? 5 1/2 hours. More than half of my shift. I said here’s a doctor to follow up with, I suggested 3 separate times that she follows up with this on-call MD that I circled a few dozen times on the discharge paper.

Me: Any questions?

BP: Can I get a work note?

I currently own RollerNurse.com, but I’m not sure if I like that as much as I like my current site (nurseonwheels.wordpress.com).

So do I change the name as it will allow me more freedom for creativity or do I stick with my current (free) one?

I like Rollernurse, it reminds me of Rollerpig from the Simpson’s movie. I could make up a theme song.Any of you blog veterans have some input?

The player’s agent told The Associated Press on Monday that Zednik is recovering at a Buffalo hospital. Zednick lost a drastic amount of blood Sunday during the game against the Sabres. He accidentally was sliced across the right side of the throat by teammate Olli Jokinen’s skate. Turns out he’s going to be okay.

If you are a nurse like me you want to see the video, not for the shock factor but more for an educational purpose: to see how much blood is lost when something like this actually happens. Does anyone know? I also heard on the news that it missed his jugular, thank goodness.

I would think that he easily lost a liter in minutes, correct? When I heard this on the news, all I kept thinking was, how volume-depleted was he when he got to the hospital? Does someone have their finger in the dam until surgery? How do you control this until he gets to surgery? How long does he have until blood flow to his brain is seriously compromised? How do you tube him in the ER? With someone holding pressure to the carotid simultaneously? I want logistics, people. Need answers.

I have taken care of soft-tissue injuries to the neck like GSW’s. But never before a severed carotid artery.

I looked up stroke volume and I am getting numbers like 120mls. So with each systole roughly 100cc’s of blood is forced out of the heart. I wonder how much gets through to each carotid.

Has anyone ever taken care of this? I am thinking that since this happened in a sports arena with medical staff ready and waiting, this guy’s chance of survival increased. But when this sort of thing plays out on the streets? I can’t think it would be as good as a chance for survival.

Maybe there are a few people reading this blog, maybe not, but I want to see what the thoughts are on this situation:

I had a cardiac arrest patient, 55 male Hx of diabetes and high cholesterol, found prone on the floor of his apartment in cardiac arrest by a female on scene (I will get to who this is in a minute)

He gets brought in by medics who tell me his wife found him unresponsive. We do a round and then call it. A few minutes later I get a phone call from a woman stating she’s his roomate. Roomate? I am starting to think of all things shady. I asked her to tell me the last name of the patient and then I tell her to hang on. Ok, now what do I do? Roomate? I thought his wife was on scene. Then I ask a very helpful registration clerk to see about a next of kin on a previous visit. It listed a sister. Am I wrong to be pissed at the medics for telling me this was his wife? Is that info you ask on scene? Wouldn’t a medic’s spider sense tip him off that this female wasn’t his wife? Sometimes you just “know,” you know what I mean? If I am totally wrong about this, I would love to hear about it.

Anyhoo, I figure it’s safe to tell this roomate to come to the hospital as the patient is very “sick.” Then I place a call to the sister listed on the demo sheet. I leave a message to call me. Then who should come into the ER? A Chaplain! Yes, now I can worry about my 20 year old DKA patient and my 90 year old lady on BIPAP because for sure this wonderful man will take over all these details regarding this dead man. That wasn’t the case.

Let me preface, I have nothing but love for the chaplains at my hospital. They are always very helpful and I can tell that the family members really appreciate them, as do I. But this was an exception.

I told the chaplain that I was waiting on a call back from this patient’s sister. BTW, it was up for grabs in the ER. I was told, “Well then, I am going out to grab a sandwich.” Excuse me? Then could you get me one as I haven’t eaten in 6 hours.

I swear sometimes there is more work to be done for a deceased patient than for someone who is alive. I get a few more calls from people who aren’t his next of kin, each call taking me out of a living, barely breathing patient’s room. I just keep thinking, this is so wrong! Where’s my chaplain? Oh, yeah he had to eat.

I finally got a call back from the sister and it wasn’t pretty, she was hysterical (with every reason to be) and I couldn’t tell her he was dead, just he’s “very sick” and please come to the hospital. They must have been close.

The chaplain comes back from Jimmy Johns and tells me he’s placed the female roomate and a male roomate in the quiet room and would I please go talk to them. These are the people who basically found him dead, and I can’t tell them he’s dead. I said, what would I tell them, I can’t tell them anything! He insisted I go. I insisted no. He followed me as I was trying to take care of my other patients. Isn’t it his job to sit with them and offer emotional assistance? Isn’t this why we have a chaplain? To help take some of the load off and counsel family, as nurses are sometimes, no wait, always too busy.

It is truly tragic for the family/friends when someone passes in the ER, and I often wish I could spend more time with the family. But it wasn’t right that I was pulled away from sick patients to socialize with family members. All I kept thinking was how am I getting out of here to go hang that insulin drip? One of my patients could die and I am sitting here talking about a deceased guy. I wanted to scream at that chaplain. I am sitting in this room fielding questions like, “Are his eyes open?” or “Can he hear you?” It was like twenty questions. It was amazing how many questions it took to determine that he was dead without me telling them those actual words. Denial is a strong emotion. I wanted to say “I wouldn’t be in this room speaking to you if he was alive.”

If you are thinking, why isn’t the ER MD doing this? It was THAT busy. Every worst case scenario was rolling in that day. He wasn’t going to monkey around with people who weren’t family.

By the end of the day, I had stayed 2 hours after the end of my shift to “wrap-up” what needed to be done with this guy. What a day. What a frustrating day. I am just glad that chaplain got something to eat.

My daughter doesn’t like to play quietly. She’s not one of those children that plays with the Little People town for 30-45 minutes straight. In fact, it has been brought to my attention that there may be an attention span issue with her by her preschool teacher.  At first I was angry, thinking she’s only 3. But as time has gone on, I am so relieved that a professional noted this. From the day she started walking she’s has been in 5th gear. I was so exhausted by the end of the day when she was around 15-19 months, wondering, if I can work in a busy ER taking care of fools all day why is this so hard? I kind of felt like a failure because I thought I couldn’t meet her high-energy needs everyday. I am only human and my child was a race car. No Joke.

So here ‘s this study

It was done in 2004, but I think this is still the general consensus. I remember reading about this and thinking, how many hours has my kid logged with Baby Einstein DVD’s? Holy crap, she’s going to have ADHD! No wonder she’s spastic! What do I do? I always think of this study when my daughter watches a little TV and hammer myself with a guilt trip.

The answer is right now, nothing.

I don’t really believe that TV causes ADHD. I think TV can take away time needed to be spent with a parent reading a book or playing, stimulating those growing brain cells. TV is simply a mindless activity and I think  it can be used in an appropriate situations with children. Sometimes a child needs a break, too. Sometimes mom needs to do laundry or fix dinner or catch up with a friend on the phone for a half-hour. Lately I find myself stressing about how many hours she’s “logged” with the TV.

Let’s be real, it was 7 degrees for the past two weeks and my daughter may have watched more TV than usual. What are we supposed to do, after we’ve ran out of crafts, cut the last of the playdoh barber-shop hair, wrote our names 50 times, and had numerous airplane rides on my feet? Sometimes you need to just sit and watch Elmo. Just be together.

Here’s the American academy of Pediatrics stance on TV and toddlers. Apparently they never have laundry to do or a meal to fix.

Here’s something to read that made me feel better . It’s from the New York times and it summarizes a study by the Pediatric Journal of Nursing on what it feels like to have ADHD.

If you want to read the entire study by Shattell, Bartlett and Rowe, click here 

I have come to the realization that I have a high-energy kid, a spirited child.  And boy do I like that. I wouldn’t want it any other way. That energy will serve her well as she matures. One thing I know, I will encourage her to find a career that is not spent behind a desk.  Not that a desk job is bad, I am just so glad I knew my boredom with being stationary when I picked Nursing as my major. (11 years ago) Wow time flies.

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As a child, every single time that show would come on I would rush to the TV for the starting credits/music to wait for the passing ambulance with lights and sirens. It was only a split second, but I believe that was my first inkling that I wanted to be in the health care field.

I  thought those doctors and nurses were so cool.

Rest in Peace Shell Kepler. 

I was watching the democratic debate last night and contemplated how we are going to put a plan together to give everyone health insurance. What is the first step? I guess we have to start at ground level. Prevention. What are the top killers of Americans? Diabetes, cancer, heart disease are the big ones that come to mind. If we can aim efforts to prevent maybe we can stave off huge medical bills when patients get older. Start at 18 or earlier. Of course, you can lead a horse to water –blah blah.  It would take a while to see results as these patients get older, but isn’t that the point? Making the world better for the next generation?

Maybe we should start with those “biggies” and put in place mandated education and screening for them. Who better than to do it? Nurses.

The same kind of situation where a newborn baby has the hearing and PKU screening test. It’s simply the law. Primary care doctors have to see kids to get into college, why not do it then? Fasting blood sugar and cholesterol could be done at that time. Questionnaires about each of these diseases could be completed by the student/parent. Even if the vast majority of these screens are negative, doesn’t it somehow plant a seed in the teenager’s head that these diseases are real? Nurse’s have an opportunity at that point to educate. Nurses also can follow these patients up.

I remember a slide show that was mandatory in college during the first week of freshman orientation. It was a slide show of all of the STD’s and a picture of the genitalia that went with each affliction. I NEVER forgot about that.  The Health center doctor basically said, see that cute boy/girl across the room? Yeah, they have this…flashes genital warts slide….now tell me, do you want to get with them now? That was good preventative medicine. At least for me.

My point is plant the seed early. I am not a politician or lawmaker so I don’t know how that will translate, but a lot of people out there have no sense of personal responsibility. I don’t know how someone can become and adult and not know there are consequences to their actions or lack thereof. Wait, I know, because the government will take care of everything if you don’t work, or have a bunch of kids that you can’t afford. We should stop that now with the next generation.

Should everybody that is “on the dole” stay on the dole? Should the middle class keep busting their butts and have to pay for the ignorant? Should smokers get medicaid? I don’t think so. You smoke, you get cancer– easy explanation. I know that welfare is necessary, I am just talking about the abusers of it.

Personal responsibility regarding health needs to start early. There needs to be a major push regarding excercise and diet in all schools. Remember when Ahhnrold Schwarzenegger was that presidential fitness guy back in the 90′s? I remember getting awards in gym class from him/government just for doing 20 push-ups. It was cool. Guess what ? I still exercise 20 years later.

It will be a big task with results not immediately seen, but I think that’s the stance everyone has to take on it. Prevention–start it early and have the government pay for a series of preventative screenings from childhood. If you don’t comply with the necessary screenings throughout your life, maybe medicare shouldn’t be available to you later. There’s the consequence. At least it puts a little fear into people to make good choices and see a doctor every once in a while.

The Super bowl is almost here and there was an article in yesterday’s Chicago Tribune that said Americans are about to ingest 25,000 tons of guacamole this Sunday. Holy guacamole! I bet  most people make their guacamole with sour cream. Guacamole wouldn’t be so bad for you if it wasn’t for the sour cream.  Just don’t use it. Put a little garlic salt and cumin, sprinkle some lime juice-Viola!

I thought I need to take a look at the avocado since I have been ingesting a lot of them over the past year or so.

Here’s a article about a study from Clemson University that was prompted by a Seinfeld episode. Remember the famous “double dip” episode? This study may surprise you. It says that if you was to kiss everyone in the room at a party, then double dip your chip. Thicker dips get more bacteria onto your chip compared to bacteria left in the bowl. Interesting.

I just love avocados. Love, love,  love.  Here’s a few facts on our wonderful avocado:

The avocado is a fruit. One of the only fruits with monounsaturated fat

90% of avocados eaten in the US are from California

A single avocado tree can produce up to 500 avocados a year (I want one in my backyard, kinda’ hard up here)

Avocados, due to their mono and polyunsaturated fat content, are a healthy substitution for foods rich in saturated fat

One-fifth of a medium avocado (1 oz) has 50 calories and contributes nearly 20 vitamins and minerals making it a good nutrient choice

Avocados contain 76 milligrams beta-sitosterol in a 3-oz serving of avocado. Beta-sitosterol is a natural plant sterol which may help maintain healthy cholesterol levels.

You can get more info here

I stopped eating them last fall, to tell you the truth I was all avocadoed-out. But for approx 1 year I was eating about 4 per week. I never gained a pound. My cholesterol screens were fine, too. I have 5 of them in a paper bag with an apple awaiting my hunger strike. Mmmmmmmmmmmm………butter pears.

This article is regarding the FDA pulling of cold medicines. It talks about children taking these medicines unsupervised.  This article states that cold medicines sent 7,000 kids were sent to ER’s  each year and 2/3 of those visits were for for taking the medicine unsupervised. What? There should never be any medication left in a room with a preschooler without an adult present. (A sober adult, please) Because that preschooler knows that grape flavored Tylenol tastes like candy and will chug the bottle.

So the FDA pulled these meds from the shelves. This article is quite unclear as to the real reason why, but I am assuming it’s related to overdoses, both by children and parents who aren’t reading the label and can’t stand junior’s cough/runny nose.

Speaking of runny noses…

I once had this cute 3 year old patient who was just being discharged with fever/congestion, when she pointed to her nose and I looked in it. I saw something in both nares and called the MD over. He pulled out a small piece of foam-like material out of each nare and the pieces were green!  They were folded up in the nare. That was the source of the fever! I felt so bad for that little girl. The mom said it was the babysitter and she was crying when we showed her the foam. I believed her. How long were those pieces in there? Poor thing.

Back on to the subject I started writing about, damn I am a spaz…

I am a living example (thank you, Mom) of why you should never tell your child that medicine tastes like candy.

When I was around 4, parents were allowed to give ASA to children for fevers/colds and such. Remember those orangy chalky tasting baby ASA’s? Well even though my mother put them up on the highest out of reach shelf, I scaled the  wall like spiderman and took the entire new bottle (I am assuming there were no child-proof caps either)My mom says she remembers thinking, “There’s no WAY she took all of those pills that fast, and was that the old bottle or the new one?”

Thank you mom for taking me to the ER. I definitely would have been a goner. I actually remember that tube going down my throat.

When my daughter says, “I’m sick, I need Motrin.” I get shivers down my spine. She only wants it because it tastes like candy. I explain to her that medicine is very dangerous even though it tastes good. I wished Motrin tasted like eggs or something gross but edible. Then I tell her my aspirin  story. I will tell her my story every single time she asks for medicine. That will make her stop. BTW I don’t even buy Flintstones vitamins because I think they taste good and look like pills. Did you ever see those “Gummi Vitamins?” Double NO. I hate those. I want to pitch them out the store when I see them. I don’t want her getting any wrong ideas about vitamins/medicine. My daughter is going to get scurvy, I guess.

Here’s a better link with info regarding medications, their storage and children:

http://www.cdc.gov/ncipc/factsheets/poisonprevention.htm

I know I have this problem of expecting people to have the same work ethic as me, but I have to call it as I see it–bag ‘o bones laziness. That’s it.

There are three patients on our Pod with four nurses. It was really slow. One nurse had a moderately sick person and I got a new pt with unstable angina, CABG 10 years ago and he’s only 51. Do these other 2 nurses get up off their asses to help? No. Throw me a bone. This guy needed a lot-Lopressor, Morphine, Heparin, Nitro, EKG, blood+2 lines. His troponin comes back positive. Nothing is helping his chest pain. It took me an hour to get all of this preliminary work done (during which I hear said nurse take personal calls at the desk) and when I finally come out of the room and I sit to start documenting, she has the audacity to say,”Can you take a rectal pain” in room 5? Please. I wish I had a rectal pain patient. Easy. I don’t have to worry about him having an MI.

And the kicker? The patient had been in the room for 30 minutes! I was taking care of unstable angina man while that man was waiting. Not my patient, sorry. Get up off your carb-loaded ass and WORK! I told her no–very hard for me to do.

I just don’t appreciate being used and abused because I work hard and push myself. I don’t mind working hard, but when there are patients sitting there waiting and no nurses are walking into the room for 30 minutes because they are lazy–it seriously fumes me. About 30 minutes before said nurse is supposed to leave, we get an unresponsive pt, she has the balls to tell me,”WE have to double team this patient, ” I said, “uh no, I am busy and I don’t care that you are leaving soon.” Felt good.