Only 30 minutes into my shift and the nurse and I are deep in conversation. About what you may ask? Foley catheter's. Some may find this a boring subject, but when you work where I work, its never the play-by-play of how to do it. These conversations come jam-packed with side stories; bladders that have been ruptured, injured or just plain funny faces from patients during a totally uncomfortable process.
It's another slow night at my friendly neighborhood job site and so I'm taking the time to read up on blogs, read my textbooks and whine about the boss man and their crazy ideas. (Trust me, if your boss thought you should stay awake for 40 some-odd hours you would bitch too.) While doing all of this and practicing patient care, the nurse and I continue a long conversation that should last all night.
The conversation jumps and suddenly we are on the topic of partners. How odd. I think to myself as I listen to her talk about past hospitals she has worked in. This was the last topic on the Handover Blog... Ironic. However, as I have come to learn to do in this job I just roll with it. The nurse I am working with and I haven't always gotten along well. We are from the same mold, she and I. Both stubborn, outspoken, smart, and fiery. We discussed how we hated each other when I began working with her, and then how over time we quickly became close colleagues.
When I first came to this unit I quickly became close friends with one nurse, and disliked the other, because the other nurse was very vocal about her opinions and me being the new girl took ALL of it to heart. (The nurse with the conspiracy theories is the one who I befriended first. There's only two night nurses that I work with) However, it didn't take long to realize why, it was because we were both strangers to each other, and that scared us both. Working one-on-one with somebody is a tough thing to do for 12 hours a day, 3 days a week; which is why if you like your partner, (or colleague) its a blessing unlike any other.
In EMT school my teacher always emphasized on how we would walk away from that class with lifelong friends. I rolled my eyes and sighed every time I heard it, however, those kids, the EMT's in my life are the people who I have loved, hated, befriended, disliked, and after so long everything has fallen into place that we are all still amazing friends. My partner from that class, for example was assigned to me, and I was scared to see where things went. I was a rough-neck hillbilly from Crazy Hick High School, and she came from the prissy rich upper East side. At first I laughed at her and begged my teacher for the other hillbilly student in hopes that between practicing CPR I could use trucks and mudding as conversations. But my request was denied and my partner stayed the 90 lb. brunette. It only took days before we became best friends, and still to this day are great friends. Some of the other kids in my class that we shared rooms with, shared good and bad days with, we have all stayed in touch... I never thought that a couple of kids saving lives for fun could turn into such an amazing bond.
My nurse, knowing my dream of becoming a paramedic, asks me about some of the decisions I have made regarding schooling, work and my personal life. We talk about it for awhile and she looks to me. "You're learning so much more here, doing shifts like these than a textbook paramedic, so even if your gonna be doing what you do for a little while longer, that's okay. It'll make you better in the long run."
I looked to her. "Yeah," I agree, "But do you think I'll learn paramedic skills in a hospital?"
"Absolutely." She replies, grabbing a chart. "You'll learn it all the slow way, perfect it then be able to whip it outta nowhere when it comes time for you to preform in an emergent situation. Hell, the nurses station can be your little ambulance bay!" We both laugh and continue on with our shift. But it made me think about how lucky I am to have such a great team here, and such great night shift 'partners.' When you think about it, its not just working nights. Its working when its just us, and no one else. In our hospital, if shit hits the fan, then we are forced to dial 911, not the ER, which can be scary.
But another big thing happened tonight. When shift change is over we are supposed to go introduce ourselves to the patients by giving them our name and title. Generally if the other is busy with another task we do it for the other, so I would write my name and title on the board, and then the nurses. Every night, I see Dani, CNA (or HCA) written on the board, but tonight, I saw something different. Dani, EMT-B
Friday, May 29, 2009
Looking Back at Myself
At times its hard to remember why I fell in love with medicine, I have been doing this longer than anyone else my age (having gotten my CNA license before my drivers license). There are nights that I question why I was crazy enough to willingly submit myself to the things I do.
This is a picture of me at the ripe ole age of seventeen. I was young, open-minded, excited, and ambitious. In this photo, I was doing what I loved most in the world. Unlike 'normal' seventeen year olds, I didn't waste my Fridays and Saturdays dating, they were spent with a first aid kit. I had been a volunteer EMT at a BMX track since I had turned 15, and was using all the skills I had learned in my EMT-B class at the track. As time passed and I learned more, I was trusted more and my patients would come to me after their crashes and I loved to bandage them up. I had this dream of the medic I would one day be, of how all the injuries I was bandaging up now would have trained me for the gory MVA's I would see later on in my life.
On the indoor track, where I spent most my time playing medic, there was what is termed a 'sweeper', which is a flat turn on a BMX track. (A burm is a rounded turn on the track.) Our sweeper was placed behind the third turn, and the track coiled itself nicely around the small equestrian center. However, one night, a new volunteer was sent to the sweeper, and when the dirt gets too wet, too dry, or even too over swept, it becomes dangerous.
But it doesn't take me too long to step back and think about where I was, who I was and where I have come from since then.
This is a picture of me at the ripe ole age of seventeen. I was young, open-minded, excited, and ambitious. In this photo, I was doing what I loved most in the world. Unlike 'normal' seventeen year olds, I didn't waste my Fridays and Saturdays dating, they were spent with a first aid kit. I had been a volunteer EMT at a BMX track since I had turned 15, and was using all the skills I had learned in my EMT-B class at the track. As time passed and I learned more, I was trusted more and my patients would come to me after their crashes and I loved to bandage them up. I had this dream of the medic I would one day be, of how all the injuries I was bandaging up now would have trained me for the gory MVA's I would see later on in my life. 
I had seen a lot in just a short while, from head injuries, fractured skulls, broken legs, concussions and heaven knows how many cases of 'road rash' (which was personally my favorite, it was something that didn't require a visit to your friendly neighborhood hospital). BMX parents who worked in hospitals would bring the supplies (remember it was a volunteer medic position) and I would fix everyone who needed the help. The ambulance and fire service in the area of the track and I got to know each other pretty well, and before too long we could transport patients and make it look like a scene from a movie. However, it wasn't just a teenager with a passion to heal people, I was taking care of people that I knew and loved.
On the indoor track, where I spent most my time playing medic, there was what is termed a 'sweeper', which is a flat turn on a BMX track. (A burm is a rounded turn on the track.) Our sweeper was placed behind the third turn, and the track coiled itself nicely around the small equestrian center. However, one night, a new volunteer was sent to the sweeper, and when the dirt gets too wet, too dry, or even too over swept, it becomes dangerous.
An adult male about 35 years old crashed, hard. We didn't see the crash, but we could see his bike flying out from under him and into the air. Grabbing my jump kit we ran to the sweeper and yelled to the volunteers to stop the riders while we assessed the patient. At this time the only other person with first responder skills was my dad, so the two of us jumped into action. I immediately saw that we was lying on his side and as his wife ran to him 
he fell onto his back. This was when I realized that he was no responding.
he fell onto his back. This was when I realized that he was no responding. " John Doe! John Doe!' I yelled to him, patting his chest. He didn't reply so I immediately instructed another racer nearby to hold the C-spine for me while I moved onto the rest of my assessment, testing to see if he was responsive to pain. He wasn't.
"I need someone to call 911!" My dad yelled. I leaned into my patient and felt to see if they were breathing, they were, then I leaned in and checked for a pulse, it too was there. Adrenaline pumped through my veins and I looked to my patient as I tried to check AVPU again, as I did so, I noticed that a visible hematoma was forming around his cheekbone, and within the seconds it took us to determine the need for 911 his face was becoming bruised. "I need 911!" My dad yelled again.
Adrenaline pumped through my veins like ice and I continued onto a head-to-toe assessment, ust like I had been trained to do. We came to learn from this that not only did he have a facial injury, but was tender around his ribs. As the ambulance pulled into the building and the fire fighters brought out a backboard I obtained the C-spine once more and waited for the direction of the fire fighters to place him on it. We did and as we did so we literally ran to the rig and I explained my basic assessment of my patient.
Two weeks later I got a call from his wife, he fractured his zygomaticus, 2 ribs and did have a hefty bleed in his cheekbone. If it wasn't for quick responders, he may not have even gotten onto an ambulance. It was one of my first real saves as an EMT, even if it wasn't completely my save.
So on nights like tonight that are so slow you can feel your dinner metabolising, and you can hear the nurses heartbeat, I think back to back when. Things have changed since then, even if its only been a few years, and I quickly realize that in a few years from now I'll have more awesome stories to share, and I'll look back at the me now and laugh. It's all a growing process, even when its slow.
________P.S. I am very aware these are HORRIBLE pictures of myself and I have contemplated NOT posting these, but they were the only ones I have from this era, and they worked all too well.
Thursday, May 28, 2009
The Body Never Lies - How we Communicate
Generally speaking my unit slows down around 5 pm. PACU, Pre-Op and the OR staff all goes home. Doctors either go to other hospitals or home to their families. Nurses slowly make their way out of the building and we arrive for night shift to a generally quiet hospital. Tonight however, was something far different than what I was used to, as I arrived to work. Jumping between helping in PACU and my unit, I got to see snippets of what goes on during the days, during the busy times and during our shifts, and was reminded of a huge factor that is often overlooked as a big part of medicine. Communication.
Verbal Orders, reports, standing orders, charts, rounds, phone reports, written orders; there are literally hundreds of ways we communicate to one another in a hospital. The communication never ends; from physican to residents, residents to nurses, nurses to CNA's, and so on and so forth. Communication is the number one tool to accurate diagnositcs.
This last weekend I went to Las Vegas and got a chance to see the 'Bodies' Exhibit, located at the Luxor. When you first enter the exhibit you see a painted quote on the wall in big bold letters, reading; "The Body Never Lies." When we think about communication, we think of it as one human being to another, but in medicine communication continues down to a cellular level. We quickly learn to listen to the body, not the lies, because as Dr. House says 'Everybody lies.'
A prime example of this was during my clinicals on an ambulance, we got called to a 'unknown cause' to a pretty familiar spot downtown. When we picked up our patient it was a young female who complained of loss of bladder control and abdominal pain. I asked two questions; "Are you Pregnant?" and "Are you sexually active?" Both questions she replied no to. The paramedic I was shadowing placed his stethoscope to her stomach and then asked if he could palpate her abdomen. Whatever kicked his hand in return proved otherwise.
Tonight we asked a patient if he has any allergies. If we were to listen to the patient, we would've given him multiple doses of a medication that would have ultimately killed him should we have listened only to him. However, we noticed the hives appear up and down his the soft tissues on his arms, stomach and back and immediately quit the dosages of that medication. He informed us later on that he knew he was allergic and 'forgot' to mention it to us. Good thing the body never lies.
As I'm writing this communication is going on all around me. Patients are talking to their loved ones, the nurse is figuring out the medication reports, and I have a chart open next to me as I chart the post-op vitals. The phone will ring as physicans call in, gathering information about their patients, and I am sitting here, writing about all that goes on around me, and embracing it.
Imagine a hospital with no communication, with no way of telling others the care you gave, the patients condition, imagine our world without communication. Would we even exsist?
Verbal Orders, reports, standing orders, charts, rounds, phone reports, written orders; there are literally hundreds of ways we communicate to one another in a hospital. The communication never ends; from physican to residents, residents to nurses, nurses to CNA's, and so on and so forth. Communication is the number one tool to accurate diagnositcs.
This last weekend I went to Las Vegas and got a chance to see the 'Bodies' Exhibit, located at the Luxor. When you first enter the exhibit you see a painted quote on the wall in big bold letters, reading; "The Body Never Lies." When we think about communication, we think of it as one human being to another, but in medicine communication continues down to a cellular level. We quickly learn to listen to the body, not the lies, because as Dr. House says 'Everybody lies.'
A prime example of this was during my clinicals on an ambulance, we got called to a 'unknown cause' to a pretty familiar spot downtown. When we picked up our patient it was a young female who complained of loss of bladder control and abdominal pain. I asked two questions; "Are you Pregnant?" and "Are you sexually active?" Both questions she replied no to. The paramedic I was shadowing placed his stethoscope to her stomach and then asked if he could palpate her abdomen. Whatever kicked his hand in return proved otherwise.
Tonight we asked a patient if he has any allergies. If we were to listen to the patient, we would've given him multiple doses of a medication that would have ultimately killed him should we have listened only to him. However, we noticed the hives appear up and down his the soft tissues on his arms, stomach and back and immediately quit the dosages of that medication. He informed us later on that he knew he was allergic and 'forgot' to mention it to us. Good thing the body never lies.
As I'm writing this communication is going on all around me. Patients are talking to their loved ones, the nurse is figuring out the medication reports, and I have a chart open next to me as I chart the post-op vitals. The phone will ring as physicans call in, gathering information about their patients, and I am sitting here, writing about all that goes on around me, and embracing it.
Imagine a hospital with no communication, with no way of telling others the care you gave, the patients condition, imagine our world without communication. Would we even exsist?
Tuesday, May 26, 2009
Medicine Simply Doesn't Wait
"I'm gonna make it through this right?"
I looked down at the frail elderly man who asked me this question. His face looked worn and tired, but his brown eyes looked hopeful and worried as he looked up at me. I touched his arm and looked at him warmly. He had been sick all afternoon and finally placed in a 1:1, where I was called to assist for a moment, after studying his face and helping him get cleaned up, I provided him with my answer. "Im gonna do my damndest to make sure you get better."
Illnesses dont take holidays, Patients don't take breaks. Medicine simply doesn't wait. When you work on an ambulance or even on an air ambulance this is considered a rush, but when you work in a hospital medical unit, this is considered tedious. By no means is patient care annoying, but when you have patients that are considered 'high matienance,' and they are stable, that takes away from the truly ill patients and their care.
People don't understand how worn out you get from working the same 12 hour shifts week to week. Generally speaking, other people, the people we consider 'normal folks' don't deal with death in their jobs. Most people don't feel their hearts break every time they enter a patient room to assist them with simple needs. These normal folks don't have to expose themselves to commincable
diseases, have no need to worry about infections that were caught too late. I once saw a father wearing a t-shirt that read 'My daughter does battle with the angel of death 40 hours a week. What does your daughter do?' Almost every week this is how it feels, a never ending battle with the inevitable.
Liver Failure. Obesity. Depression. Cellulitis. Anxiety. CF. Diabetes. Week after week. Month after month. After so many hours, so many days of working, and so many months of giving to others and not even considering your own needs, you start to contemplate who the patient really is. Then to make matters worse, family, friends and your loved one becomes the patient. Life doesn't give out breaks. You don't get a vacation from life.
'This world keeps spinning faster, to a new disaster, so I run to you, I run to you baby.
When it all starts coming undone baby your the only one I run to. I run to you, I run to you."
-Lady Antebellum (I run to you)
I looked down at the frail elderly man who asked me this question. His face looked worn and tired, but his brown eyes looked hopeful and worried as he looked up at me. I touched his arm and looked at him warmly. He had been sick all afternoon and finally placed in a 1:1, where I was called to assist for a moment, after studying his face and helping him get cleaned up, I provided him with my answer. "Im gonna do my damndest to make sure you get better."
Illnesses dont take holidays, Patients don't take breaks. Medicine simply doesn't wait. When you work on an ambulance or even on an air ambulance this is considered a rush, but when you work in a hospital medical unit, this is considered tedious. By no means is patient care annoying, but when you have patients that are considered 'high matienance,' and they are stable, that takes away from the truly ill patients and their care.
People don't understand how worn out you get from working the same 12 hour shifts week to week. Generally speaking, other people, the people we consider 'normal folks' don't deal with death in their jobs. Most people don't feel their hearts break every time they enter a patient room to assist them with simple needs. These normal folks don't have to expose themselves to commincable
diseases, have no need to worry about infections that were caught too late. I once saw a father wearing a t-shirt that read 'My daughter does battle with the angel of death 40 hours a week. What does your daughter do?' Almost every week this is how it feels, a never ending battle with the inevitable.Liver Failure. Obesity. Depression. Cellulitis. Anxiety. CF. Diabetes. Week after week. Month after month. After so many hours, so many days of working, and so many months of giving to others and not even considering your own needs, you start to contemplate who the patient really is. Then to make matters worse, family, friends and your loved one becomes the patient. Life doesn't give out breaks. You don't get a vacation from life.
'This world keeps spinning faster, to a new disaster, so I run to you, I run to you baby.
When it all starts coming undone baby your the only one I run to. I run to you, I run to you."
-Lady Antebellum (I run to you)
Saturday, May 23, 2009
Humanity : The Search for Something
Humanity is always in search of something. We search for more, we search for less, we search for simple things, and the most complicated of things, and when you work the job I do, you see the search daily. EMT's, CNA's, RN's, Paramedics, we all are exposed to this battle for searching for something, and so we search for outlets. Some use sports as an athletic outlet, others art, and some of us use writing, but almost every human being uses music as a part of their lives. Music plays an enormous part in being human beings, and so we embrace it for its multiple qualities.
Every day when I drive into work I set my Ipod to my 'Hospital Playlist.' Its taken me quite awhile to compile this playlist, and the songs include the following:
Life is short - Butterfly Boucher / Where I stood - Missy Higgins / Be Ok - Ingrid Michaelson / Kristy, Are you doing okay? - The Offspring / Peace of Mind- Boston / Prayer of the Children - Kurt Bestor / Sky - Joshua Radin / Fools Like Me - Lisa Loeb / Broken - Lifehouse / Here's to the Night - Eve 6 / A Call to Courage - William Ross
Each song has a special meaning to me, from EMT training courses or even as simple as the lyrics mirroring the feelings I harbor concerning my life. Each song helps me focus on what my job is really about.
Working in a hospital isn't just about answering call lights and taking vital signs. Its about helping other human beings cope while in terrifying situations that may only occur a handful of times in the span of their lives. Its about connecting with human beings on a deeper level than you can as a RN or a Paramedic, simply because you have more time to do so. When taking classes to get my CNA, my teacher read a study to us that in a day at a hosptial, care center or doctors office, on average a doctor will see a patient for about 1 minute and 45 seconds, a nurse will spend 7 minutes with a patient, but a CNA will spend over 3 hours with their patients.
As I drove into work today this playlist, like every night at work, played loudly, and I tried to absorb the inspiration as I prepared myself to go to work. We don't have a job where we can post photos of our families, friends and children in our cubicles and talk about them during lunch breaks, heck we are lucky if we even obtain a lunch break during some shifts. We have a job where our lives end at the time clock and are placed on hold until we clock out. Finally, I was ready to head into work, and did so.
Before every shift I work without fail I do two things, the first, I say the EMT's prayer, and second I ask myself 'what will I learn from my patients?'
In my city there isn't much diversity, even in the heart of the state capitol. Generally speaking, I deal with middle-aged caucasian patients, on both units that I work on, so when I arrived at work and heard someone say 'Gurl lemme tell you somethin bout Jesus,' I was a little bit suprised to say the least (not the part about Jesus, but a different dialect of english!). When I arrived in the patients room during introductions I smiled to see an African American man and a woman who looked to be from an Asian ethnicity. Both were minorities in our population, and both were a breath of fresh air.
"Lemme tell you somethin." The man tells me as I write my name on the white board. "You need to know this if your gonna love sumbody." I turn and smile at him. Growing up I spent a few years living in Chicago and was used to this, but not where I am at, and was loving the flashbacks. "Gurl you gotta sleep on your left next to the woman you love, then they are close to your heart, and that is love. You understand me?" Watching my patient and their loved one I realized that 20 minutes into my shift and I already had my lesson for the night.
As I got to know my patients I had come to realize that they were in search of something simple, healing. When I asked for the patient wish while in our unit the reply was; "I want to heal, I want to be healthy again." The search was an easy one, to find their way back to a pain-free happy life that they once had.
So while they sleep tonight I put on my playlist and continued to listen carefully to the lyrics, because while they search for their wishes, I too am human and am searching for inspiration to help me help my patients.
How to save a life - The Fray / Big Sweet Life - John Dee Graham / Soundtrack to Your Life - Ashley Parker Angel / The Climb - Miley Cyrus / Into the Fire - Thirteen Senses
Every day when I drive into work I set my Ipod to my 'Hospital Playlist.' Its taken me quite awhile to compile this playlist, and the songs include the following:
Life is short - Butterfly Boucher / Where I stood - Missy Higgins / Be Ok - Ingrid Michaelson / Kristy, Are you doing okay? - The Offspring / Peace of Mind- Boston / Prayer of the Children - Kurt Bestor / Sky - Joshua Radin / Fools Like Me - Lisa Loeb / Broken - Lifehouse / Here's to the Night - Eve 6 / A Call to Courage - William Ross
Each song has a special meaning to me, from EMT training courses or even as simple as the lyrics mirroring the feelings I harbor concerning my life. Each song helps me focus on what my job is really about.
Working in a hospital isn't just about answering call lights and taking vital signs. Its about helping other human beings cope while in terrifying situations that may only occur a handful of times in the span of their lives. Its about connecting with human beings on a deeper level than you can as a RN or a Paramedic, simply because you have more time to do so. When taking classes to get my CNA, my teacher read a study to us that in a day at a hosptial, care center or doctors office, on average a doctor will see a patient for about 1 minute and 45 seconds, a nurse will spend 7 minutes with a patient, but a CNA will spend over 3 hours with their patients.
As I drove into work today this playlist, like every night at work, played loudly, and I tried to absorb the inspiration as I prepared myself to go to work. We don't have a job where we can post photos of our families, friends and children in our cubicles and talk about them during lunch breaks, heck we are lucky if we even obtain a lunch break during some shifts. We have a job where our lives end at the time clock and are placed on hold until we clock out. Finally, I was ready to head into work, and did so.
Before every shift I work without fail I do two things, the first, I say the EMT's prayer, and second I ask myself 'what will I learn from my patients?'
In my city there isn't much diversity, even in the heart of the state capitol. Generally speaking, I deal with middle-aged caucasian patients, on both units that I work on, so when I arrived at work and heard someone say 'Gurl lemme tell you somethin bout Jesus,' I was a little bit suprised to say the least (not the part about Jesus, but a different dialect of english!). When I arrived in the patients room during introductions I smiled to see an African American man and a woman who looked to be from an Asian ethnicity. Both were minorities in our population, and both were a breath of fresh air.
"Lemme tell you somethin." The man tells me as I write my name on the white board. "You need to know this if your gonna love sumbody." I turn and smile at him. Growing up I spent a few years living in Chicago and was used to this, but not where I am at, and was loving the flashbacks. "Gurl you gotta sleep on your left next to the woman you love, then they are close to your heart, and that is love. You understand me?" Watching my patient and their loved one I realized that 20 minutes into my shift and I already had my lesson for the night.
As I got to know my patients I had come to realize that they were in search of something simple, healing. When I asked for the patient wish while in our unit the reply was; "I want to heal, I want to be healthy again." The search was an easy one, to find their way back to a pain-free happy life that they once had.
So while they sleep tonight I put on my playlist and continued to listen carefully to the lyrics, because while they search for their wishes, I too am human and am searching for inspiration to help me help my patients.
How to save a life - The Fray / Big Sweet Life - John Dee Graham / Soundtrack to Your Life - Ashley Parker Angel / The Climb - Miley Cyrus / Into the Fire - Thirteen Senses
Friday, May 22, 2009
Tools of the Trade
"Do you wanna hear my latest conspiracy theory?"
For those of you who keep up with my blog, you have come to understand that working in medicine is a roller-coaster ride unlike any other. However, tonight I have time to sit back and look around me, to study the tools of my trade. The things that make us the professionals we are.
It's 2230 pm and I'm in the middle of a 1600-0400 shift when my nurse turns to me and asks me this question. I cannot help but smile, not because I am as into her conspiracies as she would like, but because she and I are close. When you work as long of hours as often as we do in the medical field, you become close. The colleague you simply talked boy talk with in the beginning suddenly becomes your sister, the nurse who answered all of your questions from how to cook certain meals to how to draw blood becomes your mentor and the doctors become your brothers. You become a family, and you learn to love them, crazy as they may be.
For those of you who keep up with my blog, you have come to understand that working in medicine is a roller-coaster ride unlike any other. However, tonight I have time to sit back and look around me, to study the tools of my trade. The things that make us the professionals we are. My scrub pockets are loaded down with various items, I have sticky notes in my back pocket, pens in both front pockets and in my side pocket on my thigh I have a pair of trauma shears, two markers, a highlighter and more pens. In my chest pocket I have the patent's information, as well as any other odds and ends I may have picked up while in a patients room. Hung around my neck is my stethoscope, the same old tool I have used since I was in CNA school, almost 5 years ago now.
Scattered around the desk behind me is more tools. Medicine cups, gloves, gauze, adhesives and lots of medical tape. Our center focuses on Ortho, on bones, on muscles, on joints, so the tape ranges anything from scotch tape, so simple IV tape, silk and so many more. It seems as if all the doctors do in our unit is ace wraps and tape, but its effective, so we keep it on hand. Needles are hidden in the cupboard above, and all ranges and sizes of them, from the butterfly's (25 g) to the regular 18 gauge needles. Oddly enough, ultrasound gel is also placed in the same cupboard, but not for pregnancy as many would assume, but for anesthesiology (to help place nerve blocks).
In almost every unit of the hospital we give patients the basic essentials to help them feel more comfortable during their stay, however, they may not always like these items. Usually this 
includes a big basin, a kidney basin, a kleenex box, lotion, baby powder, comb, toothbrush and toothpaste, socks, a water mug and an incentives spirometer. These are also stored nearby and some of these things are simple needs with understandable explainations, but as I study these tools I smile as I come to the incentives spirometer. Its the simplest of any tool you will come across in the hospital, designed like a game, and has so many purposes to help you with your health. Who would think that this tool (pictured left) would help you with your pain management, let alone assisting your body in preventing blood clots?
includes a big basin, a kidney basin, a kleenex box, lotion, baby powder, comb, toothbrush and toothpaste, socks, a water mug and an incentives spirometer. These are also stored nearby and some of these things are simple needs with understandable explainations, but as I study these tools I smile as I come to the incentives spirometer. Its the simplest of any tool you will come across in the hospital, designed like a game, and has so many purposes to help you with your health. Who would think that this tool (pictured left) would help you with your pain management, let alone assisting your body in preventing blood clots?My job has become a family business. I take care of the basic needs and odds and ends, while my sisters have become pro's in medication administration, IV acess and treatment needs. They take care of the wound care, and I'll assist. In the family business we make things work, and for the best, because our patients live, and while their in our care, usually are extremely happy.
I call that one hell of a job well done.
Tuesday, May 19, 2009
Pneumonics
When your training to be an EMT, you find yourself overwhelmed at times, so the big shots decided that pneumonics would help the EMT-In-Training learn better and faster. Alot of these pneumonics are used for Nursing, for becoming a doctor, and even for becoming a first responder.
At first you think they will be easy to remember;
OPQRST (onset, provocation, quality, radiation, severtiy, time),
SAMPLE (Signs and symptoms, Allergies, Medications, Pertinent Past Medical History, Last Oral Intake, Events leading up to incident),
ETA (Estimated time of arrival),
AVPU (Alert, Verbal, Painful, Unresponsive- Stimuli),
PMS (Pulse, Motor, Sensory),
JVD (Jugular Vein Distention),
ALS (Advanced Life Support),
PERRL (Pupils are Equal Round and Reactive to Light),
A&O x3 (Alert and Oriented to Person, place and time)
LOC (Level of Consiousness)
ETOH (Ethanoyl-Drinking)
SOB (Shortness of Breath)
MVA (motor-vehicle accident)
But the easiest and most important pneumonic is this; ABCDE. Airway, Breathing Circulation, Decision to Transport and Expose (Trauma).
Last night at work I had a chance to review my EMT skills and remember my basics all over again. While sitting in a 1:1 with two patients, I was taking vitals of one patient between visits from the physicans. They spoke quietly to each other and then to the fairly alert patient, and then back to each other. They preformed small medical procedures, and then left. The patient's respirations had jumped from 20 breaths a minute (10 L on a face mask) to 44 breaths a minute (on a Bipap). Convinced that if it was an issue the doctors would have done something, because this occured while they were in the room, I pulled the call light to get the nurse in there, but only a CNA showed up. I instructed the CNA to go get the nurse and explained why, then was pulled to the other bed to tend for my other 1:1.
This was when my ill patients family member showed up. She shook my hand and kindly talked to me about his needs. I gave her as much information as I knew about her loved one, but then stopped and looked at him. She started to ask questions to which I didn't know the answer to, and then gave her the nurses' names, the doctors names and the interns names, so she could ask them. When I explained to her my title she understood and left the room briefly. I took his respirations again and realized they weren't adequate and thought to EMT class. Airway, he was sitting upright, mouth open, he had a patent airway, Breathing, he was struggling to get adequate air in, let alone talk, but he still had Circulation. ABC. The next step would be 15 L NRB, but he was on 10 L with a BiPap, I couldn't change the O2 due to the doctors orders.
I looked to the charge nurse standing in the doorway, recieving information and talking to the family member and told her, "His respirations are irratic and at 44 breaths a minute." This was when the nurse ran to the nurses station and seconds later the room filled with doctors, nurses, x-ray tech's and phelbotomists as they began immediate care that was almost the same as a code.
As I watched all of this hustle and hubub from the corner of the 1:1 I realized something. Medicine isn't as difficult as everyone makes it out to be. You just have to go back to the Basics. My patient is fine now, and is doing better, but we needed to step away from the cool fancy projects long enough to remember the basics, because without those, we wouldn't even have a pulse.
Until next time, BSI (body substance Isolation)
At first you think they will be easy to remember;
OPQRST (onset, provocation, quality, radiation, severtiy, time),
SAMPLE (Signs and symptoms, Allergies, Medications, Pertinent Past Medical History, Last Oral Intake, Events leading up to incident),
ETA (Estimated time of arrival),
AVPU (Alert, Verbal, Painful, Unresponsive- Stimuli),
PMS (Pulse, Motor, Sensory),
JVD (Jugular Vein Distention),
ALS (Advanced Life Support),
PERRL (Pupils are Equal Round and Reactive to Light),
A&O x3 (Alert and Oriented to Person, place and time)
LOC (Level of Consiousness)
ETOH (Ethanoyl-Drinking)
SOB (Shortness of Breath)
MVA (motor-vehicle accident)
But the easiest and most important pneumonic is this; ABCDE. Airway, Breathing Circulation, Decision to Transport and Expose (Trauma).
Last night at work I had a chance to review my EMT skills and remember my basics all over again. While sitting in a 1:1 with two patients, I was taking vitals of one patient between visits from the physicans. They spoke quietly to each other and then to the fairly alert patient, and then back to each other. They preformed small medical procedures, and then left. The patient's respirations had jumped from 20 breaths a minute (10 L on a face mask) to 44 breaths a minute (on a Bipap). Convinced that if it was an issue the doctors would have done something, because this occured while they were in the room, I pulled the call light to get the nurse in there, but only a CNA showed up. I instructed the CNA to go get the nurse and explained why, then was pulled to the other bed to tend for my other 1:1.
This was when my ill patients family member showed up. She shook my hand and kindly talked to me about his needs. I gave her as much information as I knew about her loved one, but then stopped and looked at him. She started to ask questions to which I didn't know the answer to, and then gave her the nurses' names, the doctors names and the interns names, so she could ask them. When I explained to her my title she understood and left the room briefly. I took his respirations again and realized they weren't adequate and thought to EMT class. Airway, he was sitting upright, mouth open, he had a patent airway, Breathing, he was struggling to get adequate air in, let alone talk, but he still had Circulation. ABC. The next step would be 15 L NRB, but he was on 10 L with a BiPap, I couldn't change the O2 due to the doctors orders.
I looked to the charge nurse standing in the doorway, recieving information and talking to the family member and told her, "His respirations are irratic and at 44 breaths a minute." This was when the nurse ran to the nurses station and seconds later the room filled with doctors, nurses, x-ray tech's and phelbotomists as they began immediate care that was almost the same as a code.
As I watched all of this hustle and hubub from the corner of the 1:1 I realized something. Medicine isn't as difficult as everyone makes it out to be. You just have to go back to the Basics. My patient is fine now, and is doing better, but we needed to step away from the cool fancy projects long enough to remember the basics, because without those, we wouldn't even have a pulse.
Until next time, BSI (body substance Isolation)
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