bunch of nonsense

i think, therefore I am (an RN)

toothache Abril 18, 2007

Filed under: for the record,nurse's notes — nixinne @ 8:33 umaga

emergency room is for emergency medical problems not for a simple toothache. but some people take for granted what the emergency services are for. especially for people who does not have any insurance.

 i am not saying that if you do not have insurance that you do not have the right for an emergency medical treatment. if you have a real medical emergency, i suggest that you go to your nearest emergency department immediately, with or without an insurance. but please, do not go to the emergency room if you have a toothache that does not have any symptoms of infection. get to your local health department for a free consultation on where to get a free dental service or the most affordable one. most counties have these services. do not waste your time and the time of the medical staff in emergency room for a simple toothache because of a dental cavity.

if you are running a fever, have pus like secretions, or serious swelling in your gums then by all means come to the emergency department, but otherwise, go to your dentist!

and do not cuss the doctor that was trying to treat your simple toothache in the ED. you will get thrown out by security and be blacklisted on your local emergency department!

i just dont understnad why people do this!!!

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exhaustion Abril 14, 2007

Filed under: english alphabet,nurse's notes — nixinne @ 11:31 umaga

i just came home from work…

discharged 2 homeless drunk before i left…

 i am now ready to go to bed…

i am exhausted…

 genital herpes looks like a bunch of small ulcerated skin…

painful too as i can tell by the look of the patients…

gross… that is what i have to dream of during my sleep…

try not to get any kidney stones (if at all possible, really)…

it really, REALLY hurts…at least the patient got a total of 16 mg of morphine iv…

sweet…i’ll be dead if i have that much morphine in my system…

swollen feet, chest pain, painful hand, drug seker, suicidal…

cardiac arrest…

they were all my patient last night…

 ok..off to bed…my name is written on it already…. 

 

cervical radiculopathy Pebrero 24, 2007

Filed under: english alphabet,my immortal life,nurse's notes — nixinne @ 1:25 hapon

in short, pinched nerves on my C6..

yea…the doctor said i probably have a nerve damage on my C6 form pulling 300 lb patients. first, i got the rotator cuff injury on my left arm..now this…i dont even want to think what else will happen to my health on the course of this career…

i love my job…i love helping sick people…i love my staff… i think they are the best staff to work with…they yawn, whine and groan but ultimately we all help each other. we also put patient’s first before anything…they were very considerate about my cervical radiculopathy with for me is “cervical ridiculousness”…

symptoms include…numbness & tingling sensation shooting from neck to fingers of the affected extremity. if you are a little bit more unlucky like iam, you will also experience severe pain from time to time. in my case, even if i need rest, i cannot stop working not just because i have to pay bills but because we are too short of nurses as it is and ther is only 2 charge nurse at night – one being yours truly…

doctor prescribed a nerve pain pill called lyrica and a non steroidal anti inflammatory drug called lodine. i will also have physical therapy on monday then another doctors appointment next week. i am hoping this will heal soon coz it israther infuriating when you are helpless yourself in the medical field…i would like to be able to help my staff in moving patients but i am limited to

 

rotator cuff injury Pebrero 20, 2007

Filed under: english alphabet,nurse's notes — nixinne @ 2:28 hapon

personally? it’s painful! i have never taken drugs so much in my adult life! i was basically a zombie after such drugs but it numb me i guess. anyway, i thought i should post an article about rotator cuff injury since its a personal experience!

thanks to mayoclinic.com

Rotator cuff injury

Introduction
Your rotator cuff is made up of the muscles and tendons in your shoulder. Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons connect your upper arm bone (humerus) with your shoulder blade. They also help hold the ball of your upper arm bone firmly in your shoulder socket, as if holding a golf ball on a tee. The combination results in the greatest range of motion of any joint in your body.

Rotator cuff injuries are fairly common. Causes of the injury may include falling, lifting and repetitive arm activities, especially those done overhead. These activities may include throwing a baseball, reaching up to work on a car on a rack or placing items on shelves above your head. The injury is also common among people whose jobs or hobbies include heavy demands on their shoulders, such as athletes, archers and people in the construction trades. Poor posture, especially as related to your shoulders hunched forward, also can contribute to rotator cuff injury. As you get older, your risk of a rotator cuff injury increases.

(more…)

 

anxiety attack Mayo 12, 2006

Filed under: english alphabet,my immortal life,nurse's notes — nixinne @ 1:24 hapon

i was having an anxiety attack. For the first time, i called my mom as early as 7:30 am just to tell her how much of a nervous wreck i was at that time. there are several posiblities as to why this happened but the worst part of this is that i almost got into an accident just being hyped up without anything. Not that i had a close encounter on a car wreck, i actually didnt have any but in my mind it was playing that i will be on a car wreck or something. i was very jittery and nervous.

it may be that i am excited to go home or that i am really hungry since i just ate 4 eggs since yesterday morning and i worked on a very stressful environment last night.

My whole night was focused on this young guy who was very sick. he was having explosive diarrhea (which i have to change his bed 3 times last night as we didnt have any nursing assistant), a blood sugar of 11 (which sometimes can push a person to a comatose state if not prevented immediately), hypertensive with a systolic blood pressure of 190 (which can lead to stroke), renal failure (cannot pee therefore cannot excrete excess fluid in the body and of course cannot metabolize some drugs), severely anemic (which resulted to giving 1 unit of packed red blood cells), mrsa infected (so he was also on contact isolation) and also has a heart failure (in conjunction to renal failure, this man wasnt breathing quite well since he is drowning on his own body fluids). See, what i have to deal with? and this is just one patient! i have 5 others with at least 2 others who are almost as severely sick as him! I didnt even get the chance to pee last night. which lead me to remember that i was starving too!

oh well, life’s a bitch..

but i still thank whoever it is that looks upon mankind, that i am not the one who is sick and is bed ridden at this time.

 

ACLS Algorithms – [ACLS.net] Marso 7, 2006

Filed under: english alphabet,nurse's notes — nixinne @ 1:55 hapon

I always like to find some interesting articles and since i am on the ACLS mood…i tried to scour the net for some eay to remember algorithms…

ACLS.net has some good algorithms with mnemonics and simulation practices (love those!)

———————————————————————————–

Universal Algorithm for Adult Emergency Cardiac Care
and Primary Survey ABCDs (Excerpt)

Assess responsiveness by speaking loudly, or gently shaking the patient if there are no signs of trauma.
Call for help/crash cart if the patient is unresponsive.

A Airway: Open airway, look, listen, and feel for breathing.
B Breathing: If not breathing, slowly give 2 rescue breaths.
C Circulation: Check pulse. If pulseless, begin chest compressions at 100/min (15:2 ratio with unprotected airway). Consider precordial thump in witnessed arrest with no defibrillator immediately available.
D Defibrillation: Attach monitor/AED. Assess rhythm. Search for and Shock VF/PVT up to 3 times if needed.

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Secondary Survey ABCDs (Excerpt)

A Airway: Establish and secure an airway device.
B Breathing: Ventilate with 100% O2. Confirm airway device placement by exam, end-tidal CO2 monitor, and O2 saturation monitor.
C Circulation: Evaluate rhythm, check pulse, if pulseless continue chest compressions (5:1 ratio with protected airway), obtain IV access, give rhythm-appropriate medications.
D Differential Diagnosis: Attempt to identify and treat reversible causes.

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Asystole Algorithm

Asystole may be discovered during the primary ABCD survey after attaching a monitor, or it may develop in a previously monitored patient. In either case, it is essential that asystole be confirmed in another lead with properly functioning equipment. If the patient is in true asystole and is a candidate for resuscitation, then proceed with the secondary ABCD survey.

Interventions for asystole are guided by the instructive phrase and acronym,

“Asystole ….. Check me in another lead,
then let’s have a cup of TEA.”

Acronym – Intervention – Comments/Dose
T Transcutaneous Pacing (TCP) Only effective with early implementation
along with appropriate interventions and medications.
NOTE: Not effective with prolonged down time.

E Epinephrine 1 mg IV q3-5 min.

A Atropine 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)

Consider termination of efforts if asystole persists despite appropriate interventions.

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Bradycardia Algorithm

Treatments for absolute bradycardia (
“All Trained Dogs Eat Iams”

NOTE:(The sequence reflects interventions for increasingly severe bradycardia)

Mnemonic – Intervention – Comments/Dose

All – Atropine – 0.5-1.0 mg IV push q 3-5 min. (max. dose 0.03-0.04 mg/kg)
Trained – TCP – Use Transcutaneous Pacing (TCP) immediately with severely symptomatic patients.
Dogs – Dopamine 5-20 µg/kg/min.
Eat – Epinephrine 2-10 µg/min.
Iams – Isoproterenol 2-10 µg/min.

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PEA Algorithm

Pulseless Electrical Activity may be discovered during the primary ABCD survey when a monitor is attached to a pulseless patient and a rhythm is shown. As part of the secondary ABCD survey, a doppler should be used to confirm pulselessness.

Interventions for pulseless electrical activity are guided by the letters

“P-E-A”

Intervention – Comments/Dose
Problem – Search for the probable cause and intervene accordingly. (see PEA Problem Table )

[Pulmonary Embolism] – No pulse w/ CPR, JVD – Thrombolytics, surgery
[Acidosis] – (preexisting) Diabetic/renal patient, ABGs -Sodium bicarbonate,
hyperventilation
[Tension pneumothorax] – No pulse w/ CPR, JVD, tracheal deviation – Needle thoracostomy
[Cardaic Tamponade] – No pulse w/ CPR, JVD, narrow pulse pressure prior to arrest – Pericardiocentesis
[Hyperkalemia] – (preexisting) Renal patient, EKG, serum K level – Sodium bicarbonate, calcium chloride, albuterol nebulizer, insulin/glucose, dialysis, diuresis, kayexalate
[Hypothermia] – Core temperature – Hypothermia Algorithm
[Hypovolemia] – Collapsed vasculature – Fluids
[Hypoxia] – Airway, cyanosis, ABGs – Oxygen, ventilation
[Massive MI] – History, EKG – Acute Coronary Syndrome algorithm
[Drug Overdose] – Medications, illicit drug use – Treat accordingly

Epinephrine – 1 mg IV q3-5 min.
Atropine – With slow heart rate, 1 mg IV q3-5 min. (max. dose 0.04 mg/kg)

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Emergency Cardiovascular Care Marso 3, 2006

Filed under: business attire,english alphabet,nurse's notes — nixinne @ 7:47 hapon

this is one of the few things that i always carry on my work bag (see side nav bar: my work bag). you could never go wrong with this one since it has almost everything that you needed in adult and pediatric emergencies (except for broselow pediatric tape). it is the bible of acls and pals providers. this one is the 2004 updated edition but soon it will be replaced by the 2005 guidelines.

Note: Please refer to American Heart Association – PDF of the 2005-2006 Winter issue of the ECC free quarterly newsletter, Currents for further information. This information is copyrighted by AHA. Also, please note the Purpose & Intent of the blog author on the right side nav bar.

The 5 major changes in the 2005 guidelines are these:

• Emphasis on, and recommendations to improve, delivery of effective chest compressions

• A single compression-to-ventilation ratio for all single rescuers for all victims
(except newborns)

• Recommendation that each rescue breath be given over 1 second and should
produce visible chest rise

• A new recommendation that single shocks, followed by immediate CPR, be used to
attempt defibrillation for VF cardiac arrest. Rhythm checks should be performed every
2 minutes.

• Endorsement of the 2003 ILCOR recommendation for use of AEDs in children 1 to 8 years old (and older); use a child dose-reduction system if available.

when i took my pals late last week, they tol us about the updated guidelines but as i have read on AHA website, they are going to release everyhting on december 2006. by updating their guidelines, they are giving easier to remember algorithms that is beneficial to both the rescuer and the patient. time is a valuable part of an emergency situation and assessments needed to be done by professionals and lay rescuers are now more definitive. chance of survival on emergency situations are increased with the new guidelines and recommendations. aed is still one of the most important things that a lay rescuer can learn. it remarkably increases the survival rate of adult cardiovascular emergency patients. especially now that a lot of establishments are investing on aed and training employees on how to use them. recommendations on aed for children ages 1 yr old and above is also promising although most of pediatric emergencies usually are respiratory in origin than cardiovascular.

there are still a lot to learn and i wish i can delve into it more. but i guess thats why AHA is there. i try to check for news and updates every week. i salute them for including lay rescuers in their endeavors to save lives.