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Balance

14 Jun

 

I am trying to keep my balance on the life beam. The write is neglected and the love is thirty stories high in a building that is not under construction. I want to marry an ironworker.

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Love IV

25 Jul

I still need that intravenous Love 1 gm STAT.

 

Love me, love me.

Hootenanny Nurses

20 Jul

Kim over at Emergiblog would love this picture, so would Mother Jones RN.

“He brought a new song to her heart.” Nice, I wonder what cardiac rhythm we would find that nurse in, if we hooked her up to the telemetry pack. I bet she is running a high sinus tachycardia there. No treatment for sinus tachycardia, treat the cause, remember? What stat treatment does that nurse need?

I have been a lazy nurse writer. I get tired of writing the same things over and over, as the telemetry pack turns over and over.  I have also been a bit distracted, life is not all about beta-blockers, rhythms, and diuretics.

I really liked this pain medication equivalents post over here, by Paramedic six letter variable. I found it very soothing and painless.

 

I am not sure what a hootenanny is, but it sounds good.

Regular Insulin

6 May

RN tired after work and only a teaspoon of gas in the tank of her car goes to the local gas station down the street from Community X hospital.

RN rolls down the window and says to the gas attendant.

“Can you fill it with Regular, Insulin.”    hahahahaha Instead of   “Can you fill it with Regular, Cash”

Gas Attendant: “What?”

Wow…..when you associate the word “Insulin” with the word “Regular” you know that you are in nurse speak mode and super tired.

Carlos (gang member) RN

28 Apr

 

Ha! My daily laughter.

sucky co-workers

25 Apr

Woow. I am still shocked. I have had this scene time and again with the same co-worker. The one who is always busier than you. One time I needed to hang blood that requires 2 RN signatures to check the right blood, right patient etc…as per policy for safety. I actually had the blood in my hand ready to go and as she was the first RN in sight I asked her to come with me. She said no!    wtf? Are you kidding me? Today I wanted to go to lunch and asked her to cover me, all my patients were stable. She said no! wtf? Her excuse was that she was doing an admission….yeah. whatever!

And she is the first hot mess always asking everyone for help all-day-long.

I have yet to come up with a name for this type of rare sucky co-worker.

but I will.

Yeah. She is a true gem. *vomiting in my shoes*

The Sepsis Cloud is following me.

26 Jan

yellow-cloudI can not escape the sepsis cloud lately. Here I am Nurse Jane, a new nurse on a telemetry floor for about one and a half years. The one thing that I see over and over again is patients swirling into septic shock right in front of my eyes. It took a few patients before I realized the pattern, the scenario was repeated many times in the form of this: A patient on a medical floor developes hypotension, the MDs and Admins in Charge decide the patient is appropriate for telemetry (alot of times it is true). The patient arrives to the telemetry, receives some fluids, sepsis workup is done including: Lactate level, cbc, bmp, urine cultures, blood cultures, ABG, chest x ray etc. 2 hours later the verdict is in: Lactace levels greater than 5, WBC doubled in a day etc..patient is hypothermic, with a systolic blood pressure in the 80s, increasing lethargy, tachypnea, metabolic acidosis and you as the nurse now need a rapid response to handle this rapidly deteriorating patient and the rest of your patients get nothing! http://emedicine.medscape.com/article/167027-overview

I mean this happens alot. These patients need aggressive resuscitation with fluids and they need an intensive critical care nurse at the bedside!

Now I am not saying that every patient with an elevated lactate level needs intensive care. I have had patients with moderate lactic acidosis, that were septic from a known source, treated appropriately with antibiotics and fluids who within 24 hours have mean arterial blood pressures greater than 60, wbc decreased in half in one day, and lactate levels return to normal with no hypothermia or hyperthermia and seemed to progress towards positive outcomes. I am not going to freak out at every abnormal lab value…

On the other hand…these patients need to be monitored so closely that the nurse on the floor has to be on guard. I had a patient with a lactate level 3.9–the patient remained on telemetry because of 1. orientated mentation 2. systolic blood pressure greater than 100. So the patient was not transferred to ICU–Sepsis workup was not done–and within 12 hours the patient had severe tachypnea, severe metabolic acidosis–and a lactate level greater than 9, WBC tripled– the patient was falling apart in front of my eyes and of course a rapid response was initiated.

We all need to know that just because the patients pressure is not low or that the mental status is orientated for now, does not mean that the patient is “ok” –they can decline rapidly. Sometimes the support is there from supervisors and charge nurses~ sometimes it is not! So till then I will keep shouting out loud about suspicion for sepsis in rapidly (or even not rapidly) declining patients and what to do when it happens to you!