Nurse Sean (dot) com

I had a pleasant surprise today. Apparently patient census and acuity is extremely low in the ICU tonight. So, because of the large excess of labor recourses (i.e. registered nurses), I was offered the night off. I gladly accepted the offer!

That definitely goes under the list of things that would never happen in med/surg nursing!

Speaking of that list, another thing that would go there is my experience last night. They did a bedside gastroscopy on the patient next to mine. They hooked up a really neat plasma television-on-wheels to the scope so everyone around can see what they’re doing.

I watched the video screen as they carefully pulled six perfectly stacked quarters out of the patients stomach where they had lodged in the pyloric sphincter.

It scored an 8/10 on my newly invented and soon to be patented nursing neat-o-meter!

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All ICU nurses are aware of the dreaded “triple alarm.” At least I’m under the impression that this is something common to all ICUs.

The triple alarm is part of the cardiac monitor and is just one of many noises, beeps, and cries that it produces. It is three loud high pitched beeps in a row, and it repeats itself over and over.

Beep beep beep
Beep beep beep
Beep beep beep

And on and on….

The triple alarm signals to everyone within what seems like a three kilometer radius that it has detected either V.Fib, V.Tach, or Asystole. In other words, the cardiac monitor is shouting, “OH MY GOD, OH MY GOD OH MY GOD!!!!!!”

So is the nurse, most likely!

However, the overwhelming majority of the times this alarms sounds, it is a false alarm. Moments after you hear it, you generally hear a nurse yelling, “I’m OK.” The general rule is that failing to shout, “I’m OK” is a signal to everyone around that you are, in fact, not OK.

So, it was 05:00 in the morning. We were all hanging out, enjoying a lull. It was that dreaded time of the morning in which your body completely rejects wakefulness, and every moment is spent struggling to keep your eyes open.

Then I heard it from another patients room.

Beep Beep Beep
Beep beep beep
Beep beep beep

I waited for the word that everything was OK

Beep beep beep
Beep beep beep
Beep beep beep

One nurse casually says, “Are you OK?”

“Uhmmmmm” Was the definitely unsure response. I could visualize the RN checking for a pulse and checking the Art line portion of the screen for a blood pressure.

“Do you need a cart?” Still casual.

“YES!”

A flurry of activity began. I waited a few seconds, probably about fifteen. I wanted to let everyone jump in before I went to watch.

As I went around the corner someone yelled, “Starting CPR!” And then the scene appeared before me. Several nurses and the junior resident were working on the patient. Where did the resident magically appear from at 5am?

The resident took charge quickly, calmly, and with purpose. “It looks like V.Fib. Everyone agree? I want 200j biphasic”

“Charging!” The cart nurse yelled**

Seriously? They already had the pads on? And hey look! that RN is doing GREAT CPR! My mind is racing, my eyes are wide.

“Everyone clear?”

Ka Chunk! The neat-o sound of the defibrillator.

“He’s moving!”

“We have a blood pressure”

The charting nurse and the cart nurse seemed bored–they were talking about something else. I know them though; they’ve done this a billion times.

“CBC, electrolytes, chest x-ray….” the resident is still making orders while everyone wanders back to their patients. Crisis averted.

No exaggeration here: I’m almost positive that the time from the triple alarm to CPR was less than fifteen seconds, and to defibrillation was about thirty seconds.

Exciting stuff!

**When a code is called at our hospital, whether it is in the ICU or on the floors, it involves three RNs from the ICU: One RN is the medication nurse who is in charge of getting IV access and pushing meds. The second RN is the cart nurse who prepares meds and passes off supplies. The third RN is there to chart everything going on. The floor nurses (or other nurses if the code happens in the ICU) are there to get supplies, prime IVs, etc.

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Change of Shift is up over at life in the NHS!

I must say, the pagan theme certainly appealed to my spiritual senses. The focus is May Day, or as pagans would call it, Beltain. Yes, I actually have danced around the maypole!

Go here to read all the wonderful blogs from this fantastic edition!

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I’m not sure if anyone has noticed, but I added a link to Kiva in my sidebar. I wanted to take a quick moment to promote Kiva in my main blog as well. Just so you know, I’m not getting anything in return for promoting Kiva, nor was I approached to promote this program. I’m simply doing this because I think it’s flippin’ cool and deserves some link love.

Here’s a description of themselves from their website:

We Let You Loan to the Working Poor

Kiva’s mission is to connect people through lending for the sake of alleviating poverty.

Kiva is the world’s first person-to-person micro-lending website, empowering individuals to lend directly to unique entrepreneurs in the developing world.

The people you see on Kiva’s site are real individuals in need of funding - not marketing material. When you browse entrepreneurs’ profiles on the site, choose someone to lend to, and then make a loan, you are helping a real person make great strides towards economic independence and improve life for themselves, their family, and their community. Throughout the course of the loan (usually 6-12 months), you can receive email journal updates and track repayments. Then, when you get your loan money back, you can relend to someone else in need.

So, basically, you go to the website and are presented with a list of struggling entrepreneurs from third world countries. Each one is asking for a small business loan to help them create or improve their business. They are looking to drastically improve their quality of life.

Once you have chosen who you would like to help, you then decide how much to lend toward their needs. I typically lent around $25. Once everyone’s pledges add up to the total amount needed, the loan is dispersed. Then, over time, the entrepreneur slowly pays back the loan, which goes directly back to you!

Did that make sense? If not, just check out the website for a better and more extensive description.

The absolute fun part is going through and reading these people’s stories. I love browsing through their businesses to see what they are doing for themselves. I love feeling like I’m truly making a difference in someones life–and I like that I’m doing it with a loan, rather than a pure gift.

Anyway, I hope you’ll check out Kiva and give it a go!

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One thing I miss about working a rotation with day/night eight hour shifts (as opposed to my current day/night 12 hour rotation) is that no matter what I worked, I always had my evenings off. That meant I never had to miss any of my favorite television shows!

Now, I miss A LOT of shows while I’m at work, but fortunately the hard drive on my satellite receiver records everything I could ever conceive of watching.

Today, on my first day off after a couple twelve hour shifts, I woke up at 07:30 and watched recorded televisions shows–commercial free–until 18:00 with only a pee breaks for me and my dog, and quick trips to the kitchen for food.

I could win awards for my ability to slack off.

Sinus arrhythmia: Beer does this.

I love this article! I can’t wait until I have the knowledge and experience to properly take care of a patient this sick. It takes years!

Grand Rounds 4.31: How … - Blogs - Revolution Health

Grand Rounds is up over at Dr. Val’s! Click the link above to check it out!

Embedded Video

This poor man was trapped in an elevator for forty-one hours while security cameras looked on! UGH!

I missed A LOT of work over the weekend. In fact, I didn’t work at all! We’re talking THREE twelve hour shifts missed by your’s truly. Thirty-Six hours of sick time taken all in one massive chunk. My manager must adore me right now…*cringe*

But today, I’m finally starting to feel better. I have no sense of smell (except for that strange, sickeningly sweet smell of infection that is stuck in my sinuses), My intercostal and abdominal muscles ache from all the coughing, and I’m a bit dizzy. However, in general, that is a vast improvement.

I find it amazing that colds always seem to come when they are needed the most. They are natures way of telling you that life is way to stressful, you’re running on empty, and you just need to stop and lie down for a couple days: preferably with season four of ER fully available for your viewing pleasure.

I left the house only once briefly. I decided that since I was missing so much work, it was only fair that I went and got a sick note (they never did ask for one). I got to the local walk in clinic and was greeted by a fresh sign stating, “We are full, please go the the nearest Emergency Room.”

I contemplated actually going to the ER. I wanted to see the look on the triage nurse’s face when I told her I had a particularly bad cold and needed a sick note for work. I didn’t have the guts though. Not to mention, the ER shares a wall with the ICU that I work in–I’m sure I would have been seen and put to work.

Today, I’m actually going to venture out of the house and visit a friend of mine for coffee. It will seem strange to actually see the light of day in it’s full glory. The fresh air may seem overwhelming, and the noise of being in public may stun me. I will let you know if I survive the onslaught of stimulation.

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Wachter’s World : Snooping At Britney’s Chart: Why Should Docs and Nurses Have Different Rules?

Should doctors and nurses be subject to different penalties for precisely the same infraction? Of course not. Are they? Sure.

Just ask Britney Spears.

Britney was hospitalized at UCLA at least twice in the past few years – once when she gave birth to her first son in 2005, and again in early 2008 for psychiatric care. Both times, dozens of UCLA staff members peeked at her medical records, despite having no clinical reason to do so.

I’m glad somebody brought this up! I have been pondering this very issue lately: particularly in light of the mentioned Britney Spears incident.

Great article!