Sunday, November 16, 2008


I just arrived home from a great and very educational EMS conference. I thoroughly enjoyed learning so much and talking with other EMS providers. I have many stories, including competing in a competition while there. However, right now I'm off to bed for a good long sleep.

Monday, November 10, 2008


YEAH!!!!! I have just (15 mins ago) completed my Paramedic program!!! I am now officially a Paramedic graduate!!! I am so excited!!! Now for a few days off, a fun EMS convention with friends, and then hit the books for some study for the NREMT.

Congratulations to me, Congratulations to me, (cue silly music and me dancing in front of my envious classmates)

Sunday, November 2, 2008

4 beds...A day in my life

A day in my life at work as an RN:

I thought I would share a quick snippet of a day with you all (whoever reads this, apparently I don't have a site meter? If someone would help me with that, I would appreciate it. However, I am not sure I actually have any readers).
Anywho, this is a picture of a moment in my day. A picture that changes constantly as patients come and go,and needs increase and are met.

Background: It was a busy day, 30 people waiting in the waiting room, all the hall beds full. We are short again, every nurse has 4 beds plus the hall beds. We had 1 tech for all 80 beds, so pretty much all he did was transport patients upstairs. Our acuity was through the roof, again, so all of us were running around, so nobody had much time to help each other.

So, with that background, here is a snapshot of my 4 beds:

Bed number 1:
Exceedingly cute little old lady (92 years old!) who lived by herself! Cute LOL daughter present as well. She had bilateral pulmonary embolisms, with one being a saddle emboli. She was fairly dyspenic, with saturations in the upper 80s on oxygen. She still needed more blood drawn, the resident wanted something or the other; and she needed report called to the step-down unit upstairs. Oh, and she kept having R on T phenomena that resulted in runs of V-tach without a pulse. Code cart was between her room and room 2.

Bed number 2:
Another cute little old lady with her partner of 60+ years by her bedside. You could feel the love between the 2 of them. He carried out her every wish, while she just held his hand and stared into his eyes with love. This LOL was extremely sick, with a dissecting aortic aneurysm from her aortic valve down to her renal arteries. She had come in with sudden onset of "ripping" chest pain radiating to her back. Classic for this presentation. She had a known small abd aortic aneurysm that was supposedly stable at 3.1 cm.. Today, she had an aneurysm measuring 7.5 cm down her entire aorta. She diminishing pulses in her left leg, and very poor perfusion throughout her body as it was shutting down to compensate. She also had a BP of 180/86 and the MD refused to lower it cause "I don't think this is acute". Herald a continuing argument with the MD to try and get this LOL some immediate help before she died. She also needed another EKG, some fluid, and some more blood drawn. Oh, and reassurance to that loving husband. When the surgeon finally showed up (he took his time since the ER MD told him this was "non acute"). When he finally showed up, she got immediate BP lowering, and rapid transfer to the OR to try and save her life.

Bed number 3:
Extremely obese patient who cannot walk due to a weight over 500 lbs. Seems while having a relationship with her husband (also over 400 lbs), she fell out of bed. He managed to avoid falling on her, how I will never know. She had some small lacs that the PA student was suturing, and some bruises that would heal. No broken bones, fortunately. Oh, and a extremely needy husband who would walk into my other patient's room to drag me out and ask about getting a taxi ride home. Before you flame me, I treated them with care and compassion. Also, being overweight myself I did not judge her for her weight.

Bed number 4:
Patient with Guillan-Barre syndrome after the flu vaccine. She came in with leg weakness that over the course of 4 hours spread to include the entire body. She became unable to swallow, and was developing respiratory failure by the time I transferred her upstairs. After much care and time from me, the annoying judgemental PA who works with the hospitalist team comes to see her and write admission orders. The PA decides that this presentation "is entirely psychosomatic and she just needs to get over it. Please feed her now with a full diet. I am calling the shrink, and she needs a regular bed (not even with tele!) and cancel the ICU bed". Herald another argument with her, and a call to the attending in charge of the hospitalist team that day. The attending comes to see her eventually. Meanwhile, I am getting chewed out for not feeding this lady, not insisting she walk to the bathroom, and continuing to place the foley against the PAs orders (but with the ER MD's orders). Finally, the attending shows up and concurs with the Guillian-Barre diagnosis. She goes back to being headed to the ICU, gets immediately placed NPO (just like I did! sorry, miss PA!), she gets a central line, respiratory gets called, placed on Bipap, etc, etc. She got intubated shortly after arriving in the ICU. She also had a million things that needed doing and several family members who needed help understanding the rapidly changing care plan.
(also, before you flame me, I love PAs. Most are excellent care providers, and I am excited to see them show up as they are often better than the residents. However, this one new one needs to learn a few things before being let loose on her own).

So, that is a moment out of my day. I generally love my job, but it sure can get challenging sometimes!


Today I cared for a elderly women who had a history of both a frontal lobotomy and a circumcision. I don't see either one of those very often, so it was wierd...

Saturday, November 1, 2008

CPR fun

This story just goes to illustrate the twisted sense of humor ER nurses and Medics develop. When you do this job day in and day out, dealing with people's lives day after day; you find you either have to laugh or cry. Most of us choose to laugh, not at the patients; but as a way to cope with what we see everyday.

Today, had a very septic patient come in. Initially somewhat responsive, verbalized a few words. We RSI her, intubate, and start the septic workup; central line (her veins were horrible), foley, EKG, labs, pressors, fluids, antibiotics, NG tube; etc and etc. While the doctor was using the ultrasound to find the femoral vein for the central line (horrible veins!), she lost her pulse. We initiated CPR, and ACLS, and etc and etc. We ended up coding her for an hour and a half before her family said "enough" and we finally let her die.

During that hour and a half of CPR, we got bored with just compressing and started trying to outdo each other with the quality of our compressions. We do not have capnography in our ER, so we were going by pulse and BP. This was a little old lady, and amazingly we were able to measure a BP during compressions. So, what do the bunch of twisted ER nurses and medics do? We started a competition to see who could perform the most effective CPR.

I am proud to say that I won. I was able to compress effectively enough to generate a radial pulse and a BP of 175/106. I was pretty impressed with myself! In the hospital, I don't generally do compressions since we are so short staffed. Most times, I am running around defibrillating, medicating, etc; while the techs do their awesome work and do the CPR. Today, we actually had some free nurses and not many techs. So, we all stepped up to the plate and did our turn. I am pleased to report that I can still perform effective CPR without tiring too much.