Choking Hazard

After taking a patient off the bedside commode (apparently it's not as cut and dry how to properly put a bedpan under the patient, the tech put it under her backwards. At least it wasn't upside down) I started walking the stool specimen to the lab.

On my way to the lab some people shouted at me that someone was choking in the bathroom.

Damn.

I put the stool specimen in my pocket (fortunately I had double bagged it and had clean gloves on) and walk in the bathroom.

First thing I see in the bathroom was a tall thin man with glasses.  He reported "I did the Heimlich Maneuver and she's still choking!"

I push the door open the rest of the way and I see a tall lady standing next to the sink who then tells me she is still choking. I make eye contact with both of them and inform them both the Heimlich maneuver  only works if the airway is completely obstructed.

I then offer to help her check in to get treatment. She refused and then returned to the sink and induced vomiting.

Seriously, what's wrong with people?

Disillusioned at Disney

Went to Disney recently and although I had a great time, I think it'll be a while before I return to the parks (still planning a cruise in a few years, we'll see how that goes).  There are a few reasons to why I feel this way. I'll write another post on the awesomeness that was had.

1) Lines. I know it's Disney, and I know to expect waits for popular rides but damn.  It's October, how many parents took their kids out of school for this trip? Obviously I did, but more than I had anticipated.  Wait times for most of the thrill rides were over an hour. One ride, one of the Avatar rides in Animal Kingdom got up to a 300+ minute wait.

And it wasn't even the good ride (Navi River Journey)

We essentially only rode each ride once on the day we were in the park, seldom did we get to two (though a lot of that was also because our kids wanted to see as much of the park as possible and did a lot of walking because of it).

2) Their fast pass system SUCKS.  You're allowed 3 fast passes per day to start. After you use/cancel your fast passes you can then try to get another one. Problem is there are so many people even the shitty fast pass rides are gone quickly. 

3) All their meal prices have gone up. Even at their "quick service" meals (burgers, nuggets, etc) I was spending $13/adult (3 adults cause 10 year olds count as adults) and $8/kid. I spent $15 for 4 bottles of water one day (probably more,

4) So many parents that let their kids do whatever they want. No discipline. Though that is a problem with society in general.

5) Motorized scooters. Holy crap they're everywhere. I'm not just talking about one or two rolling around with a family. I'm talking groups of 10. I would literally walk the opposite direction each time I found a group with more than 1.

I swear anyone can rent them, I saw several young kids riding in them (granted they were obese and probably couldn't handle the walk in the park all day).  And, in case you don't know, anyone in a wheelchair or motorized scooter gets to cut in line. I don't know the entire process but every day, every ride, someone in a wheelchair/scooter would cut to the front of the line and their entire group would go with them. There seemed to be no wait time for them.

Please don't get me wrong, I used to work for people with disabilities. I was a program coordinator for the adult socialization program and the summer camps. I understand why it is done. But it seems like everyone is taking advantage of this. After waiting for 45 minutes to get on a ride 2 different groups came in and went straight to the front. It became tiresome after seeing this happen all week long.

So long story short, it'll be a while before I enter a Disney park again.  I do love the experience but I need some time away.

Horror Movie Reviews: Stephanie

I've seen a few horror movies recently and I figured what better way to spend a sleepless few hours reviewing them (without spoilers).  Once again I know there are other platforms to review movies, but I'd rather do it here.

Stephanie

Stephanie is living at home alone. There is something stalking her, an unseen and unknown entity.  

I really enjoyed this movie.  The first few minutes had me holding my breath at some parts.  There were several other parts that had me creeped out.  It takes a lot to get me to that point (I've seen more than a few horror movies). 

If you like a good supernatural horror movie (that's my category), you should watch this one.

Triage Hell

Spent the last 12 hours in Triage. Definitely one of the worst days I've had out there. 

I clock in at 11a and we're holding 10 admitted patients because there are no beds upstairs, 3 transfer patients, rapidly transfusing blood on another, with several overdoses. We have a really high acuity going on (unusual that we have this many at one time).

We get word of an OD needs help out of a car.  We drag his strung out ass into a wheelchair with the help of security. As we take him to a room, security disappears.  The patient becomes combative and we end up calling a code gray (violent patient). Everyone shows up who is supposed to respond (security, maintenance, basically everyone available), and NOBODY helps. They stand outside the room listening to the patient ramble on about being raped by the person living in his head (I think that's called masturbation) and how he's travelling at the speed of light.  Homey is tripping on something.

As we deal with all this in the back, people continue to come in to the department, obviously we can't exactly close.  I end up with 23 people in the lobby with a 5 hour wait time just to get to a room.

One person waiting tries talking to me about how he doesn't understand how this hospital can handle an emergency when we can't even get patient's in the back to be seen.  This is the same fucker that eloped with his wife because they had been there 4 hours (she had an ulcer on her ass with an abscess starting to tunnel to another location, and it appeared necrotic) without an answer. 

I told him they had to wait because of the large number of traumas/overdoses/unresponsive patients. He didn't seem to happy but it shut him up.

After triaging a few other people, I marked 2 for the rapid medical side of the department.  One of the RNs working that unit called me to ask if we could bring them back.  Mind you, I'm still 20 deep and trying to get protocol orders completed and still triage the rest. She had 4 patients, one of whom was being admitted and the others nearing the end of their treatment.

I asked her to come out and grab the 2 extra patients.  She starts bitching about patient abandonment and how she is the ONLY one in that section (not true) and how she is leaving the provider without help (maybe true, but they don't need us to wipe their ass while working).  Instead of calling her out on her bullshit I decide to ignore her and hang up the phone.  A couple of minutes later she comes out and is still bitching about all the work she had to drop so she could get more patients for herself.  Again, instead of calling her out on her bullshit I ignore her (and so does the other triage nurse).

Basically she needs to get off her high horse and take one for the team. It's not like we have a lot of options.

The other triage nurse gets a call from home and her grandma is sick and she has to leave.  I'm then left alone for over 30 minutes trying to get everyone triaged (yes, still 20 deep, people still coming in).

I'm then told by the charge nurse to take a lunch break whenever because people are going to keep coming in.  I'm not the kind of guy to leave my coworker alone to triage 8 people in 30 minutes.  I opt to not take a lunch break unless someone comes to cover for me and help triage (never happened).

Towards the end of the night it FINALLY starts to slow down.  I'm finally in the single digits for people needing to be roomed/triaged.  Rooms are becoming more available. Someone checks in and reports leg pain. She is making such a big scene that her boyfriend goes up to the registration desk and asks for the patient to go back twice in 5 minutes.  I opt to triage another person in front of her (had been waiting for almost half an hour for the triage and palpitations come before leg pain anyway). She's making such a big stink about her pain that everyone in the waiting room was happy to see her go back to a room (turns out she was just drug seeking and she was escorted out by security. I'm SO shocked by this outcome).

Overall there were a lot of variables I couldn't control in the ED. I thank my coworkers for helping us all get through this without any real incidents.  Over the course of the 12 hours I had more people leave without being seen than I have in the 5 years I've worked in the department.  I don't blame them (other than they probably didn't need to be seen if they left).

At one point someone asked if I hated my job.  Honestly, even through all this shit today, I still like my job.

Chilean Adventure: Cementerio General

The Cementerio General is an estimated 210 acres of graveyard. It has an estimated 2 million graves and 237 sculptures located throughout. Unfortunately there isn't a lot of information regarding some of the burial sites, at least not the way I entered. Chile doesn't mind the tourists but they don't cater to English speaking people. You're basically SOL when it comes to most "tourist" areas of Chile unless you're fluent.

Larger mausoleums have statues and stained glass windows

A stone angel has come to life! Beware the weeping angels!

One of the more beautiful statues I found

A giant mausoleum, hundreds located on the grounds. Wealthy families purchase their own

My Chilean friend informed me if your family doesn't pay you will get evicted to make room for a new tenant. I couldn't find official documentation on this, the Socialist country probably wouldn't advertise this to everyone.

More beautiful artwork on another above ground tomb.

Several of the mausoleums are overgrown. It's unique and beautiful.

More ornate stained glass in a tomb.

Found this empty grave. Anyone want to pitch in and buy it? We could decorate it how we want.

Guardians to the tombs in this mosque

This is where the poor people are buried.

No information surrounded this mound with plaques. One can assume this is where the "evicted" people live

One of the many earthquakes that hit Chile opened this tomb from the late 1800s. Yes I poked my head in. Yes I found multiple skeletons from when they were entombed. Spines, skulls, leg bones still attached to the shoes. It was awesome.

This wall goes for half a mile, maybe more. It was spectacular to see.

This was found outside the crematorium. Another beautiful sculpture with some creepiness going along with it.

This one isn't as well kept as some of the others. It adds a great creepy factor to it.

IV frustrations

Less than a year ago I was trained for the first time how to start ultrasound guided IVs for the department.  The superiors are trying to have more IV "experts"  so we don't become so dependent on a few people.

This was by far my favorite training.  I wasn't given a lot of details on how to do it properly, just showed the differences between a vein and an artery.

Veins and Arteries appear like black circles on the screen, when you push on it arteries pulse and veins collapse

I wasn't given a lot of information other than that. I was great at finding veins, it's not that difficult.  I didn't know how to access the vein, that information was briefly discussed but that's it.

After the training I would find the vein, set down the device and stab blindly for the vein I had just found.  Any seasoned nurse can tell you that going in blindly for a vein is horrible.  You end up digging and chances are you're just hurting the patient.  I was so bad at the ultrasound IVs I hated when people asked for my assistance with the ultrasound IVs.

Right before Christmas I was called and asked to do additional training after the holidays.  I jumped on the opportunity because, as described, I was horrible.  I needed additional training, I'm sure everyone knew.

The trainer taught me to find a vein, no problem here.  He then showed me, using the ultrasound guided device, what the needle looked like when inserted into the skin.  He then showed me what the vein looked like when the needle was inserted.  

The bright thing in the middle of the vein is the IV needle. When you see this image you're in and just need to advance the catheter.

He explained a couple of more things, and something clicked in my brain.  I don't miss frequently anymore.  I know I'm not the best but I can get an US guided IV quickly, with blood work, in less than 15 minutes (sometimes longer, depends on how much extra skin they have).  The most difficult part for me is finding the needle after it's inserted (again, sometimes takes a while but I'm pretty good at it). 

The other day I started an IV on a patient, it worked perfectly.  Several hours later I found out the IV had infiltrated and nobody was able to get another IV.  Even the doctor entered the room and wasn't able to get the IV.  He contemplated starting an IO on the patient.

Later that evening, before I learned of the first IV infiltration, I had been called in to start another IV.  The patient was extremely sick and required 2 IVs.  I got them without a problem, both of them were started quickly and without difficulty. Both in the antecubital just like before.  This patient, right after I let go of his arm, bent the arm to keep himself warm.  

I learned about 2 hours later that all the IVs had infiltrated on both patients.

I've had a lot of IVs lately infiltrate after I leave the room.  It's becoming frustrating to me because it appears as though I'm incompetent with my IVs.  I've done research as to why the IVs would infiltrate after the fact and it basically boils down to the patients are moving too much causing the catheter to dislodge from where I secured it.

Or they are bending their elbows too much causing the catheter to kink.  Those are the only two explanations I can come up with.

I think ultimately I need to start trying for other locations for the IVs.  I think that's my only solution.  Talking with other nurses they aren't blaming me.  Personally I don't know, but I got to try something else.  I'll try again tomorrow.

My Dilemma

Several years ago I worked with a tech in the ED.  I'll call her Molly.  Molly was lazy, only liked working with certain people, and if she was asked to do anything she needed company.

At one point she was the tech working in my section.  I asked her to start a Foley Catheter in a room while I took care of an ambulance in another room.  Molly immediately turned around and asked her friend, the RN, to help her. This RN was already mad at me for starting an IV for me (she just wanted to sit in her section and literally do nothing).

The combination of Molly and this RN was enough to tarnish my name.  The RN stepped out of the room and started yelling that I was lazy and I needed to get off my ass and stop eating tacos so I could do my own job (at this point this RN had only started an IV and helped Molly do her job, literally nothing else).  The Charge nurse that night for the next several months harassed me about me doing my own work. Never allowed me to speak, etc, etc.

I lost all respect for Molly (and that RN, but that's another story).

Fast forward, Molly was terminated from my department for attendance problems (considering her work ethic, this was no loss in my mind).

Fast forward again to yesterday. It was a horribly busy day, we got slammed by multiple sick patients within a few minutes of each other (including a cardiac arrest).  This backed up the rest of the ED for several hours.  Molly checked in as a patient where people were waiting up to 3 hours just to get into a room.  

15 people ahead of Molly, she was the only one who came up to me and asked how much longer until she was seen.  Once again, not exactly the best thing to do when there are no rooms and the triage nurse has little respect for you as a person.

Molly was eventually seen and discharged.

Over the last several weeks the schools in the area have been sending us nursing students.  Guess who was sent our way today?  That's right, Molly.

She spent the first 4 hours of her shift with someone else.  I'm stewing in my section, avoiding her as much as possible but still keeping it professional (that's what I do). I vent to some people about the person, the situation and my complete lack of respect for her as a professional.

After those first 4 hours she is then transferred to me to I so I can precept her.  I'm not thrilled about the situation. 

I'm glad I could keep it cordial but she was no different at with my interactions tonight than she was when she tarnished my reputation several years ago. She was still the entitled, lazy tech who is now in nursing school. 

I still have no respect for her as a person. I hope she never works at my facility because I guarantee I will have no respect for her as a nurse.  

Is this a bad thing?

What if?

After a long day at work I went to the grocery store.  Nothing out of the ordinary.  As I pulled in I overheard a domestic dispute.  The lady in the car was yelling at the man in the car to "get out of my car", "stop it", etc.  I couldn't tell what was going on but I could see the woman hitting the man.

Thinking this was only an argument initially I thought nothing of it.  As I walked to the store entrance I got to thinking "What if?".  What if he was doing something to her? What if this was the start of a date rape, etc? What if?  I didn't know.  Because of the situation I didn't want to be the guy that could've stopped it but didn't do anything.  A simple phone call could stop a potentially dangerous situation.

I decided to call the police when I was out of their sight (I parked next to them and my car is pretty easy to point out. I also wanted to remain anonymous).  I gave them all the information I could and the police informed me they would check into it.

I finished shopping and less than 10 minutes later went back to my car.  Four police cruisers had responded.  The lady was arguing with one of the officers stating she was just having an argument with her boyfriend and they argue all the time.  The officer was handling it like a champ.

Though this may have been an over-reaction to the situation after the facts were known, what if?

I'll take a moment here to thank all the officers who respond to calls like this, potentially putting their lives on the line. They never know what they are walking into but they do it every time they respond to a call.  They are underappreciated in our time and we don't have nearly enough of them to help. 

Thank you, officers, for everything you do.