Not much to say.

Day one of ACLS completed. Not as bad as I thought it would be, as most of the things I have learned already through pre-hospital care (such as oralpharyngeal airways, Bag-valve-masks,etc) but the drugs are still new. Apparently this is ACLS for dummies now, because really, the drug list isn't as bad as it used to be.

Went to see the new Batman tonight. It was fantastic. I highly recommend.

That's it for me, no bitch sessions tonight.

I do have to say that Mr E and I have a very good strategy for our co-op play for shooting games. He goes rambo, I stay back and shoot from a distance. That way, when he dies, he can respawn and rambo again. Did I mention we play a lot of shooting type games? Lets see, we've gone through Bond 007 games (beat them but took some time), Army of Two (beat it in 3 days), Halo 3(beat it fairly quickly), Gears of War (beat it in a week), and now we're on this Rainbow Six Vegas. We've also conquered everything but the last set on Guitar Hero 3 on expert. Yeah we're video game burnouts. We also went a little nutty with Mario Kart for the Wii. The only goal we have now is a bigger TV so we can use our 360 better and be able to see the letters of the words!

Not much to blog about...

Spent the day on an off-service floor. Pooh. It was snoresville, but I'm glad there are nurses that like transplant nursing. I don't' think I could handle seeing the same patient for 2 weeks-months.

Tomorrow (or shall I say, today) I take ACLS. Did the prepwork so I'm feeling pretty good. Wish me luck!

Acetaminophen: good for headaches, bad for liver.

So a man who has had a rough past (he wouldn't go into detail) calls 9-1-1 after he has run out of percocets. We get him around 0200 and he states he has taken 6 percocets around 11pm, and has pain. Blood tests were drawn around 0300h. His acetamenophen level was 1105µmol/L. According to this chart, in the Merck Manual, he was at the top of the chart for probable hepatic toxicity.

Yikes.

I have never had an acetaminophen overdose ACTUALLY BE an overdose. It was too late for activated charcoal, so we gave him acetylcysteine (Mucomyst). He handled the first dose well (the dose has a bolus and then it is reduced and has a regular flow for about 16 more hours), but then developed facial swelling, nausea, and itchiness. This reaction is not uncommon. So diphenhydramine (Benedryl) and dimenhydrinate (Gravol) was administered, and we turned the rate down.

I had to do this (I never have done this before) and I also had 2 other patients. The other nurse who was mentoring me was on break, but she came back and helped once she was back. I felt that I was in panic mode, but I think I did ok, despite the fact that I think I was slower then most (I hadn't hung that drug before so I had to look it up, make sure I double checked the dosages, etc). I also had to start an IV because the person continued to insist they only took 6 percocets. Man that was an interesting 45 minutes. I was sweating buckets by the end... I sweat when I get anxious.

The manufacturers of acetaminophen state to not exceed the 4g a day limit on acetaminophen. It can wreck your liver. Please read the box carefully.

Another case of NETY (nurses eating their young)

I think I'm the unlucky one.

The other day I was asked to escort a monitored patient to a diagnostics lab. No problemo. However he needed a transfusion of Fresh Frozen Plasma after his initial blood transfusion had been completed. Well I wasn't sure what the procedures were 100%, so I quickly looked it up on the computer at the diagnostics lab before I went to prepare for the transfusion.

A nurse goes to me and says "hey, is Mr X your patient?"

"Yes," I reply. "Why?"

"His FFP (fresh frozen plasma) is there."

"Ok, thanks. I'm just reviewing how to hang it before I head in there."

"You're an emergency nurse and you don't' know how to hang blood products???" She asked in an incredulous voice, as if I was the worst ED nurse ever. That stung.

"I'm a new grad, and new to the ED" I fumbled, flabbergasted.

I then proceded to hang the transfusion appropriately, but that comment pissed me off.

She was totally and completely in appropriate for saying that to me. The other nurse at the lab clued in and tried to console me by saying that "we were all new at one point, how else are you supposed to learn?". I appreciated that, but still. Pisses me off that someone could belittle another person. I would NEVER do that to anyone. If I do, that's the time I need to get out.

Also, I really need to start thinking about what to say at the TIME of the incident, not afterwards. One day.

Change of Shift

This week's Change of Shift highlights the initial post of many different nurse-bloggers, including myself.

Thank you for stopping by, and enjoy!

Dreaming as a nurse

I have committed a crime of sorts.

I have taken work home with me.

Not in the usual way by bringing home paperwork or completing an online test for continuing education. Nope, I get it personal. I DREAM about nursing.

Considering I'm not 100% sold on nursing, it shocked me that I would start dreaming of it.

I was dreaming that I should be working with my patients and shouldn't be sleeping on shift. Then I startle and think WHY THE HECK AM I SLEEPING WITH SOMEONE BESIDE ME... WHO IS IT? ANOTHER NURSE? A PATIENT?

Then I wake up and realize I'm at home, in bed, with my boyfriend sleeping, blissfully unaware of my dorky-ness. I will attempt to have non-nurse dreams in the future.

God I can't imagine what I will dream about after 5, 10 and 15 years of this. Thoughts?

Punished

So here's an interesting topic

I got sent home from work today because I was too eager to work.

We have an inservice day today, from 0830-1630. As you can see by the time that I'm sending this message (0850), I am not at the inservice. WHy am I not there? Because I had to work last night, or so I thought.

See, apparently I was supposed to know that I was only supposed to work 4 hours last night. No
one had told me this, and it was not on the schedule. I had even mentioned that there was a inservice tomorrow all day and that I was working... people didn't blink an eye or suggest I shouldn't work all night

So I jokingly say to the Educator today that I'll make sure I stay awake today.... and she asked why. I stated because I worked last night.

She looked at me in shock and said, well I can't keep you. Go home.

I ask, "what do you mean?"

She says " you were only supposed to work until 2330. " I say "o really? I didn't see anything on the schedule and no one had told me this, so I assumed that I had to work all night. I would be more than willing to stay the day and I am wide awake now, so it's no biggie."

Yes I still use the phrase "no biggie".

Continuing on....

The Clinical Educator said to me that she thought she had made comments earlier on about going home early if you had a night shift before things during the day, and that she had made this clear. I was not aware of this, nor was I not paying attention. It is a new job after all, and I'm the new kid on the block.

How was I supposed to know that I was supposed to ask to leave early (aka 2330)? Am I being punished for being too eager? (the Educator was ticked off that I worked last night and that I'm going to be missing the inservice cuz she wont' let me stay)

I guess I have a different work ethic than others. I didn't even blink an eye when I thought I had to be at work for 21 hours

I'm just hoping no bad repercussions come of this, and I'm pissed off that people assume that I know the policies of the department.

I'm still learning them. How was I to know this is the way things are done in Emerg at cityhospital?

Because in Small town hospital, if you had a meeting to go to all day, and you were scheduled the night before, you worked the night shift and then went to your meeting, unless you had traded or booked with someone else.

I'm ticked off because the situation makes me look bad (despite my good intentions), and since I dont' have a full time job secured, it makes me angry that something has happend that could put me in a bad light with the Educators and bosses.

Anyway, I'm done ranting now, thanks for listening.