So, if I drop my helmet from a height of 3ft or greater, I need to replace it. I am 5' 11" at minimum, sitting on my bike, I lose at most 2ft...
After several years, my helmet has been exposed to the elements, 3 to 5 years is the recommended lifespan of a helmet...
So, I will not argue what the DOT Standards are, I will let you read them and determine them for yourself!
http://www.fmcsa.dot.gov/rules-regulations/administration/fmcsr/fmcsrruletext.aspx?reg=571.218
Ask me again?
Thursday, June 27, 2013
Tuesday, June 18, 2013
I have endured...
As I nurse, I see a lot of things. I experience sights, sounds, smells...
I admit though, I have an "Achilles Heel."
No matter how bad the injury or illness, how much blood, the color of (insert bodily fluid here), what the odor is, or the grossest thing you can ever imagine... I have probably seen it, experienced it, and dealt with it.
Yet, the one thing, that will bring me to my knees...
Is a sore throat.
I will curl up into a ball, sleep, drink my Sprite and Gatorade, eat my pretzels, take ibuprofen till my kidneys scream at me, and just wait for it to pass...
I can handle cough, congestion, headaches, fevers, NV&D, aches, just about everything that a human body experiences! A sore throat though...
My worst enemy! As it knows how to defeat me!
I admit though, I have an "Achilles Heel."
No matter how bad the injury or illness, how much blood, the color of (insert bodily fluid here), what the odor is, or the grossest thing you can ever imagine... I have probably seen it, experienced it, and dealt with it.
Yet, the one thing, that will bring me to my knees...
Is a sore throat.
I will curl up into a ball, sleep, drink my Sprite and Gatorade, eat my pretzels, take ibuprofen till my kidneys scream at me, and just wait for it to pass...
I can handle cough, congestion, headaches, fevers, NV&D, aches, just about everything that a human body experiences! A sore throat though...
My worst enemy! As it knows how to defeat me!
Saturday, June 15, 2013
Alarms...
Any healthcare provider will tell you about all of the "alarms" there are on all sorts of electronic monitoring equipment in the hospital. A long time ago, a Nurse could use there judgement and turn off an alarm. Well, obviously there was an incident... somewhere...
Now days, all alarms must be on, and at full volume! In fact, there are some hospitals that actually disable the ability to turn off alarms. One can silence and/or suspend for a few seconds or a minute to correct the problem, yet once the timer runs down, alarm goes off again! This is one of the major causes of the cacophony that is experienced when a person enters an ED. It seems like a fairly chaotic place, people moving around, talking, the incessant dinging and bonging and beeping. The unanticipated consequence of requiring alarms to be on and at full volume... it causes people to "tune" them out. So when an alarm is "real" it may not be responded to so quickly.
However, the solution to this has been to create certain tones. These tones are not heard often, so when they are heard, it tends to get the attention of the healthcare provider!
~06:51am:
The Nurse I was working with and I were talking about her father coming into town next week to help her drive back home. She is a fellow travel nurse and her contract is ending soon. She knew that I rode. Her dad also rides and we were talking about her renting a Harley for them and her going with him for a day ride around the Tucson area before they left.
We were sitting at the Nursing Station, she at the north desk, me at the south. There is a Central Station Monitor on the north desk at the east end. A CSM is basically a computer screen that displays patient's heart rhythms from a remote telemetry pack that they are wearing. This allows us to monitor all of the patient's heart rhythms from a single point simultaneously, rather than having to go into individual patient rooms.
The CSM was to my right, her left. The angles made it so that as we were talking, we could each see the CSM.
06:52:56am: (Start time verified by time-stamp on the rhythm strips)
Out of the corner of my eye, I saw a particular patient's "window" turn from a black background to blue... then the "ding." The patient had had a premature ventricular contraction (PVC). As we both turned to look, the first PVC was immediately followed by a second... then a third...
My peer said out loud, and by out loud I mean loudly, "Oh Shit! We both jumped up and started to move towards the patient's room... there must have been a fourth and fifth consecutive PVC... as the "ding" changed to continuous "bonging!" Sustained arrhythmia...
I yelled for the PCT to grab the 12-lead EKG machine, I turned to grab the Crash/Code cart... the sixth consecutive PVC occurred... as now the "bonging" turned into the "warble," that no Nurse ever wants to hear... the phone started to ring...
06:53:06am (Time notified verified by event-mark on rhythm strips)
As I passed the desk with the Crash Cart, I saw it was from our Central Telemetry Department, I picked up and said before they could even utter a word, "We got it." Later I saw that I had just dropped the handset and it was laying on the counter...
My peer reaches the patient's room, flips on the lights, starts Emergency Resuscitation Procedures. Yells at and shakes the patient to determine responsiveness... no response. She checks for a pulse... present but weak. She calls out her findings... there is no need for immediate CPR.
I arrive with the Crash Cart. PCT is coming down the corridor. My peer once again yells at and shakes the patient... this time he opened his eyes... the "warble" stopped...
06:53:23am: (End time verified by time-stamp on the rhythm strips)
After a few seconds of a blank stare, the patient gruffly said, "What!?" He was OK.
The patient had an episode/run of ventricular tachycardia (V-tach), a life threatening heart arrhythmia that if left untreated can quickly deteriorate into ventricular fibrillation (V-fib), which again left untreated, results in death. This is what is believed to be the cause of "Sudden Cardiac Death."
27 seconds... from start to finish... and shift change was still 17 minutes away! No need for a morning coffee. It would take at least an hour for the adrenalin burst to wear off...
What truly amazes me, is that the two of us were able to recognize what was occurring before the computer did, and initiate a response. It also amazes me that the three of us were already in a full response mode, well before the other human being in Central Telemetry recognized and initiated notification.
No one will ever know if this was a paroxysmal run of V-tach, or if my peer's yelling and shaking the patient converted him. Usually, electrical intervention (a shock) is needed to convert this arrhythmia. Yet, down the resuscitation algorithm, the first line drug given is epinephrine... adrenalin. Perhaps the patient had just enough perfusion to allow his brain to react to the "startle" and initiate a natural "fight or flight" response... releasing a natural adrenalin bolus.
I began to chuckle. My peer asked me what was so funny. I began to relate the scenario I had just seen flash in my mind...
"Patient Codes! V-tach! We enter the room, determine unresponsiveness and pulseless, initiate CPR, expose chest, attach defib pads... PCT enters room and hits CODE BLUE button on wall... We shock! Patient converts... awakens... is hemodynamically stable. Four minutes later, when the CODE Team arrives because we forgot to cancel them... we are all sitting at the Nursing Station acting nonchalantly, like nothing happened..."
We all had a good laugh at that, especially after the patient earlier in the shift that had a seizure...
07:05am
Five minutes to shift change... so far, uneventful, final approach, coming in for a landing...
07:10am
Our relief arrives. My new friend and I can now relax... there are others responsible now.
Two significant events in a single 12 hour shift... I can no longer say my week has been uneventful!
Now days, all alarms must be on, and at full volume! In fact, there are some hospitals that actually disable the ability to turn off alarms. One can silence and/or suspend for a few seconds or a minute to correct the problem, yet once the timer runs down, alarm goes off again! This is one of the major causes of the cacophony that is experienced when a person enters an ED. It seems like a fairly chaotic place, people moving around, talking, the incessant dinging and bonging and beeping. The unanticipated consequence of requiring alarms to be on and at full volume... it causes people to "tune" them out. So when an alarm is "real" it may not be responded to so quickly.
However, the solution to this has been to create certain tones. These tones are not heard often, so when they are heard, it tends to get the attention of the healthcare provider!
~06:51am:
The Nurse I was working with and I were talking about her father coming into town next week to help her drive back home. She is a fellow travel nurse and her contract is ending soon. She knew that I rode. Her dad also rides and we were talking about her renting a Harley for them and her going with him for a day ride around the Tucson area before they left.
We were sitting at the Nursing Station, she at the north desk, me at the south. There is a Central Station Monitor on the north desk at the east end. A CSM is basically a computer screen that displays patient's heart rhythms from a remote telemetry pack that they are wearing. This allows us to monitor all of the patient's heart rhythms from a single point simultaneously, rather than having to go into individual patient rooms.
The CSM was to my right, her left. The angles made it so that as we were talking, we could each see the CSM.
06:52:56am: (Start time verified by time-stamp on the rhythm strips)
Out of the corner of my eye, I saw a particular patient's "window" turn from a black background to blue... then the "ding." The patient had had a premature ventricular contraction (PVC). As we both turned to look, the first PVC was immediately followed by a second... then a third...
My peer said out loud, and by out loud I mean loudly, "Oh Shit! We both jumped up and started to move towards the patient's room... there must have been a fourth and fifth consecutive PVC... as the "ding" changed to continuous "bonging!" Sustained arrhythmia...
I yelled for the PCT to grab the 12-lead EKG machine, I turned to grab the Crash/Code cart... the sixth consecutive PVC occurred... as now the "bonging" turned into the "warble," that no Nurse ever wants to hear... the phone started to ring...
06:53:06am (Time notified verified by event-mark on rhythm strips)
As I passed the desk with the Crash Cart, I saw it was from our Central Telemetry Department, I picked up and said before they could even utter a word, "We got it." Later I saw that I had just dropped the handset and it was laying on the counter...
My peer reaches the patient's room, flips on the lights, starts Emergency Resuscitation Procedures. Yells at and shakes the patient to determine responsiveness... no response. She checks for a pulse... present but weak. She calls out her findings... there is no need for immediate CPR.
I arrive with the Crash Cart. PCT is coming down the corridor. My peer once again yells at and shakes the patient... this time he opened his eyes... the "warble" stopped...
06:53:23am: (End time verified by time-stamp on the rhythm strips)
After a few seconds of a blank stare, the patient gruffly said, "What!?" He was OK.
The patient had an episode/run of ventricular tachycardia (V-tach), a life threatening heart arrhythmia that if left untreated can quickly deteriorate into ventricular fibrillation (V-fib), which again left untreated, results in death. This is what is believed to be the cause of "Sudden Cardiac Death."
27 seconds... from start to finish... and shift change was still 17 minutes away! No need for a morning coffee. It would take at least an hour for the adrenalin burst to wear off...
What truly amazes me, is that the two of us were able to recognize what was occurring before the computer did, and initiate a response. It also amazes me that the three of us were already in a full response mode, well before the other human being in Central Telemetry recognized and initiated notification.
No one will ever know if this was a paroxysmal run of V-tach, or if my peer's yelling and shaking the patient converted him. Usually, electrical intervention (a shock) is needed to convert this arrhythmia. Yet, down the resuscitation algorithm, the first line drug given is epinephrine... adrenalin. Perhaps the patient had just enough perfusion to allow his brain to react to the "startle" and initiate a natural "fight or flight" response... releasing a natural adrenalin bolus.
I began to chuckle. My peer asked me what was so funny. I began to relate the scenario I had just seen flash in my mind...
"Patient Codes! V-tach! We enter the room, determine unresponsiveness and pulseless, initiate CPR, expose chest, attach defib pads... PCT enters room and hits CODE BLUE button on wall... We shock! Patient converts... awakens... is hemodynamically stable. Four minutes later, when the CODE Team arrives because we forgot to cancel them... we are all sitting at the Nursing Station acting nonchalantly, like nothing happened..."
We all had a good laugh at that, especially after the patient earlier in the shift that had a seizure...
07:05am
Five minutes to shift change... so far, uneventful, final approach, coming in for a landing...
07:10am
Our relief arrives. My new friend and I can now relax... there are others responsible now.
Two significant events in a single 12 hour shift... I can no longer say my week has been uneventful!
Friday, June 14, 2013
Events...
I haven't posted in two weeks. I really haven't done anything except work... no rides, the insights and observations I have had weren't worth posting, and about the only thing to note is that I renewed or extended my current contract. Pretty uneventful, that is until last night...
In previous posts I explained the CDU (Clinical Decision Unit), well I was assigned there last night with two other nurses as there were ten patient's. Two of us had three patient's each, the third had four. Well, the two of us who had three patients, each ended up discharging to home one patient and fully admitting one patient. So we each now only had one patient. That was quickly resolved within a few hours, as several more patients were admitted to the CDU.
So far, pretty uneventful. When my peer received her third admit around 11:30pm - a patient that reportedly had a seizure at home, brought to the ED, monitored for several hours, and finally the decision was made to keep the patient "overnight." Now the patient had no further seizure activity while in the ED for the past 12+ hours. The patient arrives, my peer goes down to start the process of admission to the unit. The other nurse and I were sitting at the nursing station, reviewing charts, documenting, etc. when not 5 minutes later our peer walks calmly into the nursing station and says that her new patient was actively seizing. We asked her if she needed any help and she replied, "umm... sure."
So as she is accessing medication to stop the seizure, the other nurse and I walk down to the room. Yep! They were seizing... full-blown, tonic-clonic, full body seizure! Pretty scary thing to see for the first time, as was evidenced by the spouse standing at the foot of the bed wide-eyed, mouth open, staring... As my peer turned the patient on their side, I hooked up and turned on the suction handing it to her so she could clear the patient's airway. I then hooked up an oxygen mask and placed it on the patient. Our third finally arrived with the medications, administered them, and within 45 seconds to a minute, the seizure stopped. We monitored the patient until they started to regain consciousness, reassured the spouse that their loved one was OK, and finally left the room giving the spouse instructions to press the call light if the patient began seizing again or if they felt anything was wrong. About 15 minutes total had elapsed since my peer came into the nursing station advising us of the situation.
The patient's nurse immediately put a page out to the admitting physician. While waiting for a callback, she called the ED Clinical Leader (Supervisor) to inform them that the patient had had a seizure and is not appropriate for an Observation Unit and needs to be admitted to an inpatient bed. About 3 minutes later, in comes the ED Supervisor, closely followed by the ED Attending, then between 3 and 5 ED Residents (hard to tell as they tend to move in packs trying to jostle to be the first one in the room behind the Attending to get a prime position), followed by the ED Pharmacist and a Respiratory Therapist! And they all looked at the three of us, four actually as the Patient Care Tech (PCT) we had on the Unit was there, sitting rather nonchalantly at the nursing station.
Once they passed, the four of us just looked at each other and someone asked, "Why the 'Rapid Response Team'?" Well, a few minutes later out come the 5 residents (yes, the tend to walk in pairs or singly when not in a rush), the pharmacist, and RT. The supervisor and the Attending stop at the nursing station to ask what happened. When my peer explained what was observed, what our treatment had been, and the patient's response, the Attending nodded and said, "Good job," then left. The ED supervisor stayed and admitted that they were a little perplexed to see the four of us sitting at the nursing station like nothing happened when they came in. I responded, "The patient had a seizure, all four of us are highly skilled and experienced ED staff - it happened, we responded, we did, we fixed, we left!" She smiled, and chuckled. I continued, "Sometimes doctors get in the way of getting things done, it's best to call them and tell them what happened after one fixes the problem." This time she laughed.
The patient was quickly admitted and transferred to an inpatient bed. And the rest of the shift was uneventful...
When another patient... at 06:52am... a mere 18 minutes before shift change...
Well, that's another story, and since this post is getting long, you'll just have to come back tomorrow to read about it!
In previous posts I explained the CDU (Clinical Decision Unit), well I was assigned there last night with two other nurses as there were ten patient's. Two of us had three patient's each, the third had four. Well, the two of us who had three patients, each ended up discharging to home one patient and fully admitting one patient. So we each now only had one patient. That was quickly resolved within a few hours, as several more patients were admitted to the CDU.
So far, pretty uneventful. When my peer received her third admit around 11:30pm - a patient that reportedly had a seizure at home, brought to the ED, monitored for several hours, and finally the decision was made to keep the patient "overnight." Now the patient had no further seizure activity while in the ED for the past 12+ hours. The patient arrives, my peer goes down to start the process of admission to the unit. The other nurse and I were sitting at the nursing station, reviewing charts, documenting, etc. when not 5 minutes later our peer walks calmly into the nursing station and says that her new patient was actively seizing. We asked her if she needed any help and she replied, "umm... sure."
So as she is accessing medication to stop the seizure, the other nurse and I walk down to the room. Yep! They were seizing... full-blown, tonic-clonic, full body seizure! Pretty scary thing to see for the first time, as was evidenced by the spouse standing at the foot of the bed wide-eyed, mouth open, staring... As my peer turned the patient on their side, I hooked up and turned on the suction handing it to her so she could clear the patient's airway. I then hooked up an oxygen mask and placed it on the patient. Our third finally arrived with the medications, administered them, and within 45 seconds to a minute, the seizure stopped. We monitored the patient until they started to regain consciousness, reassured the spouse that their loved one was OK, and finally left the room giving the spouse instructions to press the call light if the patient began seizing again or if they felt anything was wrong. About 15 minutes total had elapsed since my peer came into the nursing station advising us of the situation.
The patient's nurse immediately put a page out to the admitting physician. While waiting for a callback, she called the ED Clinical Leader (Supervisor) to inform them that the patient had had a seizure and is not appropriate for an Observation Unit and needs to be admitted to an inpatient bed. About 3 minutes later, in comes the ED Supervisor, closely followed by the ED Attending, then between 3 and 5 ED Residents (hard to tell as they tend to move in packs trying to jostle to be the first one in the room behind the Attending to get a prime position), followed by the ED Pharmacist and a Respiratory Therapist! And they all looked at the three of us, four actually as the Patient Care Tech (PCT) we had on the Unit was there, sitting rather nonchalantly at the nursing station.
Once they passed, the four of us just looked at each other and someone asked, "Why the 'Rapid Response Team'?" Well, a few minutes later out come the 5 residents (yes, the tend to walk in pairs or singly when not in a rush), the pharmacist, and RT. The supervisor and the Attending stop at the nursing station to ask what happened. When my peer explained what was observed, what our treatment had been, and the patient's response, the Attending nodded and said, "Good job," then left. The ED supervisor stayed and admitted that they were a little perplexed to see the four of us sitting at the nursing station like nothing happened when they came in. I responded, "The patient had a seizure, all four of us are highly skilled and experienced ED staff - it happened, we responded, we did, we fixed, we left!" She smiled, and chuckled. I continued, "Sometimes doctors get in the way of getting things done, it's best to call them and tell them what happened after one fixes the problem." This time she laughed.
The patient was quickly admitted and transferred to an inpatient bed. And the rest of the shift was uneventful...
When another patient... at 06:52am... a mere 18 minutes before shift change...
Well, that's another story, and since this post is getting long, you'll just have to come back tomorrow to read about it!
Subscribe to:
Comments (Atom)