Tuesday, December 02, 2008

Happy Granny Dump Days!

A couple of months ago one of the flight nurses from our competition approached me with an idea. He is the coordinator for a critical care transport course for paramedics. (CCEMT-P). Its a class that I wanted to take a couple of years ago when I was trying to get my shit straight to get a flight job. Its a pretty long course with all kinds of critical care concepts covered. He asked if I wanted to teach the neuro lecture! That was a pretty big deal to me. So I got my lecture straight and went in to teach yesterday. I think it went well.... I was REALLY nervous but I hope it didn't show. I originally thought I had 2 hours to cover neuro assessment and Intracranial Pressure... but turns out I had 4. (I can't imagine talking for 4 hours about anything but Jimmy Buffett and maybe Key West!) I get my evaluations in a couple of days so we will see how I did. He already asked me to come back and teach next year so I take that as a good thing!!!

I also was approached by the professional practice council from the ER about teaching a critical care class down there as well! Its weird how stuff works out. I don't mind teaching, but I'm always nervous that someone is going to ask a question that I don't know the answer to.

The ER leading up to Turkey Day was absolute insanity. The Monday-Wednesday are officially referred to as "Granny Dump Day." Thats when families come up with a good story about why grandma needs to be admitted to the hospital over the holiday. Usually they drop off Monday or Tuesday and are "unable" to pick her up on Wednesday or Thursday morning. Its sad, but predictable.

Had a transfer head bleed (from coumadin and htn) that has an INR of over 7, no ffp of Vit K given. She had no exam on arrival and we were in the process of prepping her for brain death testing. When the neurosurgeon went to tell the family (all 40 some of them) they started screaming, yelling, throwing up, throwing themselves on the floor... someone went AFTER the doc and got arrested. It was quite the scene. The poor chaplain said its the worst reaction she has seen in 15 years. At least they were OUTSIDE of the ER and couldn't get back to where I was.

I also had a lady who weighed 450lbs and was short of breath (surprise, surprise). She was too big for the bedside commode and would have crushed the bedpan. I tried to take her to the handicap bathroom and help her to the toilet. Let me refresh.... I am 5'0 and not a big person.... she was about 5'3 and 450lbs. This was not an even match up. Had she gone down I would have had to just get outta the way! When we finally got back and the MD ordered Lasix that was my limit. I recruited some (very good) friends to put in a foley. It took three of us and I was in the bed with the patient. I can tell that there is still some ICU left in me.... I had to clean her up down there before I would put the foley in. It was just the right thing to do.... even if the right thing smells like it hasn't seen warm water and soap in several weeks.

My (former) base manager left for Afghanistan yesterday. He is going to be a medic embedded with the Afghan army. Please keep him in your prayers... I am so worried about him.


Blogger GingerJar said...

My last shift I had a patient (much like your brain dead lady) who had already coded 4 times before I got there...family would not make a DNR, although Cardiac MD said there was nothing more they could do for him. They couldn't do a balloon pump, even though they tried because he had a new valve, and recent open heart in Oct. with all new grafts already blocked. He coded time number 5 during my report...and time number 6 15 minutes later. He did not make it and we had hysterical screaming family members coming at us because the Priest had not arrived yet and we "did not do our job and keep him alive" until the priest got there. All I know is that my arms are still hurting like hell today from doing compressions for so long. Poor guy...he was 74 years old and they couldn't understand why he died,

5:11 PM  

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