HAPPY EMERGENCY NURSES DAY!!

To all my fellow ER nurses (and to me!). Its Emergency Nurses week and today is 'our day'.

Some days I still sit back and go wow am I really a nurse?? An ER nurse? Holy crap how did that happen! LOL. Mom says, I never think that I always knew you would be one!

Still love it. Still learning every day - sometimes several things a day! Still love being hands on with my patients making differences in their lives - at least I hope so!

xoxo

Tuesday - what a difference a day makes

Simply put Tuesday was a refreshing break. NOTHING compared to Monday. In fact when we left this morning there were only 3 pts in the ED. Big difference compared to Monday. And I only had a full zone of pts for like 3 hrs. After that, I only had 1 or 2. Its a blessing though cause anyone who was there Monday could not have done that again Tuesday.

And my orientee is on her own and flying high! So exciting she has been on her own for 2 weeks now and doing awesome. Pat on the back to me, pat on the back to her. I know I can only teach so much and she has to do it and that she has! It actually came full circle when the nurse who oriented me on day shift for two months complimented my orientee after picking up her pts one morning. Kinda nice to see what goes around comes around - in the good sense.

Monday....or as we referred to it....hell day

(Long - but will give u a glimpse into some of my nights if you read it!)

This past Monday was the worst I have EVER seen my ER......plain old down right so freaking full its not even safe for the patients that are there. Why do I say that? Well when I walked in the door and took a look at our 'tracking board' that tells us who is in all the beds and who is in the waiting room..........the waiting room had more than 35 people in it. Now, keep in mind that's 35 people IN ADDITION TO the 40 people already in our beds to be seen. Also keep in mind our typical flow is around 145 pts in a 24 hrs period. Needless to say with 75 of them there at the same time.....it wasn't a good thing. The top person had been waiting something like 4 hrs.

So I put on a smile and go to get my assignment (yes I actually do try to smile!). In a situation like this there are 2 things you really don't want to be #1 the Triage nurse who has to see every pt that walks through the door and decide how sick they are or...... #2 be the nurse in T2 who brings pts back prior to having rooms and starts their work up. IV's, blood work, urine, CT scans, xrays, etc. Well guess what. I was saved from #1, but not from #2. Laughing, that's how I responded. I mean seriously if I didn't find humor in having to deal with irate pts who have been here for hours listening to me call their name only to tell them we still don't have a room but I will draw their blood, etc what else was I to do? Cry? I seriously considered it and that came in as a close second.

Only relief was that we were OVER staffed for once and I had 2 other nurses in T2 with me. Which is nice to have more than just one, cause typically that's all there is. On to the next step - evaluate the 35 pts in the waiting room........well lets see I have 5 priority 2 pts meaning they are at the top of the list to be started some abdominal pain, one chest pain, one change in level of consciousness...and it goes on. Start taking those pts and working them up. Then I lose another nurse to do conscious sedation. Bam down to 2 nurses, ok that's still better than 1. Next work up another pt. Find out the triage nurse is 45 minutes behind triaging pts cause so many are walking in the door. Bam down to 1 nurse, just me. The other nurse got lost to helping triage for about an hour....... I'm still working pts up. She's back and we are two-timing which helps us get through the list faster. But then again the faster we worked the more pts that walked in the door. Pts were being seen IN THE HALLWAY by docs cause there was no where else to take them!!!!

Lets just say I'm all excited at 11 pm that I should be getting a zone and have my 3 or 4 pts and be in my own little world. Just kidding, we are still overstaffed. I need to do a conscious sedation on a pediatric pt with a broken wrist. Grand, exposure to radiation for me and small hot cramped room with a crabby ass orthopaedist. Just a topper for the night. Rounding up the papers, the cast cart, the portable xray machine, etc. So I can be ready. Then I get told you can go back to T2, the other nurse can do the sedation and we have an agency nurse coming down from one of the floors to cover the other nurse. SERIOUSLY? Back to T2....that's like totally not nice!! But ok, off I go. Back to T2 only like 20 pts in the waiting room, ok we are making progress. Phone rings, Beth the agency nurse isn't coming down from the floor and the other nurse started the sedation so now we need you to cover Peds. O Lord.....peds, me?? NOT a good combo. Last time I had to start 2 IV's on kids 3 y.o. and 6 y.o.. Did not make me happy at all. The good news is there is only 1 kid (Other than the one who was being sedated) and there could have been 4 more. The bad news, its a 7 week old baby.....who needs blood and a straight cath for urine. Just my damn luck. Can I take the conscious sedation back with the crabby ortho guy and give this to the other nurse? Nope sure cant. So I call charge cause I have never cathed a baby girl and I don't like to stick peds pts. I tried and felt a very small but good vein, stuck her....nothing. But the other girl had trouble too so I don't feel so bad! Blood and urine, done. Other nurse done with sedation, so I am back to T2 around 1230.

Sit down review the computer to see who to start first....call charge and confirm she really does want me in T2. She says no, actually I want you to float and take pts upstairs. Ok done. 1245 went to main nurses stations asked if anyone needed help. Told the nurse for room 2 I would take her pt upstairs when transport got there. Walk to main 2 ask if anyone there needs help. Start an IV medicate a pt. 130 am - Go back to main 1 see charge nurse.....get told I'm picking up a zone of pts because that nurse just tripped and fell and now needs to be seen. LOL. seriously how many more times can we change what I'm doing?? Laughed and went with the flow. Fortunately she wasn't hurt and I only inherited 2 pts in a zone that was closing. Stayed there for 1.25 hrs.

3 am pick up a zone with 3 pts. Be happy, that's all I have to worry about. 1 demented little old lady, one lady with sob chronic probs and one belly pain we are ruling out gall bladder and appendicitis on. Happiness is......till the box goes off that tells us an ambo is coming in. I can hear the alert noise but nothing after that. Finish doing my work. Medicating a pt. Get a call from the doc, we are moving your pt from room 7 and putting an ambo pt in there. But wait, where the hell did my other pt go cause she needed a rash of things.....can someone tell me where she is??..... Finish medicating several minutes later. Go to gret the new pt - realize she hasn't been triaged. Notice the EMS guy being an asshole, so I give him the same courtesy. O except this lady was having trouble breathing and this asshole couldn't bother to at least put her on some oxygen once they switcher her bed? Are you kidding me.........jerk. Realize this is the mom of a CCU nurse here, woa gotta love that.......watch your steps. I think I'm a good nurse and I do things like I should but a little extra attention to details doesn't hurt things.

645 New nurse asking 'who has B zone'. O thank God ......and I turned it all over. Except at 708 CCU called to get report on one of the pts. Can I give them reports since I'm still there and the new nurse doesn't know about the pt? Of course I can. I would want someone to do it for me......if only they new the night we had.

Home, in bed and asleep as fast as I could get. And to think I had to go back on Tuesday.

So freaking overdue

Not even going to apologize! Those of you who know me....know my life and its been busy as hell in the last few months!

What have I been doing? Well lets see....................

I bought a house. Actually a town house - I'm now 205K in debt further than I was! LOL. But I love it. Its getting painted next week and after that I can finally hang things and will truly feel like home. That will be about the time something else will break or stop working or blow up. Apparently that's how home-ownership goes. So whatever! I keep thinking -taxes, you should get a lot back in taxes (should help considering I'm going to make like 70K this year)!

I spent a lot of time at the Hospice facility in Rockville. My Great Aunt Gladys, at 101 years old, lived out her last 2.1 weeks there. In a fabulous facility with fabulous employees. With family by her side nearly 24/7. Although we've had our experience with hospice before, this was a new one. And I wouldn't trade it for the world. Rest in peace Aunt Gladys, you had a long, wonderful life and touched so many people, you are missed!

I am orienting a new grad at work. Its fairly exciting to know they trust me and have that much confidence in me although I'm still fairly new. Its also demanding. Yes I sit a lot more than when I carry my own weight, but I'm also responsible for ensuring she is doing everything that she needs to be doing, and that she understands why. I've never really been in the supervisory role before (only had the manager title with no one under me!), its new, and challenging on some level. I hope to birth my first baby nurse near the end of September! Here's hoping all goes as planned. I've basically already been told (and seen in other new nurses who are also orienting) that I should get used to it.....they're going to keep me at it.

I'm now working at least 4 nights a week. Typically 3 12's and an 8, but sometimes 4 12's. Just depends on what I'm feeling. And last week I worked 4 12's AND an 8......some days I wonder what kind of illegal drugs are in my water that convince me to do that!

In the works is one of my newest goals. Something that I pondered after consortium during the first month I worked at the hospital. I want to become a SAFE nurse. What does that mean? It means I will have the letters FNE-A after my name. It also means I will be certified to perform exams on adult victims of sexual abuse. I will be able to collect forensic evidence from these victims that will be used to prosecute the offender. I know its sounds kind of creepy, but its just one more way I will be able to help people as a nurse. I am really looking forward to it. Of course it means more classes, etc but it will be worth it in the end. Not sure if I will be in a fall or spring class, they don't offer it that often.

I haven't taken a vacation this summer as I am officially house poor. But I am taking one soon, spending a week in the OBX with my sister/brother-in-law and nephew. It should be fun. I haven't been woken up by the cutest little man on the planet in a while. I'm sure it will prove to be late nights out and early mornings with him waking me!! Going to have a hangover.....probably.....who knows how long it will take me to recover!

Things that I have been pondering lately:
- why does the group home for deaf people that's two doors down have a van they use.....that beeps when it backs up? what the hell kind of sense does that make?
- why do people insist on NOT using their turn signals?
- why is it that people who are on their cell phones cant freaking drive properly? Is it that difficult to do 2 things at once?
- how come I see so many white trash redneck ass people at work who are knocked up AGAIN...... yet there are couples who cant conceive that should!! And why do these dumb ass neckers come to the freaking ER for a PREGNANCY TEST? That's my hard earned tax dollars at work.......assholes
- I think I forgot to mention I had a pt who was bitten by a rattlesnake.......HIS OWN PET SNAKE......that he decided to help shed after ingesting several beers. And then this SOB left AMA, against medical advice, from the hospital.....he probably lost his finger, or two, or possibly his whole hand. But man was that an experience for me!

Things I love:
- the sound of my goofy ass cats sliding across my hard wood floors when they are Indy-5hundreding through my house.
- that i own my own house!!
- that I'm going to Broadway in November to see The Little Mermaid, aren't you jealous?
- that I'm going to buy a new car in the next 6-9 months. Honda Pilot here I come!!
- that snow comes soon........ahhhh I love winter!

Anyway, sorry for the random catch up. I know I've been neglecting. And if I EVER get my damn wireless set up, I can maybe get back to more frequent updates that I type while I am settling down in bed. As of now, I'm dealing with being attached to the Internet via the cord.........and seriously I'd like to cut the cord. Just need the patience to figure out whats wrong. O and I need to set up my TIVO..........I'm going through SERIOUS withdrawal.

Peace out (had to say it cause its my blog and I can!)

Seriously

Ok, sorry to have depressed anyone who read the two previous posts. I'm trying to get all the damn things Ive been meaning to put on here out - I'm about to start a 7 day stretch at work and doubt highly I'll get to do any posting. Only because even when I'm not working I cant seem to get it done! LOL.

Anyway, this weekend we went to the beach for Little Man's 5th bday party. On the way home, Karen and I stopped at the new rest area on 64 West around exit 220. When you have been in nasty rest areas, new clean ones can be quite exciting! So we go in to go to the bathroom and we had several interesting experiences.

For starters they had a toddler toilet! U know the ones that are literally only like 12 inches off the ground and have smaller seats. So cute, so nice for kids so they aren't balancing on the seat attempting not to fall in. Now my problem with this is #1, why the hell wasn't there a sign on the door? Because had I not been paying attention I probably would have fallen on the ground trying to sit on the seat. I noticed when I opened the door that it looked a little small. I have a big ass and all, but it was still puzzling. So I stepped back and checked the next stall, and it had a regular toilet. You'd think it would at least have a sign to prevent injury to that unsuspecting person who really has to pee and goes in the one stall open and isn't paying attention. You seriously could probably throw out your back sitting down on that, or getting up for that matter! Not to mention the possibility of not 'making' it in the toilet due to the smaller size.

U know most everything is automatic now, the toilet flushing, the water faucets, sometimes the paper towel dispensers. This rest area followed suit and had an automatic hand dryer. Except it wasn't just a dryer it was a freaking cyclone! I know I can exaggerate, but I'm telling you this thing was NUTS. I stuck my hands under it to dry them and the next thing I know its like I was at a rock concert (cause of the noise) and the skin on my hands was being 'blown' so hard, it actually had ripples in it!!

Picture this its almost midnight on a Sunday after a long weekend at the beach. I'm tired, Karen is tired and I'm trying to tell her about this blow dryer except its so loud I can't. All I can do is SHOW her the ripples (not to mention I'm laughing hysterically at this point). She proceeds to wash her hands and dry them, but is forced to experience the cyclone herself. Lets just say the hysterical laughter started all over again. I'm not kidding you when I say it could blow a small child over. I only wish I had video on my phone or had taken my camera in cause I would have recorded the shit and put it on here so people could see the nonsense. Karen and I laughed about it all the way back to the car. And decided that was one of those dryers you could actually use to dry your hair, unlike the cheesy ones people try that on sometimes. But be prepared, cause your face would get blown off in the process.

I promise, I'm stopping there next time to record it, I apologize to whomever may be traveling with me. (And maybe it doesnt sound so funny in writing, but I'm telling you it was crazy).

11 years and counting....

Counting to what I don't know. Today is the anniversary of Dad's death. Eleven years. Saying it still seems surreal. Some days I imagine living on West Edmonston and life being like it was before those few days. Before we had to say goodbye to probably one of the best men that ever lived. I truly cant say I miss him any less than I did back then, in fact I quite possibly miss him even more. More in the sense that although I know he can 'see' everything that goes on in our lives he has missed out on so much. Well, maybe he hasn't 'missed out' but we have missed out on those experiences with him. In eleven years, he has missed so many things, my graduations - from high school and college TWO times! His kids (except Nickee and I) moving out of the state and finding their own places to build lives in. Tony's retirement and Nickee getting a degree (well soon at least). His grandchildren who would have been his light. Well, maybe he hasn't 'missed out' but we have missed out on those experiences with him. I often wonder how different life could/would be if Dad was alive. I simply cant imagine.

The older I get the more I realize that the simple things in life are what matter most and when those whom you truly hold close to your heart are no longer around to experience those simple things with you, they lose some of their meaning. Don't get me wrong, I'm thankful for knowing him the time I did, but would give anything to have that back and to relive so many experiences (including ones to come). Miss you and love you Daddy.

It finally happened

Its actually taken me two weeks to write about this one cause it got me good. I didn't even know what I was walking into until it was too late, I had no time to attempt to mentally prepare myself. I didn't just watch this time, I actually participated in a pediatric code. I had to push on a 6 year old's chest to help his heart beat (only done it on a mannequin before). I had to push some of the meds. I had to hear the mom scream out 'NO' when we asked if we could stop the resuscitation efforts (it had been 45 mins). I had to see the grandmothers come in just before we called the code so they could hold his little hand and say their goodbyes - all the while hysterically crying and practically falling on the floor. I experienced it, couldn't escape the emotions this time. I could feel the tears welling up, then streaming down my face. I saw some of the other nurses who I've seen in this same situation and not cry start crying. I lost it. It seemed so so unfair. A perfectly healthy little boy (appearing so with no major medical history) just collapsed while doing what kids do running. I even saw the pediatrician cry and the respiratory people. My face was red, my eyes blood shot - and I had to shake it off and work the rest of my shift. As it was it occurred in the first 2 hrs of the shift. No way to start out the night. The next morning when I told Mom about it, I started crying all over again. And even know, I've got tears welling up.

It happened on little Kenny's Bday, and I had just talked to him on my way into work to wish him a Happy Bday. And all I could think while doing what we were was how does anyone survive that. What if it was one of the 'seemingly healthy' kids in this family. How in the hell would I cope. How in the hell would their parents cope? Lets just say I don't want to find out.

Sometimes I wonder what I've gotten myself into being an ER nurse - seriously I know someone has to do it, but why did I choose to? I cant even answer it for myself. I guess this type of experience is not what I got into the career for, its unfortunately a piece of it sometimes.

Rest in peace little guy. God knows with all the crazy s&^% going on in the world today you are truly in a better more beautiful place.

Think about it

"Don't be afraid to fail. Don't waste energy trying to cover up failure. Learn from your failures and go on to the next challenge. It's OK. If you're not failing, you're not growing."

H. Stanley Judd

Insight to my life as an emergency room nurse

ACEP News September 2006
By David F. Baehren, M.D.

For a generation or two, we have lamented the loss of role models in society. As parents and individuals, we naturally seek out others we would like to emulate. Sadly, a serious search through the popular culture leaves us empty-handed and empty-hearted. Thanks to a long list of legal and moral shenanigans, many entertainers, politicians, and athletes long since abdicated this momentous position of responsibility.

We usually look afar for heroes and role models, and in doing so overlook a group of professionals who live and work in our midst: nurses.

And not just any kind of nurse: the emergency nurse. There are plenty of people involved in emergency care, and no emergency department could function without all of these people working as a team. But it is the emergency nurse who shoulders the weight of patient care. Without these modern-day heroes, individually and collectively we would be in quite a pinch. This unique breed of men and women are the lock stitch in the fabric of our health care safety net. Their job is a physical, emotional, and intellectual challenge.

Who helped the paramedics lift the last 300-pound patient who came in?
Who took the verbal lashing from the curmudgeon giving admitting orders over the phone?
Who came to tell you that the guy you ordered the nitro drip for is taking Viagra?

The emergency nurse has the thankless job of sitting in triage while both the long and the short buses unload at once. With limited information, they usually send the patient in the right direction while having to fend off some narcissistic clown with a zit on his butt. They absorb the penetrating stares from weary lobby dwellers and channel all that negative energy to some secret place they only tell you about when you go to triage school.

Other kinds of nurses serve key roles in health care and attend to their patients admirably. However, few function under the gun like emergency nurses do.

It is the emergency nurse who cares for the critical heart failure patient until the intensive care unit is "ready" to accept the patient. The productivity of the emergency nurse expands gracefully to accommodate the endless flow of patients while the rest of the hospital "can't take report." Many of our patients arrive "unwashed." It is the emergency nurse who delivers them "washed and folded." To prepare for admission a patient with a hip fracture who lay in stool for a day requires an immense amount of care--and caring.

Few nurses outside of the emergency department deal with patients who are as cantankerous, uncooperative, and violent. These nurses must deal with patients who are in their worst physical and emotional state. We all know it is a stressful time for patients and family, and we all know who the wheelbarrow is that the shovel dumps into.

For the most part, the nurses expect some of this and carry on in good humor. There are times, however, when the patience of a saint is required.

In fact, I believe that when emergency nurses go to heaven, they get in the fast lane, flash their hospital ID, and get the thumbs-up at the gate. They earn this privilege after being sworn at, demeaned, spit on, threatened, and sometimes kicked, choked, grabbed, or slugged. After this, they go on to the next patient as if they had just stopped to smell a gardenia for a moment.

Great strength of character is required for sustained work in our field. The emergency department is a loud, chaotic, and stressful environment. To hold up under these conditions is no small feat. To care for the deathly ill, comfort suffering children, and give solace to those who grieve their dead takes discipline, stamina, and tenderness. To sit with and console the family of a teenager who just died in an accident takes the strength of 10 men. Every day emergency nurses do what we are all called to do but find so arduous in practice. That is: to love our neighbors as ourselves.

They care for those whom society renders invisible. Emergency nurses do what the man who changed the world 2,000 years ago did. They look squarely in the eye and hold the hand of those most couldn't bear to touch. They wash stinky feet, clean excrement, and smell breath that would give most people nightmares.

And they do it with grace.

So, here's to the emergency nurse. Shake the hand of a hero before your next shift.

DR. BAEHREN lives in Ottawa Hills, Ohio, and practices emergency medicine. He is the author of "Roads to Hilton Head Island."

Such a slacker

O My Gosh.............I just realized I seriously haven't posted in TWO MONTHS. What the hell have I been doing? Who knows but I will try to recap and fill you in on all the things I can remember. Actually Ive been working a lot but y'all already knew that!

This may disturb some, but just laugh a little with me please. Lets see, there is such a thing as a fecal (rectal) bag - yes it attaches to your butt hole and drains well you know.....and honestly I.m sure the person who invented that made bank sadly enough. Why wasn't it me? The night I learned of such a thing I was kinda in shock I had heard there was such a thing, but seriously didn't believe it! I had made a copy of the directions just so I could post them for your enjoyment but right now its in my car, so here is a link to a picture of one http://www.nextag.com/rectal-bag/search-html . The best part were the instructions on the one we had in the ED which had 'Be sure to cut hair prior to attaching' listed as one of steps. I seriously could only laugh...........

Last week I got to shock a patient, he was in cardiac arrest it was only my second time doing that and I happened to be the closest one to the machine that shocks. So it was my duty but I was freaking out for fear that I wasn't going to remember how to do it - but I did. Unfortunately we didn't get him back but, I got the experience.

In that same night I put a HUGE (well for me) 18 gauge needle in an old guys arm, but that's cause he needed a transfusion. I have only put in like 3 of these in my life.....and sadly enough they make them bigger than this! Here is a link so u can see the size......and laugh with me this is off a veterinarian supplies site and it lists the 18g as for a HORSE!! That should give u an idea how damn big it is......... http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=11043&cm_mmc=Shopping%20Portal-_-NexTag-_-Dogs-_-Monoject%20Needle,%2018%20gauge,%201&ref=3665&subref=AA&GCID=C12188x007 LOL!! The 20g next to the 18 is what I typically put in people. Just look at the difference in SIZE of the barrel.

O and to end the night, I got to stop a mans heart again - he was in SVT where his heart beat was in the 180's. I pushed a medicine and he converted into a nice Sinus Rhythm just like that!! :) It was sweet! Pts just become very symptomatic and complain of bad chest pain or that the are going to pass out, and some do.

I have oriented two different new nurses over the last two months - on an as needed basis. One was just about to come off orientation and the other had been in the ED a while so they both were fairly competent, however its awesome to know I am trusted and respected by the 'higher ups' enough to allow me to do this!

I should also be orienting to triage soon.......but that really isn't anything terribly exciting, just something that will be a change of pace. (well last night I was put in triage WITHOUT any orientation!! How scary is that......but I did just fine! I still want to be oriented for the simple sake of doing it cause there are things I would have questions about. )

Yesterday I completed my ACLS - Advanced Cardiovascular Life Support Class, so now I am certified in that. I have to attain my PALS certification within the next few months - that's Pediatric Advanced Life Support. And finally, I will probably be going after a S.A.F.E. - Sexual Assault Forensic Examiner certification later this fall. It means if someone comes in after a rape and the police are brought in to prosecute and/or find the suspect, I will be the one who does the exam, takes the photos, documents the pts description of what happens and the one who is responsible for making sure the 'evidence' has a chain of command so that it can be used in the trial. I think it will be very rewarding to help people who have been assaulted. I know it wont be an easy certification as there is lots of training, orienting and METICULOUS documentation involved. But I am certainly interested.

I'm house, well condo, searching. Had originally looked in Westminster but decided what I was looking at and the size just wasn't where and what I wanted. Currently the hunt is on in Frederick and I have several I am interested in - all basically in one area. I'd like to be able to buy and move within the next few months (2-4). Basically I have most everything paid off except my car and student loans, so those few months I'm going to be really checking out whats available I should be able to finish paying off the credit card debt I still have - but its a LOT less than it was!
Tricia and Desi are engaged! I have a wedding to be in this November and I love our dresses. Looking forward to the events for that.

That's all for now, but that's cause I'm tired of thinking and need to get this post out.

Two in two weeks

I've been in the ER nearly a year (next month it will be) and until now, I've been lucky enough to not have this experience, but last night I witnessed the second of two pediatric arrests in two weeks. Two innocent beautiful babies died (9 months and 17 months). Fortunately neither were my patient, but it was something I 'needed' to see for the time that comes when it will be my patient.

I saw two different parts of the process. The first arrest, I saw them roll the baby through the doors and into the room (at the very start of a shift, not really a good way to begin). Then I saw bits and pieces of the attempts to save this childs life. TWENTY ONE people in the room from nurses to docs to techs to respiratory therapists - everyone trying to do something to help. There were even a few of us just watching for the simple fact we hadn't seen a pediatric resuccitaion in progress before. I knew it wasnt that different than an adult, but I needed to see it. I dont want to be a disaster when I have to be the pts direct nurse. It was amazing to see that many people in the room because for an adult arrest there are probably no more than ten people. And not because adults dont matter so to speak, I just think in a pediatric situation everyone needs to feel like they are doing something to help. The first parents were less dramatic than I would expect out of someone who lost a kid, but I know everyone reacts differently. I only saw that baby while they were performing compressions and bagging the kid and pushing meds. While it was still being worked on. I wouldnt be surprised if something turns up in the investigation on this one, the family dynamics were very odd and their hygiene sucked (in fact they smelt like cat piss).

In the second arrest, I knew the ambo had called and consulted. I knew they were coming and I actually wanted to be in there start to finish, but because I had my own patient load I couldnt. I missed all of this one didnt see them come in, didnt see them work on the kid. What I did see, or really hear was the parents hysterically sobbing. The mom had to be wheeled down the hall she couldnt even walk. The Dad left the room and was walking down the hall just bawling his eyes out. That was horrible. I was literally seconds from losing it myself. Just imagining the weight on your heart after an ordeal like that. Honestly how the hell do u even get out of bed? I certainly don't think I could. For pediatric patients we have a color coded bag that is stocked with the proper equipment and meds for patients based on their weights. You have easier, faster access to the items that will fit the child based on weight versus having to search or try several different ones. Adults are built differently and there isnt so much variance. This bag, once used has to be restocked acccording to a list we have detailing the sizes that belong to each color. Tonight the nurse responsible for the baby asked if I had ever seen it restocked, I said no and she said ok when I stock it you can learn. We went into the room, and I knew the baby was still there. (There has to be an autopsy and police investigation into any pediatric arrest) So the baby was waiting to be taken to downtown Baltimore for the autopsy. In any case, I walked in and the baby was so sweet looking just like a porcelin doll. Still had the tube down his throat, covered mostly with a blanket. So peaceful. Yes, his face was very lifeless with a blue/purple tint to it, but all I wanted to do was stroke his little face. It just seemed so unfair - whether he was 'in a better place' or not - he was so sweet, so innocent, just a baby. I felt the tears welling up. I didn't touch him but I wanted to, I just couldnt stand the thought of him being alone although I knew he was gone. It was just sad, and I can assure you when it is my direct patient, I will be a disaster. I just hope and pray that no one I personally know will ever have to deal with this. And I pray for those that do.

Suicidal at 13

So this is one Ive been meaning to post since I had the experience.

Either just before or just after Christmas I had a THIRTEEN year old girl who I had to treat. Why was she in the ER? Because she, for the last 24 hours or so, had been taking Tylenol in an attempt to kill herself. Now, her immaturity shows in the simple kind of drug she decided to take. Her immaturity was also apparent in the fact that she was barely pubescent. And I literally mean barely.

She arrived lethargic, barely able to climb into and out of the wheelchair. While one of her parents was getting her registered, she was brought back to my zone. Actually she was put into the room we reserve for codes, and we only use when busy if something is super important. I see this very lethargic, very petite little girl get up onto the bed. I go into the room, we help her get undressed. I introduced my self to her and as we are doing all this I begin questioning her as to why she is at the hospital. (I will refer to her as A in this post)
She said "I've been taking Tylenol since yesterday".
I said "A, do you know how many you took?"
A said " I think about 32"
I said "Honey why did you take all those Tylenol?"
A said "Because I was trying to kill myself"
Now at this point I paused for a moment, partially in shock, partially because I just could not understand what could possess a 13 year old to want to kill them selves. And quite frankly I don't know that I even knew what suicide was at 13, or even how to attempt it.
I then said "A, have you tried to hurt yourself before?"
A said "Yes"
I said "When"
A said "Last year, I tried to cut my wrists"
I said " Did you end up in the hospital when you tried to cut your wrists?"
A said "No, I didn't do a good enough job"
At this point, I'm about to bawl, I mean all I wanted to do was tell this little girl that she had a long life ahead of her and that she was going to be alright, but I kept my cool and kept talking to her.
I said "A why are you trying to hurt yourself?"
A said "Because my mom and dad are getting a divorce"
Then she started bawling.

Do you have any idea how weird it is to ask someone, let alone a 13 year old, why they tried to kill themselves? Its not easy, but it is part of my job, and I sadly enough do it on the regular. And actually I thought I was used to it, but apparently this had a slightly different twist to it. The twist was that this little girl had barely been on earth 13 years, she'd only really been talking for 11. There was so much more for her to see and learn and love. But the truth is, I bet she doesn't get to. Her acetaminophen levels were high enough when we tested her blood, that its a good possibility that she died several days after the event. See Tylenol metabolizes through 2 pathways in the body. In the first it breaks down into something non-toxic to the body. In the second pathway, which only gets used when the first one is overloaded (in the case of an overdose), it is broken down into something toxic. This is what kills someone who OD's on Tylenol. Indeed, you have to ingest nearly 7 times the maximum dosage in order to overload the first pathway, but once that's done, you are stepping into bad territory.

Unfortunately she went there. I asked the Dr. who had her if he knew what happened to her and he said, no I don't know what happened. What he did say was "I wouldn't be surprised, based on the levels in her blood if that little girls liver stopped working a few days later". Keep in mind, you treat them with something called Acetadote which blocks the Tylenol from being broken down in the toxic pathway, thereby removing more of it via the safe pathway - but its not a guarantee of any sort.

This is another one of those that I won't forget. For the simple fact that she was so young and, so immature making such adult decisions (to take her own life). It's also something that makes me wonder what in the hell our kids will have to face, if this is happening to 13 year old's now, what about in 15 or so years when I have one? What will he/she be facing? How in the world will I be able to protect my child from things like this? Or at least raise them somehow to allow them not to feel the weight of the worlds problems? What if I get a divorce (not planning on it, but who knows), how is that going to weigh on my kids? The whole thought scares the hell outta me. Just wanted to share.