gonzo1 21,570 Views
Joined: Jun 8, '05;
Posts: 1,733 (46% Liked)
; Likes: 2,490
You don't HAVE to be crazy to work here. We'll train you
Pt reported... 2 drinks a day? Double it.
Don't say the Q word, the S word, or the B word. (Quiet, slow, or bored).
When introducing patients to the lovely disposable mesh panties during pericare on postpartum:
"These are Victoria's Other Secret."
"All bleeding stops, eventually"
Also (stolen from the owner of Bob's Country Bunker in the Best Movie Ever Made - The Blues Brothers) muttered under my breath to countless visitors over the decades:
"You don't have to go home, but you can't stay here!"
Nobody dies without a dose of steroids.
Keep ‘em alive until 7:05
Patients often mistake me for a doctor.
I tell them, "Listen, I didn't go through two years of nursing school to be called 'doctor', thank you very much!"
Practice in the field (yes, paramedic stuff but still useful) is that if we have any question of the possibility of spontaneous circulation a person NOT engaged in current resuscitation efforts takes the doppler, finds the femoral pulse WHILE compressions are occurring and stays on that site. When compressions are stopped for whatever reason, that person will know if the whooshing continues without compressions. It also verifies effective compressions. That's what we do and it is pretty useful.
We do use a doppler in our codes in my ICU and I find them VERY helpful. That said, the doppler doesn't replace good ol' feeling for a pulse, it only enhances it. We don't delay any part of the ACLS protocol for not having a doppler present. We typically will feel for a pulse, start the code per ACLS, and while we're in our first two minutes of compressions someone goes and grabs the code doppler, which is stored at the nurses station in a dedicated spot. While compressions are going we apply the doppler to the femoral artery- you can clearly hear the blood flow with compressions. Then when we pause for pulse check it's very clear to hear whether there is a pulse or not. We still do check a carotid (and typically a fem) pulse on the other side, but it makes things way faster and more accurate in the pulse check to clearly hear whether there is a pulse or not and to assess how strong the pulse is.
In the ED, we take for granted that there's always an ultrasound machine nearby to look at the cardiac windows. There are definitely patients whose pulses are physiologically or morphologically hard to palpate, and I occasionally will toggle the ultrasound over to the linear probe to look at the carotid to actually see the pulse or to assess effectiveness of CPR. It's VERY effective if you're comfortable with vessel anatomy but I don't think it should be how the initial pulse check should be done: looking like mad for a piece of equipment and trying to doppler a pulse that some couldnt even find by hand if it WAS there. Shaming another nurse for not embracing something that isn't yet the standard of care is just rudeness and superiority.
My hospital routinely uses a Doppler on the femoral artery in codes. HOWEVER, we would never delay CPR to get one. Normally once CPR is already in progress, somebody grabs one for the next pulse check. I second MunoRN's comment about palpation of a pulse in a code being unreliable. I feel like it's more helpful and quicker to Doppler a pulse, and the person running the code can listen for it as well.
You being in psyche, you should know you have "avatarimagination." It's an insidious condition that manifests slowly through visual and tactile stimuli via keyboard and monitor. I'm glad you've admitted and embraced the condition.
Patients and families say thank you a lot less than I thought they would.
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