emerjensee 1,951 Views
Joined Nov 19, '12.
Posts: 77 (40% Liked)
It very well may end today - there are two courts hearings, one Federal - schedule for Fri. Jan 3rd. Do you think that when the ventilator is finally disconnected, the family STILL won't be able to let go, and there will be much wailing and gnashing of teeth over the body? For how long - hours? Days? Just a little more time? Gruesome.
I had a thought - if there are any miracles from this case, it is this; It has very clearly opened many peoples eyes on what could possibly happen in a worst-case-scenario, and perhaps more people are expressing their wishes to family members in terms of health directives / end of life issues. Maybe because of Jahi's tragic end, more people will choose to donate their organs, resulting in REAL miracles.
I'm just trying so damned hard to see any good end to this.
I know its the "same' diagnosis,but let's not forget that Jai is a child. That makes a big difference.
I've never met an ER nurse or medic who didn't have a small handful of patients permanently seared into their memories. And it's generally not, as you said, the most gruesome wounds or the most life-threatening situations ... but the ones with raw human emotion attached to their stories.
Take care of yourself. ((hugs))
Turn on a dime and reprioritize my previously reprioritized priorities.
I swore that I would never again think of, or being up this story buuuttttt.....
Once I was helping the MD lance and pack a cluster of very large, very turbulent abscesses from a woman's groin. I had sneezed rather loudly in the middle of the procedure, getting boogers on the inside of the mask I was wearing, so I took it off to put on another one.
As I walked back to the table with my new mask in hand (not on face sadly), the doctor injected lidocaine into one of the larger boils, causing it to burst. Aaaannnnd causing a large glob of god-knows-what to land. Land right on my face. If I had screamed it would have went into my mouth.
Debrief with the team that was involved. After what I consider my worst failed code I asked the attending if we could debrief and discovered that yes I'm important and what I do makes a difference, but I'm not the super uber only person in the code determining the outcome. The resident had had a hard time intubating, the ED Tech had a malfunctioning EtCo2 monitor, etc, etc. I had a hard time getting a second line and there was a delay by a resident in achieving IO access. I did not kill the poor patient, nor did any one of us. We did our best to save him and it just wasn't meant to be.
My first ACLS teacher told us, if you're doing CPR the person is dead, it's a miracle to bring them back, but the odds are not good....and even if we bring them back they may be facing disability and pain....it may just be their time to go.
I felt so much better after debriefing - still sad but not so guilty and over-responsible. We do amazing things in the ER but not all the time, and that's OK because we are always striving to do our best.
I use the SBAR format:
Situation: Mr. Smith is a 60yo male who presented to the ED for a chief complaint of chest discomfort, onset at about 2pm today while mowing the lawn.
Background: Mr. Smith has a previous cardiac history including MI with stents. When his chest pain started today, he took 3 NTG 5 minutes apart, and when the pain didn't stop, he dialed 911.
Assessment: EKG and initial trops are WNL. He is currently pain free after 2mg of morphine. He is A&O x 4, and no other complaints at this time. An 18g was started in his RAC en route and it is patent.
Recommendation: Mr. Smith is being admitted for observation to rule out MI. He will be on telemetry and serial cardiac enzymes are ordered. Mr. Smith's wife is present and will accompany him to his room. He was hungry, so I gave him a sandwich, but he's still hoping for something more substantial when he gets to the floor.
That's it. Short and sweet.
We all have different coping mechanisms for traumatic events, utilise the employee assistance services or speak to staff development to see if they offer in service courses on dealing with death
We got a water bottle and some chocolate. I'm fairly new but management seems to really come through in supporting the nursing staff on the floor.
I just passed the CEN, first try. I've been an ER nurse for about 1.75 years now. I don't feel like I ever got great training, so I had to teach myself a lot.
-Mark Boswell Youtube lectures are awesome and free. I listened to all of them, and took notes in a google doc about everything he said. In some ways it's kind of nice that you don't have the powerpoints in front of you because you have to write everything down. I reviewed my notes a day before the test and that helped tremendously. The lectures don't cover everything but they give you a pretty good start. The Toxocology lecture was definitely helpful.
A little lacking on ortho maybe and that's a weak point of mine too. I need to catch up on that.
-The ENA CEN review book is really good and kind of necessary. 5 book tests and 2 online tests. I did all of those tests and then carefully reviewed the answers and rationales. It definitely showed me stuff I was missing.
-I also paid for the Jeff Solheim videos which are online. There's like 7 of them. The topics are pretty sparse, but the electrolyte stuff was really worth knowing well and I'm glad I did them. Apparently he has a taped lecture series but I could never find it.
-I also got a used, somewhat outdated copy of the Lippincot Q&A Certification review in Emergency Nursing. I got the 2005 edition on Amazon used very cheap. There are definitely a few outdated things in it but generally it was totally useable. The questions are HARD and that helped. I never finished the whole book but it was worth buying.
I looked up a lot of stuff on youtube. There's a lot of good ER videos. Larry Melnick is some ER doctor who puts up a lot of live videos in the ER, some of them were helpful. Looking up things like placement for a needle decompression and other things that I've read about but never seen.
-Be prepared to really hunt out an answer. For me the questions on the test were simpler as far as the knowledge required relative to the review book but took a little more figuring out, the answer wasn't obvious, you had to use your knowledge of the situation to piece together the answer. So I'd just be prepared for that. There were no major curve balls though.
-The test is long, long, long. Just get ready for that.
Anyway, good luck! It was totally worth doing. At this point I'm more clear about what I don't know than what I learned but it was helpful for illuminating that.
And a special thanks to Mark Boswell. I appreciate your generosity very much.
While it helps with the story.....we can't use profanity even if it is disguised with letters and symbols....please use all symbols....
I have been called everything but blonde and white (which is my hair color and race). There is something about the impaired mind that goes straight to profanity. Every 18 year old head injury, or intoxicated with substances, will shout repetitively at the top of their lungs their favourite four letter word that begins with the letter.....F. Somehow they never get hoarse.....on of natures wonders.
I have confronted gang members and I can indulge in some colorful language myself on occasion.....but never let the patients get under your skin.
Even if they are sober and just being spiteful and mean.....I will NEVER give them the satisfaction of knowing the bugged me.
I really can't be bothered with someone that has such a limited vocabulary that profanity is the only way the can express themselves indicates to me that they have the IQ of the amount of teeth in their mouth divided by 2.
Clearly not worth my time......
This particular patient that used that language to you is clearly why they got jumped at the club.
Consider the source...and when you start their IV...you just never know if they need a large bore.....just saying....
You'll be FINE! I'll tell you the same thing Oneida the nurses told me an hour into day 1- leave the nerves at the door, you're in for a hell of a ride!
Posting from my phone, ease forgive my fat thumbs!
Hello, I just wanted to say congrats again!!
Its so exciting to hear other new people in the ER. I start on Monday and am SO nervous and excited wrapped into one!
Any interesting cases the first few nights?
(Tried sending you a PM but your inbox if full!)
I just finished 3/3 and I had a frigging BLAST!!!!! I am having the time of my life! Pretty much tell my preceptor to sit and relax and let me do it, when I need help, I'll ask, but I'd rather drown when I know I have backup than think its all ok because I'm not carrying a full load.
Posting from my phone, ease forgive my fat thumbs!
wow......get the enpc course book and read it. pediatrics is a speciality all it's own. their airways are different....smaller and structurally....they can eat and breathe. remember that 1mm of swelling on an adult airway that is 5mm wide is completely than 1mm of swelling on a 1mm airway. vital signs are not a predictor of how sick a kid is for they can compensate forever and by the time they reflect it in their vitals....they are in critical trouble. the cap refill/urine output is a great indicator on the younger pedi population as an indicator of distress and end organ perfusion.
so when did they last pee and how many wet diapers in x amy of time is huge!!!! using accessory muscle is a huge sign of distress.
they need fluid, o2, and keep them warm. a crying and screaming kid is a stable kid....it's the quiet ones that will/should scare you. if the child has a congenital/chronic illness listen to the parent.....they have done this before and can help you.
rhythms for kids....slow, fast, and absent. familiarize yourself with the normal vital signs for the age group!
infants....was the baby full term, what was birth weight, weigh all babies regardless of what the parents say...emphasize how important it is as that is how the medicines are given. small mistakes have huge consequences for the pedi population. if they are small so should the dose be as all doses are weight based.
the enpc (emergency nursing peds course) has a terrific pets triage standard that should be used by all eds.
ciiamppedds: c is chief complaint, i is immunizations, i is isolation (has the child been exposed to any communicable diseases), a is allergies, m is medications,p is past medical history, p is parents impression of the child's condition, e is the event surrounding the illness or injury, d is diet, d is diapers (voids) and s is signs and symptoms
great power point triage assessment
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