Ayrman

10-12??? Are we talking long-term care pts. or actual acutely ill people? LTC is one thing but if this is an actual acute care floor my advise, sincerely offered, is not to walk but run like there is no tomorrow. My hospital has a maximum of 7 pts per nurse on nights, and that is the Med-Surg floor. The ratio only goes down from there, with max 6 on nocs for Telemetry, and 3:1 for ICU if the patients are stable, and 2:1 the norm and 1:1 for unstable ICU pts. Ayrman

Mattress tags = "Do not remove this tag under penalty of law except by the consumer." On every new mattress or pillow sold in the US. Ayrman

Minimal response here at my facility. According to Infection Control regular masks are enough. Plenty of folks test negative on the N95 - myself included - and there are NO Powered Air Purifying Respirator (PAPR) units in the facility. Regular flu shots have been handed out, the H1N1 vaccine has been started but they were depending on weekly shipments and last week's hadn't come in. No one has come to M-S or Tele to offer the shots yet even though there have been a fair number of ER and Urgent Care clinic people refuse them (first in line over everyone else). They aren't taking this too seriously. After all we have negative air pressure rooms for isolation - 3 beds out of 140. A few hospitalized cases, yes, but none on vents I am aware of so they don't see this as anything serious here. I have better PPE at home than we are being supplied with. And I have Tamiflu stocked up as well, for what it's worth. To my knowledge they aren't screening personnel for exposure after confirmation of infection in patients. Ayrman

I believe their sign on bonuses have fallen dramatically to around $8-10K, same with Western Arizona up the road in Bullhead City. A new hospital opening in Kingman has drained some of the available nursing staff away from the area. You will find rents in the Fort Mohave area cheaper than up in Bullhead City. Use an agency - there are a half dozen at least, McGhee Property Management in Bullhead City being a reputable one - for your own peace of mind. Yes, there are some private rentals that are good but the agency should take care of common repairs, etc and shield you from "difficult" landlords (ask me how I know) who otherwise get nosey, etc. Right now there are a plethora of brand new houses for rent in the area, never lived in, rents dropping in a bid just to get some income coming in. Apartments are scarce in the Fort area, plentiful up in Bullhead, but that also means 10 miles of traffic on a highway with nearly daily accidents bad enough to make the paper. VVMC is growing, has added on once since opening in 2005 and is expanding again, patient rooms and procedure rooms alike. The busy season is just starting what with the snowbirds, will last until April. Cheapest gas in the area is always at Maverick, just up the road from the grocery stores. Cheapest groceries are Wal-Mart in BHC but Safeway has better meat and a much better bakery; watch for sales. The best restaurants are across the river in Laughlin, but the buffet at the Avi Casino (across the river from Fort Mohave) is reasonable. Superior Tire is good for most auto repairs, etc, honest, won't take advantage of a single female. There is a uniform shop (Scrubs n' Such) a couple miles north of the hospital. Proprietor has a daughter who works VVMC, is very friendly. Ayrman

Very helpful, and I do thank you sincerely. Very much look forward to another trip to your country sometime in the future, hopefully spending more time there than last. Ayrman

Interesting if telling tidbit from my current employer. We currently have a patient under isolation who will be with us for a while, and has been for a couple of weeks already. Active TB case, no other co-morbidities. The percentage of nurses who basically refuse to accept assignment for this patient - they (the patient) are otherwise a cakewalk - is currently running well in excess of 50%. This is something we all see eventually - TB that is. The patient rarely coughs, is in a reverse air flow room and other than meds, routine vitals and hotel care (food, etc) is quite content to watch TV and veg. Pleasant, cooperative and goes entire shifts without requesting so much as a sandwich or a soda. What do you think the chances are that these same nurses will put themselves at risk during a true pandemic when the number of cases runs into a high percentage of total patient load on the floor? 1 or two reverse airflow rooms, and maybe 10, 15 or 20 active flu cases on the floor, possibly infected with a flu variant with a relatively high case fatality rate? Ayrman

Ludicrous in what way? You say that it is impossible yet which is historically valid, i.e. we have seen it before. The current pandemic is little akin to the historical pandemic of the late 19-teens, i.e. people are not dieing in droves and the overall acuity of the infection remains low, and whether you'd care to admit it or not the values of today's population in general are a far cry from those of nearly 100 years ago. A significant percentage of those who proudly proclaim themselves self-sacrificing and unafraid to report for work in the face of a deadly pandemic strain may find themselves having to eat their words before all is said and done.Ayrman

Officially 7:1 on nocs with an aid for every 11-18 (yes, they staff that tight) patients. Even the Charge may have 7:1, and I have seen 6:1 for 2 nurses with no aid or secretary. This is a CHS facility for anyone who cares. Ayrman

Anti-aircraft shell, 37 mm IIRC. Live round, too. You can look it up on the net. The guy had been using it for years to alleviate a dangling hemmorhoid, when his dog ran in on him and caused him to fall on it. End of story the shell was removed and deactivated, the offending dangly repaired and the now dewat shell returned to owner, who had saved it as a souvenir from his days as an ack-ack gunner on the British Isles during WWII. I did not view the x-ray personally but it is available on the net as I say. Somethings are just too weird not to save for posterity. Ayrman

Thanks for the article, Al. Interesting to know that our foreign counterparts have the same misgivings and problems that we contemplate here. Ayrman

Thanks for the article, Al. More food for thought, and it's not just here in the US that staffing may be a problem. Ayrman

140th (?) Case for Indonesia AVIAN INFLUENZA, HUMAN (81): INDONESIA, SUSPECTED ************************************************* Date: Wed 17 Dec 2008 Source: Antara News [edited] Suspected birdflu patient dies ------------------------------ A suspected birdflu patient of Bintaro, Tangerang, Banten, known by her initials as Su (24) died on Tuesday [16 Dec 2008]. Su's aunt said before she died her niece was intensively treated at Sari Asih hospital in Ciledug, Tangerang. She said Su initially had breathing problems, cough and a high fever and as her condition worsened her family then took her to the nearest hospital. "However she finally died after being treated in the hospital for 3 days," she said. Su's body was taken to Punggelan in Banjarnegara, Central Java, for burial. The head of the Tangerang health service, Hari Heryanto, said his office could not as yet confirm if the cause of Su's death was birdflu virus. "Her blood sample is still being examined and the result of laboratory tests is needed to confirm if the cause is really the [avian influenza] virus," he said. The district of Tangerang which is located west of capital city Jakarta has been known as an endemic area and has recorded the highest number of bird flu cases so far, totalling 17 that led to 15 deaths. ---- This would be the 140th "official" case for Indonesia if confirmed. How many have been missed one may only speculate. No matter what they claim the Indonesian authorities are not aggressively fighting this disease. Earlier this year they tossed the NAMRU (Naval Medical Research Unit) out of the country that has served there for a good number of years, because they were afraid they (NAMRU) might share samples of the local virus with the rest of the world, and thus infringe on Indonesia's "proprietary" rights to any vaccine derived from same. In the end that battle will be all about money and have nothing to do with saving lives. Politicians are funny that way. Ayrman

Crunch, H5N1 was first identified in Hong Kong in "97, and saw a 2/3's mortality rate. That was 11 years ago, and all we are seeing is a slow but determined spread. As cliche as it may seem it remains not a matter of if but instead of when. Ayrman

Not only the teeming numbers but the fact that there is a LOT of migration to/from from there with family vistations, business trips, etc. Much more so than we see even with a commercially up-and-coming Indonesia. Then too the modern, commercial Indonesia is much farther removed from the affected areas than we are likely to see with India where the barriers can be as little as the width of a street. Ayrman

You'd have to split the hairs very finely to be able to say that you "could" have given more than the 1 mg ordered. The other responses are correct. You mixed the med in saline and gave half which by all rights should have figured out to a 1 mg dose. Glad to see I'm not the only one who dilutes. At a concentration of 2 mg in 1 ml solution (here any way) it's extremely difficult to make a slow controlled push when your syringe plunger only travels a fraction of an inch (3 ml syringe is the smallest we have without a pre-attached needle, and of course we use needleless access ports). I dilute all my controlled meds for that reason, regardless of the concentration, and much to the dismay of many a tweeker I refuse to "slam" the push just so they can get a quick fix. Slow and safe or not at all. Ayrman