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psychomachia's Latest Activity

  1. psychomachia

    You don't work in anER. Get over it.

    Mostly minor care, occasionally urgent care, rarely emergent care...room
  2. psychomachia

    What would YOU ask the E.R.? (interview)

    What color scrubs can I wear? Does this ER make nurses give enemas? Or a Fleets-to-go? Anything else is unimportant...
  3. psychomachia

    Rules for dating my daughter

    My favorite line from the movie "Clueless": Dan Hedaya as Cher's father Mel: "Hey you! Anything happens to my daughter, I've got a .45 and a shovel. I doubt anybody would miss you."
  4. psychomachia

    What can I do with my BSN that Assoc. RN's can't?

    And the "nursing theory" classes I took for my BSN were very helpful too... they made me realize I could endure any form of torture and brainwashing...
  5. psychomachia

    What can I do with my BSN that Assoc. RN's can't?

    You get to take the side of "A BSN is better than an ASN/ADN/Diploma/Regent's/Foreign trained/everyone else debate" That's always fun....
  6. psychomachia

    IV in AC

    Hmmmm....another way to "P" off the floor....he hee hhee...just d/c the IV before sendin' 'em up and tell 'em it infiltrated...yea...that's what I'll do if they gripe about the placement...let 'em start their own IVs...heehehehhehheee...next time you won't be takin' a break when I call, will you??? heehehehhehhehhehheeeehhehheehh.....
  7. psychomachia

    IV in AC

    OK. But apparently it's OK to gripe about ER nurses and not about med-surge?? Like I said before, some of it was in jest, some not...If I hit a nerve, perhaps I wasn't too far off the base...or maybe your retort was in haste and you didn't read what I wrote???
  8. psychomachia

    IV in AC

    Just goes to show you can't please all the nurses all of the time... But I'll take a chance and offer my "enlightening" reasons why the AC is sometimes the site of choice: 1. Easy to start when you're behind and up to you a** in patients who all think their "emergency" is the ONLY emergency in the place. 2. Some pt.'s actually prefer them since they may not hurt as much as some tiny little hand/wrist vein...to each his own... 3. When you have to draw your own labs (unlike most floors) you can't fart around trying to suck blood out of some 22g in a micro hand vein, just to have to do it over again when the lab calls and says "it was hemolyzed." 4. We often don't know what is really wrong with the pt, so a "good" line that is capable of whatever (meds/fluid/blood) we need it for and able to handle any amount is often started. Sorry if that doesn't fit in with your plans. 5. It gives us a way to get back at the floor nurses who seem to always be on break and "off the floor" when it's time for report from the ER. Who watches your pt.s when you're gone?? And why can't they take report when you're gone?? Perhaps if the floors stopped playing games with their census (funny how so many beds open at shift change), then maybe we would try a little harder to make your life easier... Some of the above is in jest; some is not... I'll let you decide which ones are/aren't.
  9. psychomachia

    Bilingual or not?

    I speak "Drunk"... It's a well known dialect that is often heard in ERs around the world and usually starts with a denial statement, such as "I schwear I ownleeeee had twoooooo beeeeeeerrrrrrssssss..." It's a very strange language in that it can incorporate yelling, swearing, abusive statements, threats, incomprehensible words, excess saliva and uncoordinated body movements along with a distinctive odor that is always present when being spoken. If you're lucky, you'll have the opportunity to converse with one of the rare "Happy Drunks" who like to sing their dialect instead of speaking... There are no "language" schools to learn "Drunk" because it is strictly on the job training. And of course, no extra money...
  10. psychomachia

    thoughts about miami area

    And practice your defensive driving skills..
  11. psychomachia

    Lysis, IV Case Study

    You're right, phlebitis should be warm and an infiltrate cold, but like everything in nursing - the patients don't know or follow the rules... If the site is cold compared to the surrounding tissues, and you don't get a blood return from the catheter...I would d/c it and restart it.
  12. psychomachia

    IV Toradol?

    It sucks for anything except kidney stones/renal colic.
  13. psychomachia

    Made Incredibly Easy

    You can never know too much pathophysiology, pharmacology, and pt. assessment.
  14. psychomachia

    All Bad Nurses - Please Stand Up

    When I'm good, I'm really good... and when I'm bad... I'm still pretty good...
  15. psychomachia

    Difference between Level I and Level III ER?

    This is from the site http://nsucomems.tripod.com/what_is_a_trauma_center.htm It's about Florida Trauma Centers, but since I live in Florida, that's what you get for free... What is a Trauma Center? A trauma center, as trauma surgeons are fond of saying, is NOT just an emergency room. State designated trauma centers meet specific criteria as set forth by governing agencies. Florida is quite specific in their designation of trauma centers and follows the American College of Surgeon's recommendations for accreditation. The Florida Department of Health has a voluminous document, available on line, that details the mechanisms behind accreditation. You can visit the DOH website or specifics. The NSUCOM EMS club will try to provide its members with a basic, "overview" of trauma center services. The trauma surgeon is the resuscitation team leader. The trauma surgeon is an individual who has completed a general surgical resisdency. Trauma surgeons have additional fellowship training (two more years) in surgical critical care and trauma surgery. Currently, the University of Miami/Jackson Memorial Ryder Trauma Center offers these post graduate surgical fellowships. Florida trauma centers are currently designated as level one or two. The state does not currently classify level III trauma centers. Level III trauma centers are basically 24 hour emergency rooms that have designated trauma teams, on call professionals, and are capable of transferring patients to a higher level of care. When injured patients meet trauma alert criteria, state guidelines stipulate that they should be conveyed via emergency medical services to level one or level two facilities. The term "closest appropriate facility" applies to the transport of critically ill patients. Indeed, pediatric patients may require expert care immediately available at level one or pediatric referral centers. Florida also approves hospitals to function as pediatric trauma referral centers. These hospitals are either Level One facilities or meet the qualifications outlined by the American College of Surgeon's Committee on Trauma. Level One Facility Requirements: In house qualified trauma surgeon In house qualified neurosurgeon In house qualified radiologist In house qualified emergency physician In house qualified anesthesiologist Trauma medical director (trauma surgeon) Emergency medicine medical director (MD/DO) Trauma program manager (RN) 24 hour CT availability 24 hour equipped and staffed operating suite Backup and equipped surgical suite Trauma intensive care facilities for adult and pediatric patients Trained trauma team -At least 1 trauma surgeon (as team leader) -At least 1 attending EM physician -At least 2 trained trauma nurses Dedicated resuscitation suites (to manage two simultaneously multi-system injured patients) 24 hour laboratory facilities Protocol for in house burn care Rehabilitation facilities Helicopter landing pad Pediatric resuscitation facilities, personnel, and intensive care units Administrative requirements Research requirements EMS requirements *The term, "qualified" pertains to state guidelines. In some instances, senior emergency medicine residents/fellows or senior surgical resisdents can substitute for their attending counterparts. Level Two Facility Requirements: Same as above, except requirements for in house and on call physicians vary. Level Two facilities generally meet all Level One criteria but are not required to have neurosurgeons/trauma surgeons in house. Furthermore, Level Two facilities are not mandated to handle pediatric trauma. Emergency rooms must necessarily be capable of managing critically ill and injured pediatric patients, but Level II facilities are generally not designated as pediaric trauma referral centers (PTRCs). Some hospitals, like North Broward Medical Center, are Level II designated and elect to keep a trauma surgeon in house 24 hours/day. The state requires that on call trauma specialists must sign a letter of commitment and arrive promptly once summoned by house staff. State Approved Trauma Centers, as of 07/02 FACILITY REGION DESIGNATION Broward General Medical Center Ft. Lauderdale Level One Adult / PTRC North Broward Medical Center Pompano Beach Level Two Adult Memorial Hospital Hollywood Hollywood Level One Adult / PTRC Ryder Trauma Center at UM/JM Miami Level One Adult / PTRC Miami Children's Hospital Miami PTRC Orlando Regional Medical Center Orlando Level One Adult / PTRC Tampa General Hospital Tampa Level One Adult / PTRC Bayfront Medical Center St. Petersburg Level Two Adult and PTRC w/All Children's Shands Jacksonville, UFHSCJ Jacksonville Level One Adult / PTRC Lakeland Ragional Medical Center Lakeland Level Two Adult Sacred Heart Hospital Pensacola Level Two Adult Holmes Regional Medical Center Melbourne Level Two Adult Hailifax Medical Center Daytona Beach Level Two Adult West Florida Medical Center NW Florida Level Two Adult Baptist Hospital Pensacola Level Two Adult St. Mary's Hospital Palm Beach Level Two Adult / PTRC Lee Memorial Hospital Central Florida Level Two Adult Delray Beach Medical Center Delray Beach Level Two Adult -------------------------------------------------------------------------------- As far as what it's like to work in one versus the other, you'll have to see for yourself.
  16. psychomachia

    How important is a PDA?

    Also, it's tax deductible.