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  1. star77

    How You Can Lose 50 Pounds In 90 Days

    Actually, I've lost 50lbs in about 3-3.5 months and kept it off by doing a ketogenic diet. I eat very low carb (20-50g net per day, rare fruit, no processed foods, lots of protein and veggies). It actually *is* realistic but you have to work at it. If you want to read some research on low carb with good evidence based practice, check out Dr Peter Attia's blog (accessible via nusi.org), or for an easier diet plan -that still takes work- check out the book Always Hungry by Dr David Ludwig, a Harvard endocrinologist. There are a lot of articles that show benefits of low carb living, and these two examples above are just some places to start.
  2. star77

    How do you treat headaches?

    1L NS, Toradol 30 mg, Benadryl 25-50 and Compazine 5-10. OR 1L NS, Ativan 1-2mg, Benadryl 25-50 and Compazine 5-10. Either or, depending on how bad the nausea is.
  3. star77

    Funny Sign in slips

    I am going to quote word for word from a friend I work with: "On the manliness scale today while in triage: a FAT zero goes to the 21 year old with a chief complaint of 'hungover.' Really? Couldn't even state "nausea/vomiting" for us. Huh. And on the opposite side, a solid 10 goes to the guy with a GSW to the penis: penis intact and functional (small entrance wound in the shaft), bullet shattered. Discharged by urology." HOLY MOLE.
  4. star77

    Trauma roon in your ED... who gets it?

    We rotate each day. Usually there are 3 RNs in there until 3am, and the Charge RN and another float will help scribe if it gets bad. Lesser, blunt-force traumas don't always end up in the trauma bays- our rooms are set up so that anyone can be treated anywhere (except for negative pressure and dialysis requirements). We're pretty good about helping each other out. If our resuscitation room nurse is getting overwhelmed, ie MCI or back-to-back BAD burns or penetrating traumas, we all pitch in if our patients are relatively stable.
  5. star77

    New Grad Oakland Kaiser

    Hey 13Virgo, PM me. I didn't start there but I have a good friend who did. He LOVES it. The nurse educators run Project Heartbeat. Josh and Alan are great teachers (I took ACLS/PALS with them years ago). :)
  6. star77

    Anyone cutting sugar while working nights??

    PS I couldn't live without caffeine.
  7. star77

    Anyone cutting sugar while working nights??

    I've gained 15 lbs from nights. I hate it. And now, I no longer snack on ANYTHING containing carbs in the ED. No chips, no cake, no cookies, no nothing. I never eat that crud at home anyway, and my snacks consist of snap peas (from Trader Joe's) and carrot sticks and almonds. I just remember that sinking feeling I have when my fat jeans started to get tight, and that's all it takes. I find that the "30g of protein within 30 min of waking up" rule works really well to keep me from being hungry all night. Don't snack on crappy food. I only eat two meals a day when I work nights, but I've still gained weight. There's an article in Wired from 2009 that cites a few studies where "shift workers" were found to have higher levels of cortisol in general. Part of the weight gain that happens with night shift is due to screwing up your circadian rhythms. I hate it. I had a small break from nights last summer when I switched hospitals, and I lost 10 lbs without trying within 3 weeks. It was amazing. As soon as I went back to nights, I just watched those numbers creep up. I've even done food journals and I consume fewer calories and work out more and the pounds still stick. My co-workers make fun of me for how healthy I am. I'm really a morning person and I'm stuck on this hellacious schedule. I feel for you. Hang in there.
  8. star77

    MRSA precautions in the ER?

    Flagged immediately. All patients who are admitted to the hospital are given a nasal swab, regardless of "risk" - patient could be a healthy woman on the L&D floor giving birth or a septic bomb going to the ICU. All of our rooms, aside from the "holding area" are single rooms, multiple are negative pressure capable, and all curtained areas are 15' from the next gurney. Housekeeping is regularly paged and responds to MRSA/VRE cleans. They rock, and are under-appreciated. I don't ever want my nose swabbed. I know who's coughed on me. We have isolation carts all over our ED. But then again, our hospital is seriously going for Magnet.
  9. Two nights ago I was looking through what we had in the waiting room, saw one and immediately thought of this thread. One word: "Hiccups."
  10. star77

    Explaining circumcision to mom....

    Yes, WHO is, but ... studies were done specifically in Subsaharan Africa, where barrier methods are not as accessible or prolific as they are in the US. http://www.nejm.org/doi/full/10.1056/NEJMp0805791 http://www.ncbi.nlm.nih.gov/pubmed/17321311 ^^^Just an FYI for everyone discussing circumcision for HIV/HPV prevention.
  11. star77

    OB RN with ED experience?

    Just curious if you think it's possible, and have you met anyone who has done so? I'm a CEN, and I LOVE the ED, but I also really love women's health, and have floated up to help out with the L&D floor in the past. Thinking about applying for a per diem job on an L&D floor now (supplemental to my ED time). I feel like the pace during delivery is like our resuscitation room - really fast, really focused and then a recovery time... and I love the intimacy that we get with patients in L&D. Ante/Post partum, totally enjoy all aspects- not just the "exciting" part of birth itself. Yes, I have NRP. Do you know of any ED RNs who have had this experience, or do you have any ED RNs with whom you have worked? Thanks for your input!
  12. star77

    What are the top 5 medications YOU administer daily?

    (Saline/O2) and... Albuterol/Duoneb treatment Zofran Morphine Dilaudid Acetaminophen Followed closely by: ASA, Plavix, Heparin (bolus and drip), Nitro (bid/stat/glycerin... all of the above, depending). Bicarb/D50/Insulin/Calcium/Kayexalate (for whatever reason, we've had a ton of hyperkalemic people this week)
  13. Keep all of the patients as utmost importance. If it gets really bad, give a red flag to management that you've had trouble, but keep it short and professional (ie "this person and I just do not get along, and I have tried to make things work; I feel uncomfortable"). Document everything. Dot your "i"s and cross your "t"s and don't let her get to a chink in the armor. And good luck. We all have one....
  14. star77

    IV Pumps--have you used Baxter's Sigma Spectrum??

    Yes- I have used these in two different ERs. I have heard there is a "Level 1 override for boluses" and I have yet to see it. (BS.) I pressure bag or use our Level 1 for severely hypotensive patients. As to pharmacologic safety, yes they're great, but often have A LOT of safety traps - and often the tubing takes that extra 30s to load that you just don't have in the ED. We do NOT use them for blood, I don't use them for ABX like rocephin or cefepime, but they are great for a lot of other meds, including high risk/buretrol-worthy meds like heparin or insulin. They are easy to transport, and are much safer than the Alaris, I have to say. For those days when it's my 6th in a row and I'm dog-tired, I love 'em. When it's my first on, I could scream. And yes, they are VERY sensitive. Like any piece of equipment, you learn as you go.
  15. AcBCD... Etc. (TNCC is really helpful, I'll echo this fact). And honestly, it depends on your hospital's protocol/system and resources (Level 1, Level 2...) and HOW BAD/WHAT KIND of trauma you are receiving. Is it a burn? Is it a penetrating? Blunt? If it's really bad and that patient is circling the drain on the table, and you're the primary nurse, you might be directing someone to run to blood bank with the non-crossmatched papers for your O neg or O pos blood, or you might be dealing with titrating a pressor, or hey, you could be looking for a third line in a limb that isn't burned to a crisp while pressure bagging a few liters in your other peripheral lines while a doc is hopefully putting in a central line, or you could be calling out the numbers on your monitor to someone who's hopefully charting for you (generally on a bad trauma you'll get at least 3 other RNs helping, plus a slough of gawkers/runners, at least you hope). You might help encourage closed-loop communication among ortho/trauma surgery/cardiothoracic/ED physician team. And you might be doing all of these things at once. All while helping maintain AcBCD....etc. If it's a minor car accident "hey we're not gonna take off the c-collar until your x-rays are back" kind of thing, yeah, that's different than a 65% TBSA partial and full thickness burn with bilateral tib-fib fxs, obvious femur deformity, systolic of 86/p on scene, unstable pelvis, tubed, and a positive FAST exam. Very different. But the methodology is the same. I guarantee that second patient is going to the OR, while the first patient is someone you have to monitor "just in case" (and one of my "just in case" folks ended up having a basilar skull fracture... hence we use the TNCC methodology). The interventions are pretty standardized. Your equipment and system may vary, and the intensity of intervention may vary, but it's the same systemic assessment in the same order for a reason. When you get something really bad and you're focused on the alphabet, it pulls you back into your job and you don't freeze. There have been some traumas that have made me drop my jaw. There are some I've seen where I've cried uncontrollably in the bathroom 10 minutes after that patient has gone to the OR and it's all over (kids - you see people do some horrible things to one another, and when kids are abused it really gets to me). But in the moment, I follow what needs to happen and do what's best for the patient, which is dictated by TNCC and the AcBCD pneumonic (Airway/c-spine, Breathing, Circulation, Disability/Deformity, Expose/Environment, Full set of Vitals/Fucntional Adjuncts/Family, Give Comfort, Head to Toe, Inspect the back)