JEEMA

I have faced similar situation. I am not out, to my friends/parents. My colleagues/friends tries hooking me up with somebody and they are bewildered as to why i dont seem to interested, till they got tired of it. Most of my patients asks me why dont i wear a ring on my finger, i just tell them i'm not married. Some will tell me I'm smart. Little did they know;) Im afraid if my friends/colleagues know, they may avoid me, or i will be given all male patients.

What is the significance of CO2 in the mentioned lab works? What will be the treatment for it? If pt. is on O2, 2L, no signs of resp distress, saturation above 90's, do i need to inform the MD about it? Thanks.

How high are BP parameters that need to be referred to MD? Im new to telemetry. Used to see pts with prn meds for sbp>160. My pt who has hx of htn had a bp of 180/100, so i called the resident on call, in case he may order some stat or prn meds, but he just told me to recheck it and inform him if ever it gets higher as my pt's bp is "not that high" and he may do something in case it gets more elevated. I ended up giving her am bp meds earlier than scheduled when it doesnt seem to drop, as i have done similar thing with a previous pt-with the knowledge of my charge nurse.

How do you check/prepare the scope prior to use (already hooked in the machine)? We had a colleague who claimed they use Pentax scopes where he previously worked and always forgets to put on the light/ do "whitening" in our Olympus scopes. We sometimes start the procedure without a light, that i have to switch on the light (as some of our docs dont double check the scope prior to use), and the doc just proceeds... with an imbalance view. He claims. pentax scopes automatically does whitening by itself? Just want to verify if he is telling the truth or not:) He also doesnt clean the scopes channels properly. Just found it one time coz i placed the brushes in the ultrasonic machine and he cleaned the scope after me. The next time it was my turn to clean the scope, the brush is still in the machine, same position and when we asked him where is the brush... he said it was there...though it was in the machine. I let the senior staff who speaks his language deal with him. He ended cleaning the scope again and stayed late. I'm glad i was out of the department... but i pity the patients who might get nosocomial infection due to improper practice/incompetent staff.

It's not that big- the most damaged part is just more than the size of a quarter dollar. That's the area where hydrogen peroxide is used which I think contributed to its slow healing (?) It doesn't need grafting, just conservative treatment. It just hurts so bad esp if i'm on duty (though I'm in light duty) because I seal it with opposite (over the gauze) which might contribute to the heat /stinging sensation that i feel after a few hours. Thanks for the articles about hydrogen peroxide...

HI! Just wanna ask how you manage a second degree burn. Got scalded recently and the doc who treated me used hydrogen peroxide on it. I think he used a silver nitrate as a first solution (haven't asked) because the healthy tissue just dried up and looked like a dead skin cell. We only used normal saline and MEBO in the hospital where I used to work and wounds heal quickly. Our plastic surgeon prescribes it. The doc prescribed a silvadene cream but I searched and ordered MEBO online. As I've reading some articles, it has a better healing effect than other ointments available in the market. The area where the doc wiped with the solution seemed to form a shallow crater and I'm afraid it won't heal by first intention. I'm still waiting for my order and plan to use it without consulting him. ? Do you use MEBO cream for burns here?

Bronchoscopy is done in our unit and in ICU in emergency cases. You just have to bring the machine and the scope and accessories needed. It's a fast procedure, some with an x-ray guide. Patient is on oxygen. Patient's oro-nasal passage are locally anesthetized and the doctor sometimes inject a local anesthesia in the throat. Patient is given sedation. We lubricate the scope with xylocaine gel and push some xylocaine sol while we enter the trachea. it is suctioned as the doc goes in.. then we flush some saline, take some biopsies or specimen using the trap. then the doc suctions the remaining saline and some secretions and pulls out the scope.

In the middle east (where I used to work), patients are usually sent home at the end of the day. We used to give them the antidote just to keep them awake and be ready for discharge. It was only when we experienced a complication after a colleague give two antidotes, narcan and flumazenil at short intervals that we kept giving them at the minimum:). Patient developed pulmonary edema after colonoscopy. She was fine after the procedure but started coughing frothy secretions after receiving the 2 antidotes. It was late and we want to discharge the patient... but it turned out we have to stay longer than anticipated. For out-patients who never respond to repeated doses of antidote, they are admitted for observation. Otherwise, those who have nobody to accompany them are advised to take a cab to reach home and come back in the evening to pick up their car. I miss working in endoscopy...

15 minutes, esp if we are running out of schedule and anxious to go home:)

Are you also asked to apply pressure on the left lower iliac region during colonoscopy, esp after reaching the sigmoid? We're usually asked to do it in order to straighten the splenic and hepatic flexure and facilitate easier insertion and to quickly reach the caecum. It's just too tiring esp with patients having big bellies. :)

Hi! Just wanna ask everyone how do u position patients after colonoscopy. We're told to keep them in prone position to press the abdomen and keep the air out; however it is not mentioned in the books. The doctor already takes the air out from the colon as he comes out, so is there still a need to keep patient in that position? Most of our patients usually asks to go to the toilet after the procedure, though their colon are empty anyway. We're drafting a policy & procedure guideline in our dept so we are unsure if we need to mention positioning post procedure.