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surgical, emergency
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mcmike55 has 40 years experience and specializes in surgical, emergency.

mcmike55's Latest Activity

  1. mcmike55

    Funny things said by ortho surgeons in the OR

    So often something said during surgery can be taken the wrong way, and Ortho seems to be the easiest target!! "that's what she says" it the punch line in our OR. I swear, during one long day in the ortho room, I bet we said that line 90 times!! Some lines that come to mind.... "You hold it, and I'll put it in" during an IM rod insertion "I'm not sure it's big enough" followed by "that's big enough for anyone" again, during an IM rod case "Positioning is very important" getting ready for a hip prosthesis case Making up a T shirt with these printed on it is brilliant !!! This is a posting that could take on a life of it's own! Mike
  2. mcmike55

    Pulling Meds Early

    We have always pulled our meds and put them on that procedure's case cart ahead of time, but I'm hearing that this may need to stop. In the morning, we take our case carts from Sterile Processing into our central hallway, and put them outside the OR that the case will be done. As the day goes on, the circulator will pull the meds that are needed for that case such as Lidocaine, Pitressin, x-ray dye, etc, and puts them on that particular cart. The center hall is a restricted area, but anyone allowed into the OR's may walk through there, including pt care techs, and the occasional vendor. During a medication administration FMEA, I mentioned that, and the administration rolled their eyes. From what I understand, it's some sort of a Joint Commission issue that will require us to pull the meds as we need them, not ahead of time. Has anyone heard of this, are we the only one's pulling meds ahead of time? We are a small rural hospital with only a few OR's, and not just anybody can put on scrubs and walk around our halls. I understand that security is an issue,,,,,but.. Mike
  3. mcmike55

    Beach chair shoulder arthroscopy and fluid control

    We use a beach chair drape from Kimberly Clark that works very well. It's sort of a split sheet, that starts above the shoulder, then pulls around below. It has some really nice sticky strips that hold it. The fluid pouch is separate, which allows you to put it where you want to. We begin with two thin platic like sterile impervious "U" drapes, also by K.C., one above and one below. Usually for shoulders the drape an some absorbent "blue cloud" on the floor is enough. For ACL's we add a puddle guppy or some sort of floor suction device along with our absorbent mat. We did trial a thick yellow disposable mat the other day. Not sure what the manufacturer was. I liked it, the suction tubing was already attached, had some nice sticky tape on it. Just threw it down, stuck it down, plugged it in. Not totaly sure the scrub team and doc liked it as well as I did. It was a bit thicker than we were used to, but as soon as water hit it....it was gone! It did trap a little water underneath, a plastic backing prohibited it from sucking up anything that got underneath. MMc
  4. mcmike55

    LSO training

    I am the Laser Safety Officer (LSO) for a small rural hospital. I've been the LSO for some time, and frankly don't do much. I primarily take care of basic laser safety inservices. We don't do all that many laser procedures, and we don't have an in house laser. We bring them in on a per case basis. The company sends a tech with the laser and takes care of all the technical aspects. My boss the other day said that Joint Commission is looking more into LSO's and wondered if I felt I was up to date, which I do not. We use a lot of holmium YAG and high power green light lasers for prostates in Uro. I "grew up" running basic CO2 lasers, and feel my education could be improved. My question is, does anyone suggest a good LSO course for someone who is not really a beginner, but needs updated badly. Several years ago I attended a Rockwell Labs course, which was very good, and I recently saw an advanced course put on by the Laser Institute of America (LIA), which I really liked the looks of. Any suggestions??? Thanks in advance. Mike
  5. mcmike55

    speeding while on call

    nrsman....if you want, search the prior posts on just this subject in Allnurses.com. I think you'll find..if you are speeding, you are breaking the law. Period. Not many OR nurses I know have the high speed driving skills to handle a high speed run to the hospital. When you think about it, how much time are you really saving?? Do the math, I bet it's not much. At our hospital, you must live within 20 minutes response time to the OR. In some situations, such as bad weather, the scrub tech's in the Child Birth Center, know how to go down to our OR and at least open the basics for us, saving some time. If you are in good with the ED and house supervisor, who ever calls you in, hopefully they would be on the ball enough to get you rolling in ahead of the official call out. Many times I've come in for a trauma, to find out that the OR isn't needed. It's a win/win, if we need the OR, I'm here, if not, I'm here to help the trauma team. I had a good friend, coming in for an appendectomy, almost get killed when someone blew a light in the middle of the night. It wasn't his fault, but to me, drove home the point that you need to get there, but safely. You're not helping anyone by going in a ditch, or worse. Mike
  6. mcmike55

    Steris Machines Shut Down

    I don't have the actual documents in front of me, but I saw some info coming down the chute on this in early summer I think. The FDA says Steris made modifications to the System 1 after it got approval. As I understand this, the modifications, in the opinion of the FDA, required another application of some sort. More paperwork I guess. Long story short, the FDA got fed up with Steris and filed this recall, I guess. This includes units made back into the 80's I think. We are still using our Steris, but are in the process of figuring out a good substitute. Initially, we thought the recall did not include our "ancent" unit, but recently discovered it did. We've got a Sterad for most of our stuff that can's handle high temps, but it will not due scopes, etc, that have a long narrow channel. It's my understanding that they now have something out, similar to Sterad, that will do the job. The run time looks to be around 30 minutes, which is about what our Steris is. The search continues....... Mike
  7. mcmike55

    The strangest thing you've ever seen on an x-ray?

    My favorite, was the metal Scottie dog from a Monopoly game. A small child swallowed it, and there it was in the AP throat film, just laying there!! Perfect side view!!! Also, I attached (I hope) a photo I found online years ago of a bottle where it should not be. What I found interesting was that this person had a hip replacement. Old enough to know better??!! Mike
  8. mcmike55

    Stupid things said by your non-nurse significant other

    How many times have you heard someone say "oh, I didn't recognize you with your clothes on !" That's a classic, though not usually from a S.O. My favorite came actually from another nurse. I was teaching CPR classes many years ago, when we used Annie's with a paper read out. It sort of looked like a large EKG tracing, and documented your compression depth, rate, volume of breaths, etc. I had one student who, just couldn't get it right, and had rescheduled her for another try. The night before, while at a local eatery, this female nurse/student stopped by my table (with my wife there, mind you) and said in a voice much louder than I suspect she meant to....said, "I've practiced, and can't wait to do a strip for you !!" I'm pretty sure I heard a few cervical spines crack as many heads spun towards our table. Nursing,,,,a different language indeed!!! Got 'ta luv it !!! Mike
  9. I can use some input on this one. Our new Ortho Doc wants to use the Moog Pain Pump on shoulder cases. You know, the kind filled with Marcaine and drips in. We used them years ago, (different type) and had no problems. Doing a brief lit review, I see all types of complications. As I see it, the problems are, the catheters are place intra-articular and they shouldn't be, the meds contained Epi (should not), and possibly they were in too long. We've addressed our concerns with the company rep, and surgeon and feel that the problems are recognized and addressed, but those above us, do not. They want a full risk assessment run before we put one in, and the surgeon is none too happy! My questions,,,,,what's your P&P, and experience with pain pumps, and what actually triggers starting a risk assessment?? I mean, when you think about it, almost anything could warrant one, from a new suture on up. Where do you draw the line. Don't get me wrong, I'm all for pt safety and all, but there has to be a line somewhere.....isn't there? Mike
  10. mcmike55

    Anesthesia Gas Making Me Tired in the OR???

    Agree with the others on this, I suggest you look some where else for your fatigue. I would bet you could leave an anes. machine on full blast in a closed OR all night, and not notice the next morning. If your OR has the correct air flow rates, functioning waste gas scavenger systems, etc, there won't be enough build up to notice the next morning. (not to mention the vaporizer would be dry!) We have a company come in on a routine basis with a "sniffer" type machine that monitors the atmosphere in our rooms. And we've never had an issue in my quarter century of working in the OR. Like others, the only time I've ever taken a hit from Sevo or any of the other gases was when I was holding a child during induction. And then it was only a mild dizziness, that went away very quickly. In fact, your co-workers in PACU are more exposed to off gasing that you are! Let's face it, hard work, stress, long hours, etc, etc, etc is enough to make anyone tired!! Especially if you are new to the job! Hang in there By the way, if you and others are concerned about gas in the air, check with your supervisor, maybe they have a periodic air check done. If not, maybe you all should consider it. Mike
  11. mcmike55

    teds and scds

    Have not done a lit review in a while, so, I'm not sure of the latest numbers and findings. I figure this is one of those, one is good, two is better type things. Especially in this case as the mechanism is somewhat different. As I understand.... The SCD's mimick the natural action of you walking, in that it stimulates venous return, and the TED's assist that as well. We use them a lot in OR for laparoscopic cases, longer cases, those in lithotomy position, etc. I've seen TED's alone, or both, usually. Again, not sure of any studies, though I've heard that they've not found any real difference between thigh high or knee highs. Kind of think, as long as they are applied properly, it should help. Mike
  12. mcmike55

    Funny scrub story...

    Great story,,,,, I used to run the CO2 laser in our OR as well. One of our surgeons was vaporizing some skin lesions off a man that I knew, so I stopped by the holding area to say hi. He asked if I was going to be there, and I said I was helping the doc run the laser. And of course, he asked if my hands were steady. I pulled the old "Blazing Saddles" gag on him, holding out my rock steady left hand, and said "sure", then held up a quaking right hand, and said, "but this is the hand I use to run the laser!!!" Everyone got a good laugh, and hopfully made his experience a little better. Laughter is the best medicine right??!! Mike
  13. mcmike55

    Sutures: Types, SIzes and Uses

    There is a lot of different sutures and suture companies out their, of course with their own brand names, so it can get confusing. Basicly, sutures come in absorbable, and non absorbable. Absorbable suture is as it sound, is absorbed by the body. In our hospital we use suture from Ethicon, so the names I use are their company names. We use Vicryl, Chromic and Plain. The difference is how fast they go away, etc. Non absorbable suture obviously does not go away. This would be for skin edges, vascular anastomosis, etc. Examples would be PDS, Prolene, Silk and Nylon. Sizes or diameter of the suture uses an "O" scale. A middle of the road size suture for general surgical cases would be 2-0 or 3-0. The smaller the suture the larger the number....4-0, 5-0, 6-0 gets smaller. For an eye case we'll often use 8-0, 9- or 10-0. Larger size sutures run the other way. 2-0, 0, 1, 2, 3, etc. The largest size we have is number 5, and you could tie up your boat with it!!! The needles attached to the suture is another story. Basicly the needle are curved or straight (Keith style). They also have different "edges". If you looked straight at a curved needle, and it was perfectly round, this would be a taper needle, used for bowel and some wound closure for example. A cutting needle, has a bit more of a triangle look to it, and is used for tougher tissue, such as skin edges, ligaments, etc. We've also got some needles that are blunt on the leading edge for things such as livers, that don't like sharp things being poked into them!:chuckle There's a lot more detail on suture and suture needles out there, and this was my worth,,,,hope I didn't mislead you. I'm sure allnurses nation will help you out! Mike
  14. mcmike55

    how you do charting???

    About 6 months ago, or so, we switched from paper charting to McKesson. I'm getting faster, but it's still slower than paper charts! I've heard that now that we are getting this system under our belts, within the next year or two (or so) we will be getting yet another system!! Word has it that it's down to two systems, one that is easier for us, the other nicer for the IS staff, but a bear for us! I do like it in some ways, but, sorry, being in the biz for 30+ years, I still do not completely trust electronic charting. By the way, we carry small laptops around with us, and chart off of those at the bedside, break room, etc. For the record,,,,I've not "dropped" mine yet! :icon_roll Mike
  15. mcmike55

    Anesthesia - induction/ emergence question

    The previous posters know their stuff alright!!! And we all are on the same page here! When helping with induction, I'm there to pull the stylet, maybe move the cheek out of the way, etc. In a crash induction, or rapid seqence, there's a bit more. In case you don't know, this is done when you have someone that's not NPO, or has a significant history of GI issues, such as GERD, and may vomit during induction. In this case, I'm holding cricoid pressure with one hand and assisting with the other. In the mean time, I'm also listening to the pulse ox, which will tell me rate, and basic oxygen level by the tone. One key in my mind with cricoid pressure......do not let go until the anes. provider tells you to. Even if you (or the surgeon) thinks the tube is in the right place. It may not be!!!! Wait for the balloon to be inflated and the anes. provider to say, OK, you can let go. Until then,,,it's not over!!! I'm proud to say, I helped save one pt from aspiration this way. On a trauma victim, the pt vomited during induction, filled the anes mask for a second before we could suction them out. Checked the cords, etc later....and nothing got past me!! It can be done! Hope that helps. Mike
  16. mcmike55

    OR Lasers, Info Please

    Thanks to you all for your input....I knew I could depend on Allnurses.com!!!!! You've all brought up questions that have gone thru our minds as well. One problem, is this "company" is the only one currently that can supply us with the High Power (HP) Green Light laser for prostates. I really like this laser. Compaired to the old way of doing TUR-P's, with electrocautery, it is great!! Less blood loss, faster, and less time with foley's post op. It's really nice. Lucky for us, these fibers are one time use, and packaged by the company, so we have no issues. The rep. tried to tell me the other day that glasses weren't really needed any longer!!! (it's always something with this bunch!!) I told him, give everyone in the room glasses until he can prove to me in writing otherwise! Even then, I would have to work it thru our P&P Committee, etc. first. To me this would be a major shake up in the world of laser safety, and I hope that I've not missed it! Mike

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