dizzygatorrn

WIMP = without inherent medical problem For the FLKs (funny looking kids), where an abnormal appearance may be an undiagnosed syndrome, you have to make certain it is not UPS. Ugly parent syndrome.

Child was in PICU with septicemia. The pediatrician tried to explain the diagnosis and planned treatment to the family. They seemed to have little understanding of germ theory and he resorted to explaining how bacteria are like little bugs and the IV medication would kill the bugs. A short time after that I overheard one of the relatives speaking to family members who were home in another city. Shouting into the phone, "What's wrong with him?....He swallowed a fly." ...cue the music...I don't know why he swallowed a fly... Told the pediatrician what I had overheard. He just shook his head.

My favorite was when a leech drinks its fill, detaches, and escapes and you have to follow the blood trail on the floor to capture it. /s/ Loved to drop those suckers in a bottle of normal saline. They just explode. Had to explain to a young physician that a child did not have bruises on his back from abuse. The marks were from cupping that his Asian mother/grandmother did as a folk medicine treatment.

A young child had died and several of us were doing postmortem care. The child had been in isolation and we had been double-bagging anything leaving the room all week. We had a brand new LPN and this was her first experience with postmortem care. I was explaining what to do and the rationale for each step. Suddenly, the LPN got wide-eyed and asked, "Do we have to double-bag him?" We all cracked up. Gallows humor.

As I read Dudette's vignettes, it struck me that in these memories that are so fresh to her, some many years later A tone of voice A facial expression Assessing a patient's understanding Determining a patient's preference Explaining what you are doing as you are doing it Assisting a mother to hold her child In these times of high acuity and decreased staffing, none of these things take any longer to do than not doing them.

If ENT says the problem is not in your inner ear, then it is not Meniere's disease. Do you have any history of migraines in you or family members? There is a diagnosis of migraine vertigo that is treated with migraine medications. A neurologist would treat for this. You say you are deployed. Have you been exposed to any explosions? Some soldiers have returned from Iraq and Afghanistan with vestibular symptoms like vertigo, tinnitus, etc., after being exposed to explosions. A VA Hospital in Tenn is doing a clinical trial with these soldiers. Good luck and don't give up until you get a definitive diagnosis. Sometimes it does a long time.

The Calmoseptine ointment explained above by icuRNmaggie is good. Calmoseptine is OTC and available at most any Walgreen's. Pediatric facilities often have a recipe for a "butt cream" - equal parts of nystatin ointment, Bacitracin ointment and zinc oxide mixed together. You can stir the ointments together with a tongue blade if you don't have a compounding pharmacy.

I had a 4 year old patient with a long-term gastrostomy. He would look for a new nurse or nervous-looking parent and whip out his G tube and wave it at them. He would stand there giggling with Pediasure oozing out the stoma. When another nurse responded to the inevitable shriek, she would just point to the treatment room. He would trot off to the treatment room, giggling the whole way. Every nurse on the floor got to practice inserting a G tube.

1. Before you insert the Foley: Cut a slit in the top of a baby nipple and thread the Foley through the nipple so the base of the nipple will end up against the patient's skin. Insert the Foley. Pull the Foley catheter up so the balloon is securely against the wall of the stomach. Slide the nipple down so it is against the patient's skin. Wrap cloth adhesive tape around and around the Foley just above the nipple. You need the tape to be too fat to slide through the slit in the nipple. You can cut a slit in a 4x4 and slide it under the nipple against the patient's skin. OR 2. If the Foley has already been inserted and you forgot the nipple: Pull the Foley catheter up so the balloon is securely against the wall of the stomach. Then wrap cloth adhesive tape around and around the catheter close to the skin. You want to make a wad too big to go into the opening. Both techniques eliminate having to put any adhesive on the patient's skin. (We did this for years before they invented Buttons, MIC-KEYs, etc.) We would teach the parent/caregiver of our pediatric patients how to insert a Foley if their G-tube came out. Those stomas can close quickly and some of our patients lived a great distance away. I had one patient whose stoma had closed down so much we could only get a 5 Fr feeding tube through the opening. The patient was going to be hospitalized anyway for their medical problem so each day we dilated the opening a little more and moved to a larger tube. It took 5 days to get back to their original size but at least we saved them a trip to the OR.

I've always thought I would be a survivor. Spent a lot of my life camping and can easily go rustic. My neighbors fall apart if we lose power for a day. (One of them drove over downed live wires to go buy a flashlight because he didn't have one in the house. Of course, they couldn't ring it up at the store because they didn't have power either. Then he drove over the wires again to get home. Linesman from the power company and firefighter had an apoplectic fit.) I always keep first aid supplies, some canned goods, extra water, and camping supplies in the house and fill the bathtub with water if bad storms are coming. "The Walking Dead" is filmed in and around Atlanta. They film downtown scenes on the weekends, especially on Sunday mornings. Warnings are issued on the local news to let people know about street closings for filming. They call them "Zombie Alerts". Sometimes the information is on the flashing signs on the interstate highways if the street closings are near exit/entrance ramps. "ZOMBIE ALERT!" I've wondered what people who are just passing through town must think. They used our big county hospital/trauma center, Grady Memorial Hospital, to portray...Grady Memorial Hospital! I would also get a katana (samurai sword) like Michonne's. And a crossbow like Daryl's.

Flyboy, Since your patient's wife asked you to attend the funeral, she did not think you "let him die". It sounds like his children were not ready to let him go. A family will talk about their loved one's death and funeral. His children probably changed their minds after subsequent conversations with their mother.

Many years ago, I had to go down to the hospital basement looking for some equipment. There, way back in the farthest corner, was an iron lung. It made a shudder run down my spine just looking at it. Polio was still around when I was young. It terrified our parents. You could be sitting next to someone in class or church who had a "cold" and the next thing you heard, they were paralyzed from polio. You didn't really understand what they were talking about, but you could tell your parents were very upset. So when the 1954 clinical trial for the polio vaccine came along, my parents signed me up. I became one of the 1.8 million 6-year-olds to participate - the largest medical experiment in history. 650,000 got injections of vaccine or placebo, the remainder were controls. I never knew if I got the vaccine or the placebo, but the vaccine was determined to be successful. The next year, the vaccine was made available to children. The line at the health department stretched out the door, down the street, and around the corner. It's not an easy task to keep young children in a lengthy line, especially when they know that is the building where you get "shots". I think it could have poured down raining and those parents would have stayed in line. The anti-vaccine crowd in the US has the luxury of not having seen the devastation these preventable diseases can cause. I only wish there was some way to get through to them, but logic and science do not convince them. Appeals for public health fall on deaf ears. (I was on a website where pro- and anti-vaccine people were commenting. A father commented that his son who had cancer could not be immunized and the anti- mother replied, "I don't care. I'm not putting that vaccine in my child.") Some people want to blame "illegal aliens". (The immunization rate in Mexico is 99%. The US average is around 93%.) I think allowing "philosophical" exemptions is counter-productive. States with the highest rates of immunizations do not allow them. I dread politicians will pander to the "choice" crowd. I don't know what the solution is.

Pediatric patients I have cared for: Varicella encephalitis - Yes, chicken pox of the brain. Obviously, the toddler was left with brain damage. One of those cases where you wonder if you did them any favor in saving their life. Varicella with massive amount of skin lesions - I don't remember if the child was immune suppressed. I do remember we had to treat him like a burn victim. Subacute sclerosing panencephalitis (SSPE) - A progressive degenerative neurological disease that rears its ugly head 6-15 years after a child has an apparently unremarkable case of measles. The child grows and develops normally while the virus hides in neurons, then begins to lose their developmental milestones. When the measles vaccine came out, I thought, "Thank God. I will never again have to see a case of SSPE." Only to learn that some parents can't be bothered to have their child immunized. H. flu meningitis - We used to have "meningitis season" every year with many, many admissions. Some died, some were left with brain damage or deafness, some we sent home completely well. It was the leading cause of bacterial meningitis in children under 5 years of age. The year after the HiB vaccine came out - zero cases. Congenital rubella syndrome - Multiple babies with PDAs and pulmonary artery stenosis because their mothers contracted rubella during pregnancy. Also eye abnormalities and deafness. Meningococcal meningitis and septicemia - Death, brain damage, amputations. I still cringe when I read about a case. Pertussis - Once had 6 babies in an isolation room. That "whoop" is unmistakable. I got very good at mimicking it for new RNs and nursing students. I know some parents have been misled about the importance, but I cannot understand any nurse or physician that is not pro-vaccine (with medical and possibly religious exemptions). Even polio is still wild in some countries that people are flying to and from North America every day.

The primary reason for the existence of hospitals is to provide nursing care. I've never understood why administrators and bean counters don't understand that nursing care is not a "cost" of doing business, the services we provide are the "product". We are the business. If the cost of the nursing care was stripped from the cost of the room/utilities/laundry/housekeeping, billing and reimbursement for nursing care could be based on the patient's actual acuity level.

You know that the media will focus on the highest number, not the Northwestern University group that has been previously accurate and forecasts smaller numbers. Fear and hysteria means higher ratings. The most likely scenario being clusters of cases in major cities, I'd like to know how they would handle quarantining the nurses and physicians who care for these patients. Whose going to take care of the patients when you have made trained staff stay in their homes?