Annony RN

Thanks for all the input. I talked to a friend who informs me that the school district she works for nearby doesn't keep them. Maybe I can go back to focusing on the idyllic parts of camp.

I wondered too if there was an emergency plan in writing for evacuation, etc. I vaguely remember that the county does have a plan because it involved evacuations to shelter in my childhood school district buildings. I hadn't thought of parental prenotification. What a pr nightmare. It seems like it should be a case of treat first in an extreme emergency, notify later- the local authorities said to give the kids a tablet so we gave them a tablet- except that we already could have it on hand which changes things. Why it didn't occur to me to check with the schools is beyond me. That makes sense. So much to think of. My first thoughts on the matter were pretty close to your anthrax analogy seems like a lot of worry over an unlikely event. I'd almost rather stock and have standing orders for doxycyline. Lol. But, the difference is that there is a local DOH protocol. I guess I'd hate to be reminded of that if things went wrong. If anthrax was distributed, at least I wouldn't be the only one caught with my pants down, so to speak. Thanks for your input!

Ha. That's probably the weirdest thread title this forum has gotten. A friend just posted online that the county where my camp is located is doing one of their periodic potassium iodine tablet distributions. My camp is within the specified 10 mile radius. Should I be keeping a supply on hand in the infirmary? We don't currently. I understand that the health department will give me some directive, but, should they hesitate, I wonder if I should push the issue. It seems so crazy and unlikely...but then I didn't live too far from Three Mile Island during that kerfuffle. Thoughts? Any one else actually work at a camp near a potential radiation site?

Lol. Yes. Indeed. I feel like I care more about general energy vs fatigue before most trips and injuries, fatigue, headache, nausea after trips. From an infection standpoint- if a kid contracts a dreaded contagious disease or wound infection during their travels, a temp check withon two hours of returning will tell us nothing. I just found the ACA manual snd went through TR and HW sections with no answers. I think it's a camp sacred cow or maybe shared with our affiliated camps. I'm going to work on something more practical- informative and time saving! Thanks!

Our camp has a policy to take temps on kids before (within 24 hrs) and after every group of girls that leaves camp on an outing. My ACA manual has gone missing from my office (ugh, the frustration) can anyone tell me if this is an ACA standard or just a camp sacred cow? When a group is leaving daily, would it be acceptable to take temps before the first trip, then after every subsequent trip (using Mondays post trip temp as Tuesdays pre trip temp and so on?)

OK, can you tell us more? I just read that chapter posted and looks like culprits during anesthesia include sedatives (I would have guessed that diprivan would cause more reactions than tiopental, hm) NMBAs, and locals. Not mentioned was antibiotics... certainly that can be an issue. I've seen a few rashes pop up mid-prep but never anaphylaxis (wheww) So by omission, and your hinting, inhalation agents are not associated with anaphylaxis? Do they not cause an IgE reaction? Why not?

That's because all the nurses are smart enough to refuse assignments with his patients... they are dangerous and unethical, even if they are miraculous and dramatic :chuckle

Just as comparison, think how tiny an 8fr foley is and how large a #8 trach~

I wanted to add that I've worked in hospitals that have a pre-op class for kids and it's great. Get a box of goodies together and invite kids and their parents to come in for about an hour on a day before the class- a nurse leading the class explains what will happen the day they come in- you'll get a bracelet and wear a gown like this. We'll weigh you like the dr does and show them the BP cuff and pulse ox. Let them touch and play with everything. Show them an anesthesia mask and circuit and let them have an EKG "sticker" to play with and keep. Try to arrange a tour- show them an ASU room and meet a cheery nurse (LOL) We always tried to keep an OR room close to the OR desk open and clean on class evenings. Took parents and kiddies to the locker room to put on jump suits, booties, and OR hats. Kids can even wear left over open-unsterile gowns if they're carried. Then we show them a "real OR" The bed they'll nap on and the anesth. machine and desk. Maybe one kid will let you put on stickies to see their heartbeat on the monitor. Meet some friendly staff members. Show them PACU and let them pick a sticker or toy if your PACU keeps goodies. Point out to parents the points on surgery day where they will leave and be re-united with their kids.

OK, I skimmed through most of the posts but not all. This thread got lenghty fast! Used to be a peds nurse in community and regional hospitals as well as homecare. Then also an OR nurse in a community hospital. NEVER saw a kid as upset as some of you are describing and I have thrown people out of pedi rooms for making a kid half so excited. All of our kids get Versed first and we have it well planned (timing) Your rooms must be absolutely ready before a kid comes back. Not the time to make ANY clatter with instruments or see people hustling around. Hvae a calm transport person bring the kids back. Everybody who must be invlved, meet the kid outside the room, masks off, get to know them a bit (takes very little time) Chat about the stuffy, toy or blanket they brought. Maybe use their stuffy to demonstrate the mask first. Ease them to the bed or anesth. lap. Keep only people they've met around them. Talk quietly and move slowly... senses are a bit hazy and keen all at the same time in the Versed fog. Show them the mask and balloon as mentioned. Show them how to blow it up. Show them the chest "stickers" before you put them on. Having some fun stickers helps, too.

Do you have an assignment that specifically asks you to make some choices? LIke the other posters said, the central lines are put in by MDs or anesthesia and the PICCs are put in by PICC/ IV team nurses or interventional radiology. Bedside nurses are only putting in peripheral IV catheters that are 1-2" long and only have the option of a single lumen. If you need more access from there, you will either need to request the MD to order a central line or you will need to add another peripheral angiocath. Now, as far as multi lumen long lines go... Most of your "input" will be in getting the correct kit for the MD who has already decided. In ICU, the drs do often ask us if we want a line and what we want. Sometimes choices are habit (we never put less than a triple lumen central in pts in ICU, PICC team routinely places double lumens in adults but is starting to use triples if asked in ICU) Really, it will depend on what is happening with your pt. Med Surg pt needs prolonged antibiotics and daily lab draws? A double lumen is fine. Onco pt who will need long term access? An implanted port might be best- it's single lumen is enough but it can be left in place longer than anything else. Typical ICU pt? Several antiobiotics, insulin drip, pressor drip, fluids, multiple electrolye infusions... you'll need the triple as you map out which meds are compatible and can share lumens and what can't. Are you dedicating one port to monitoring central venous pressure? Is he in ICU with significant heart issues? He may need a multi lumen Swan line with ports for CVP monitoring, pulmonary artery monitoring, and cardiac output measuring as well as the many meds. As far as placement... lines placed by a surgeon in OR are tunneled and you will see an additional suture line when they are new. Lines placed at the bedside are not tunneled. Tunneled lines can remain in place longer for long term home use for chemo, TPN, or temp dialysis.

Hug to you, mama! Hope th follow up gives you answers... good ones! I'm sure your husband and even daughter are a little shaken, too, and hiding it in that teasing.

It's interesting how RR teams are set up in different facilities... may I ask who's on yours? In our hospita it's an ICU nurse, the ICU RRT, and the resident/fellows on the intensivist service that month... so we rarely need to call them overhaed from ICU as they're usually already there. In the hospital I worked in, there was always a CRNA on the team but not sure who else (I was in the OR so never saw an RR team come in... only the CRNA tearing out)

Our in-room "code buttons" in the OR were only wired to that department. THe OR and anesthesia teams handle their own codes there. Honestly, anyone else would be useless... you want the person (CRNA or anesthesiologist) who gave meds and watched monitors prior to the code to manage it. They know the best course of recovery. There are usually enough scrub techs and anesth. techs around to run for supplies, send labs, get blood, etc. Th way those normal procedures are done on the floors is completely different from in the OR in our hospital. Our ICU code buttons are wired into the hospital system but we use our discretion before smacking them... if the code takes us by surprise we hit it to make sure we get the drs running and resp therapist and chaplin there. If it's the 5th time the pt coded that night, has been known to be deteriorating, or the drs are already there, we just code them without the whole hospital knowing about it. There've been times that the front hall has coded a pt without the back hall even knowing about it, LOL.

Otho guys do that here. It's hard to get the podiatrists to use them... even the ones that do the long procedures. Those are the cases where the cuff is on (not necessarily inflated!) for 2+ hours. We have to be extra careful not to slop when prepping if using betadine. It's important that betadine isn't left to soak into the webril and lie there moist against the skin that long!