ohthatswhatthatdoes

This happens. Could be someone did some damage placing the foley... I've had several patients pull them out with the balloon still inflated. Some people are just tough and/or delirious. This might be a language thing (I'm not from the US), but why is everyone talking about saline? I learned you never put NaCl (= saline, I suppose?) in a balloon, always Aqua, as the salt could from crystals.

I heard from a floor nurse that a patient told her she had a good nurse in the PACU, because I believed her when she said in how much pain she was (hemicolectomy with PCEA not working). I was happy to hear that, as it was quite tough taking care of two other patients, while she was in so much pain she could barely process what I said. Keeping her calm and convincing her we'd take care of the pain, without frustration or irritation (I tried to, at least)... It just takes a little while to kill all that pain, you can't just push everything all at once through that central line... And figuring out if there was any nerve block at all when the only communication consists of variations of aaaaaaaaaaaaaaaaaah and oooooooh and it huuuuurts... I like opiates as much as anyone, but I'm a bigger fan of decent loco-regional anesthesia :)

Interesting comment about the balloon, I hadn't heard that before. Where I work, it is common practice to deflate the balloon (1 or 2 ml) when the patient complains of cramps/pain (and give Vesicare). I was told this reduces irritation of the bladder. I never questioned this (there's still soooo much to learn :) ) but I'm going to look this up, real EBN style stuff. Maybe we'll end up putting in an extra ml instead of taking it out... I leave a gauze ball in front of the lady parts, and the urinary tract is the hole below the privy parts and above the gauze. I have yet to miss. Nor do I need a flashlight. The only 'trouble' I sometimes run into is Instillagel blocking the foley, but that's easily fixed by aspiration with the syringe. I think the main reason people have difficulties, is because they're afraid to really dig in and wrestle through the layers of labia. It's not fun for anyone though. I have more difficulties with male patients and their prostates...

My guess is that muscles have bigger blood vessels, so it gets absorbed relatively quickly. SC injection or extravasation leaves a big pool of nasty just hanging around because absoroption rate is slower, so it has more time to do some damage. I have thought about this question before, but haven't asked one of our doctors yet :) I've never seen Phenergan being used IV, and I've only been ordered to administer IM injections of Phenergan to patients with a PCEA who experience itching, when Zofran offers no relief.

Pressors on a seperate lumen.

I like Diepenbrock's Quick reference to critical care, which is exactly what the title says it is. Portable so you can use it at work and it seems to contain just the information I need when looking something up. It's not the study book you're looking for, I know, but I can't help you with those (I use a Dutch book) :)

No, but I do stalk a colleague

I learned that paradoxical bradycardia when you give too little atropine is a very real thing.

Go to the ICU, unless you're certain you want to work in the OR. It takes more than a few weeks to get it, to really understand what's going on (in my experience, after rotation and working in the OR for about a year) and you probably won't be allowed to do anything cool. Perhaps try to find out what students can do? If the assistant surgeon places the foley and the anesthesiologist sticks in the 14GA because he won't let you **** up the one good vein he needs... If you love anatomy, it might be worth it though, the colors and smell of real tissue can't be experienced through books or film :)

It might also help to remember that your BP is one of the last things that will change. Your body will compensate a whole lot of bad things before your BP drops to the level of uh oh.

I never even questioned the fact that I clean things up as best as I can before I give them a call. Perhaps I'm naive. It takes 30 seconds to put on gloves and reach for the paper towels... Now let's talk about the real cleaning, projectile vomiting or a carotid rupture, that's what you need the mop bucket cart for

Oats oats oats Rolled oats with banana and yoghurt, I don't leave it overnight, I mix it first thing when I get out of bed. Add some nuts, chia seeds... Grind oats in the blender until powdered, add milk, banana, peanut butter and chocolate powder. Grind oats in blender, combine with wholemeal flour, eggs, milk and oil for making pancakes. You can make breakfast bars, there are endless recipes, usually vegan/vegetarian blogs cover them well. I either bake or freeze them.

Thanks for the recommendation. I've started reading in Drain's... It certainly covers a lot of ground. I also like this one that I found: Fiches techniques en salle de surveillance post-interventionnelle: surveillance anesthésique et chirurgicale du patient opéré. It's in French (obviously), but I think there's plenty of people here who speak French, so I thought I'd mention it.

I'm working my last few weeks on my current job, so I can relate. Different environment, different reasons, but still... The job gets to you and even at home you're becoming a different person... One thing I learned from all of this is don't make drastic decisions or talk about leaving when you're too emotional. I ruffled some feathers, burned some bridges, I think. I don't mind though as I really needed to quit, but in retrospect I'd handle it differently. So my advice would be: think and talk when you're calm (if that's even possible )

15 minutes from my living room to the locker room, by bike. The downside is I tend to leave home at the very very last possible moment...