Archive for October, 2007

Quick! Get the EHPB…

Posted on October 25, 2007. Filed under: Journal from behind the desk... |

Well what a lot of panic we’ve had around here recently. I used to be an Emergency Nurse – I had subscription to the journals and everything!  I was one of those cool dudes.

One for Kim and MJ

Some kind of trauma or resus going on, all the pumped up adrenaline junkie newbies would be rushing around, getting aroused by someones potential death, not me.  I would be the one staying outside managing all the other patients on my lonesome, while everyone else was looking after that one patient.  COOoooool as a Cucumber. 

If you wanna get a head

So it’s not to suprising I now have a job where I pretty much work on my lonesome.  I have appointments, sometimes I run late, sometime I run early.  Mostly I stay cool. For the most part I hope my laid back approach to my patients is contagious.

This morning however I have had two patients, wanting to get me running around….

One was Mr ooooooh-my-god-i’vegotchestpain-pins’n’needlesdownarms-its-my-chest-I-can’t-breath-my-heart-is-going-toooooo-fast.

Max: Alrighhhhhhhhtie then. Lets have a little look at you.

Mr Long surname: But-I-can’t-breath-my-chest-hurts-what-are-you-gonna-do?

Max: OK so you’re lungs are fine, I’m just going to get something to help your breathing.

But what I was really thinking was: Oh-my-god-I-need-to-get-the-EHPB-before-this-dude-collapses-on-my-floor.

I “rush” to the dispensary, and grab an EHPB…

Eh? Oh what’s an EHPB? I hear you ask!

Emergency Hyperventalation Paper Bag. The ones in dispensary are the best, nice and noisy when you breath.

Not the 1st bag I’ve worked with

It’s another miracle.  Breathing restored to normal, pins and needles gone. Now lets get to the chest pain….

Max: It hurts when I press here?

Pt: Oooow!

Max: and when I move your arm across here….yep….You’ve pulled a muscle.

The first clue this guy was not having a cardiac event or respiratory crisis is my favourite: “I can’t breath!”

To which I always want to respond: “But you can talk, how impressive!” 

Then I get to thinking “I wonder if you could project enough air passed your vocal chords with you stomach muscle to make you speak” – Then I remember those hideous drunken nights when we used to see who could say there name by just burping – gross and childish – no need to try it….no stop it!

I then had another patient hyperventalating. Pins and needles. The whole thing. Two in one day, what are the chances?  Anyway, she WAS hyperventalating because her Epiglottitis symptoms made her scared.  Fair enough! Paper bag and hospital. I’ve never sent anyone to hospital with a paper bag before, I hope they don’t laugh when she gets there!

Oh what a wheeze!  Now relax….

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Half of all adults could be clinically obese by 2050.

Posted on October 18, 2007. Filed under: Apply topically |

Oh cracking! Another piece of quality “government research” has been fed to the media in an attempt to scare us….Yes “half of all adults could be clinically obese by 2050”.  When I heard this my immediate concern was….Oh my god which half?

Half Fat!

There I am on New Years Eve 2049, my usual slim physique, then midnight strikes on Big Ben… I lean to kiss my wife and “SPLUNPH!” Half of all adults are obese. The kiss continues, she runs her hand down my slender back, but suddenly her hand gets stopped by the barrier that is my butt. 

Please to see you?

“Oh my god it’s true, half of all adults are obese – and it’s my lower half!”  Still it could be worse, think of the strain on my slender legs, if my top half became obese! 

What’s that you say? Oh I see! Half of the adult population will be obese! Phew what a relief! So I stop panicing…

…but what’s this… Alan Johnson Secretary of State for Health has added his comments that Obesity is as serious a threat as climate change.

Mr Johnson…double chinned and too lazy to walk into the building!

What a bizarre statement….lets have that again: “Obesity is as serious a threat as climate change”.

Is this because fat people leave a deeper carbon foot print, or something to do with fat people farting more than skinny folks?  No! Fair enough, it is not saying that fat people will have an effect on climate change (that’ll be the next “government research” paper), but that obesity is as serious a threat….to what? I don’t know?

…Hang on!  Global warming, massive amounts of the planet flooding as polar ice caps melt, while massive areas become over heated and dessert like.  Potentially half of the UK flooded  verses  half of the UK being chubby…

No I’m struggling to see the comparison….oh I get it. Too many fat people to fit into the UK, so we export them to the north pole, where they have to open lots of McDonalds, and the heat from all that frying causes the ice caps to melt, or perhaps the UK floods as the Island sinks under the weight of so many fat people?

No I don’t get it! Sorry.

Lets look back…in Jan 2004…..we were advised that global warming was a more serious threat than terrorism.  Therefore according to this logic, fat people are more a threat than terrorists!  Personally I’d rather sit next to a fat person on a plane!

Watch out for fat terrorist, highly dangerous!

Talking of dangerous….Change of shift is out, which leaves you in danger of spending the whole day reading, and getting absolutely nothing else done!  Enjoy.

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Really(?!) Don’t mention it….

Posted on October 11, 2007. Filed under: Journal from behind the desk... |

Hmmmm, I was unsure whether to entitle this one:

“Really, don’t mention it” or “Really! Don’t mention it…”

It is a post about thanks…and not things you just don’t want to talk about (e.g.:Bleeding haemorrhoids and the smell of malena – if you don’t know what I’m talking about consider yourself lucky). I’ll let you decide on the punctuation.  Now I know this has been discussed recently,  but after last week I just need to get it off my chest…..

I have to get this off my chest before I explode.

It was one ‘eck of a week. Don’t know why – it just was, come Friday I was begging for a boring UTI or sore throat. (Well a patient with one, don’t fancy one myself!?)

My two extremes that prompted this post were as follows:

1: A young lady presents. She has a chronic history of lower abdo pain, intermittent vaginal discharge, and despite numerous investigations and treatment very little change.  She is to see the gynae consultant in a week.  Her discharge has returned.  I have a chat with her, do a few routine bits and pieces, but essentially tell her that until she has had her appointment there just isn’t much more I can do, the usual treatments don’t help, so I don’t prescribe anything. Not a sausage. I was expecting her to say……

“Well that was a waste of my bloody time! Here I am with the devil’s own festering sputum sloughing it’s way out of my vagina, and you say “oh just hang on a bit…..”.

BUT NO. She couldn’t have been more grateful for my useless consultation. 

Thank you very much….

2: I can’t go into too much detail, but a patient came in asking for a genetic test I’d never heard of, he was asymptomatic, but he stated it was important due to his family history. 

I asked all the doctors and as usually when I say “Hey guy’s I don’t know….”, they say. “Well if you don’t know…..ring the hospital” (AKA We don’t know either).

I spoke directly to a consultant at the local hospital, he said: “Hmmmm” ring the specialist hospital……

I spoke to a specialist, who I have to say was a walking encyclopedia and new exactly what I was talking about….even though I didn’t.  She was lovely, and pointed out that the patient didn’t actually need this test or any other test and the information he had given me…was not correct. 

This between other patient’s took me the best part of the day to sort out, phone call, messages left, returning calls. Doctors don’t just answer the phone! Especially consultants.

My mobile cost’s a bomb!

I rang the patient to tell him what I’d done and found out, and he said, “Oh, OK”

Now I know I don’t do this job for the thanks, if I did I would have no motivation at all, but a tinsy-winsy “ta” might have been nice.  It always seems to be the way, the harder you work the less thanks you get for it! 

On a grander scale it is typical of the health service. Bust our arses trying to do the maximum work with the minimal resource and scarcely get thanks, but one little slip up and you name is on the front of the Daily Jail Mail and you have to hand your gun and badge in….

…perhaps if I didn’t use the gun to stop the patient’s from moaning, I wouldn’t get complaints….

So much bottox, the bullet couldn’t get through?

On the subject of thanks, I’d like to say thanks to the interest I’ve had in the “Nurse Bloggers Lounge” and also for a great big mention by the Moofster on her blog. Complements indeed….

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Run, before the nurse stabs you!

Posted on October 4, 2007. Filed under: Did I say that?, Journal from behind the desk... |

In my former life as an Emergency Room Nurse it was often dangerous. Various incidences occurred that could turn your hair grey(er).

 I’m not a grey hare…

Some “classics” spring to mind…

Like the time a mother and father stormed into their son’s cubicle to attack his hypnotherapist – who they had hired, but felt had corrupted the boys way of thinking (is that not what they are paid to do?)   The situation was FAST getting out of hand. Myself and a colleague where trying to calm and separate.  My colleague was about to get punched when my mouth opened and out fell the words….

“This is a hospital, not the bloody Jerry Springer show…”

Amazingly it had a calming effect and the situation resolved….

I also had the typical dispute in triage, with a guy who didn’t want to wait 4 hours for his girlfriend to be seen with conjunctivitis, as HE had to meet his parole officer.

I advised she was the patient, SHE that needed to wait, and he could leave at any time. I also explained the usual bumph about triage, and if I made one exception the rest of the waiting room would riot. He became increasingly verbally aggressive, threatening my family (I didn’t like to tell him they lived miles away!) but I coolly stood my ground, until he left.

After which the girls in reception told me he was the local gun dealer, with a history of GBH etc.

 “Swap these for some chloramphenicol mate!”

Next time tell me before not after!  I suppose the whole “need to meet my parole officer…” discussion should have given me some kind of warning…

I thought perhaps moving to a sleepy towns primary care service would be a safer environment…..however this week I have had two potential dangerous occurrences.

My first near death experience was trying to do an ECG on a patient with 100% polyester floral blouse.  The static was rising before I had even put the stickers on. I was worried I was going to end up defib’ing both of us!  

 Her ECG was fine, but there was nothing I could prescribe for her fashion sense!

The second incident was typical. One of our receptionist has printed off a huge amount of huge signs reading “FLU CLINIC THIS WAY” with whopping big arrows pointing towards the practice nurses room. Every year when the practice nurses given the ‘flu’ immunisations, these signs get bigger, as no matter how big the signs – someone will ignore them and get lost….

Consequently when the Practice Nurse found a patient wandering in the corridor, she promptly told him to stand round the corner in the ‘flu’ queue, and so he did….meanwhile, I sat at my desk, wondering what had happened to the patient whose name had just gone on the waiting room screen.  If I had been 30 seconds longer before getting off my arse and finding him, he would have had a needle stuck in his arm!

Patient safety indeed!

Just when you thought it was safe to go on line again….Change of Shift is out again

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