MGS RADAR

Well today we didn’t have many patients on our ICU, and the ones who were present…well not something you might expect on an ICU.

I took the chance to do some things…I visited my head teacher about some things and then she asked me the following question.

“Well do you feel capable about working on sick kids and babies?”

And I answered :”Iam expected to take care about any patient around any age!”

“Well, then go to the Neonatal Intensive Care Unit right now, there is a 4 year old intubated child on a respirator where your expertise is needed!”

TRUE CHALLENGE!

I really liked pediatric nursing and working with the children on the ward, and I miss it during the days I spent washing 90 year olds. But…I’m formally not capable of doing it

Well long story short, there it was the intubated, sedated child with a minor surgery. I’m not in the position of mockering about other nurses, and I’m not a pediadric nurse but the nurse on THIS particular ward was a real bitch!!!

But, with some knowledge I pulled out of my back part in my memory I was able to take care of him and another newborn child, very pleasing for me at last!

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

…what a freaking PiCCO Line is and how to set it up!

…what a Swan-Ganz-Cathether does!

….how to prep an arterial line!
…all emergency medications used in case of Resus!

…how to interpret an ECG quickly!

…what the fuck BiPAP and CPAP does!

…the different forms of enteral nutrition!

…the differential diagnoses for chest pain!

Three weeks to go!!!

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

If you think Diarrhea is nothing to bother and nothing but a symptom or sign, you are WAY wrong…it can…no wrong it WILL fuck you up if it will last LONG and it is dangerous…but no tears and fears - It can be handled without beeing a physician.

Why do I write this article?
First of all, I’m an official victim of Diarrhea…I catch it up at least once a year since I work with infectious patients OR I was getting fucked by a homojock Kebap - Maker - Idiot with lack of hygiene in his meatshed.

I also hear a lot of childish - half knowledge - cowfarm alike - rumors about dealing with Diarrhea…even in the internet on professional webpages which give actual medical ADVICES to people without any medical backround.

I spare you the routine disclaimer, I mean why should I point out that you should catch up professional medical advice and that this isn’t something you should transfer 100% to your case of bad luck?  Thats common sense and even medical disclaimers won’t let this show up in front of the idiots that got and will get killed becaused they tried to cure SEVERE illnesses just by wikipedia (nothing AGAINST wikipedia, I absolutely HATE Wikipedia-Credibility-Bashing - It’s just about the stupid shitbags putting medical advice into practice without load up their brains from a hybernating status.)

If some of my former or future employers will read this, see it as a part of small nursing science research shit. I mean I’m not the new Nancy Roper, but hands down I know something about Diarrhea. It’s still an advance if some of my employers is smart enough to understand the language I tend to write in, but no offense!

No make anything clear, I’m speaking about a short !(1 day to 4, maybe 5 days depending on your system)  diarrhea which is probably from eating something bad or having an infection in your intenstines. Now comes the bad part which is part of my job: Take a look at the diarrhea if it’s anything than fluid shit or something inside (slime, blood, something you might not really identify as old food) this mess must be reviewed by a physician!!!

Also I’m just speaking about diarrhea alone. They are common symptoms like nausea, general sick-feeling (like you have a flu) vomiting, light general stomach-pain and sometimes high temperature. If they are symptoms present which can’t be related to the diarrhea itself or the effects of this –> Physician

THE PRACTICAL PART FOR HELPING YOURSELF STARTS HERE
What causes diarrhea ?

For the average diarrhea it really doesn’t matter which bacteria or which virus exclusevely infected your intestines.  It doesn’t matter!

Does antibiotics help in case of diarrhea ?

I see some physicians prescribing masses of antibiotics against diarrhea, but the guidelines do not see the clinical outcome in this step. This might be a point of discussion for medical experts, but I see it rarely and in case I see it - never helped. Period.

What is the best medication against diarrhea?

Loperamide
I would personally not recommend loperamid in case of in infectious diarrhea…only in cases where you need to buy some time to get yourself in a calm position to heal, but loperamide and any other stuff like this will lower your peristaltic - bowel - movement of and you might give the possible virus or bacteria the best place to establish himself in your system. 37°Celsius - No bowel movement - Wet and dark condition PERFECT for developing of bacterias and viruses. This means the medication loperamide will actually make your diarrhea last LONGER.

Saccharomyces cerevisiae (Yeast) is something very nature and it hasn’t got many side effects, no relevant to me I think. It will re-establish the intenstinal flora in your colon and it will fight the bacteria. It helped me very often and also you can take this as a PRECAUTION a week before a flight to turkey or egypt OR you know that you’ve eaten something from the east that tasted not very good. Take it, it won’t bother you that much except some well…sounds and flavor.

This is basicly the BASIC medical treatment of diarrhea, if you are not interested in the whole understanding part you start here.

This is my flowchart like “MGS RADAR Diarrhea Treatment Scheme”
CAUTION: Brain must be used by application!

• If you have the first Diarrhea like stool and no other symptoms that may lead to a serious shit (take the word!) LIKE stomach mumbling or a “different” feeling in the guts, you start preparing but you should not call the cavalry ! One time can happen!
• If you got some strange feeling that this might last longer OR you have the second occur of diarrhea take exactly ONE pill of loperamide + 2 - 3 pills of  Saccharomyces cerevisiae (Perenterol etc.)
• In the first two days take 2 pills of Saccharomyces cerevisiae three times a day after the third day and if the symptoms are weakened take one tablet three times a day until you got exactly one week after the first occur of diarrhea
• Go to the local supermarket and buy:
  - Three bottles of Powerade or similar like Isostar (without bubbles, with sugar and with electrolytes, they need to be isotonic!!! NO ENERGY DRINKS!) The Powerade is the base of your re-hydration it works very fast and very well to my experience
  - Lots of salty stuff like Potato Chips, something that you really like
  - Buy lots of water without carbonide and with some taste in it, so that you can consume masses of water.
• You go home and consume the bottles of powerade in a row, after that you need to drink at least 2 liters of water, if you are able to do more drink like a moron!
• Eat the salty stuff whenever you feel like it
• The keypoint behind this is, if you are hydrated very well the side symptoms like weakness should be lowered to a point on which you can keep alive daily tasks, but KEEP A LOW PROFILE . You gotta imagine your body has a large wound and it may lose MUCH fluid.
• You should keep hydrated like this at least for a week
• Now comes the part which many people don’t aggree with, THERE IS NO REASON TO STOP EATING NORMAL FOOD. You can eat a light version of your normal stuff, but if you feel very good there is NO REASON to stop eating.
• Avoid food like: Whitebread, ANY FASTFOOD, eating outside, very sweet things, FAT FOOD, Salad, EGG
• food to like: Fruits in general, Carrottes, Apples, BANANAS, Potatoes
• Don’t drink alcohol, it’s a rollercoaster for your digestive system
• Use common sense!!

Be safe!

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

At my best-rotation the anaestesiology-nursing department I was late the first day because of high traffic levels….and it is not good to be late the first day….two minutes which means two hours by nurses time.

I scrubbed in, went to the AN-Nurse manager and gave her my apology…already in a rush and beeing nervous in a working place (Operation Rooms) not common to me she calmed me down and said “Go to Operation Room Number One, Doctor M. and Nurse Linda (both changed) are already awaiting you!
The anestesiologist was the best attending physician in the department, I intoduced myself to him and he assessed me from head to toe…..”So, I assume by your choice of words and language that you have a unusual-high education….would you be kind telling me some biographic aspects of yours?”

I told him I did the Abitur….”You did something fundamental like…….Biology or Chemistry as main exam subjects?” and I said “Biology!”

He paused…“What was your favourite topic in Biology?” and I answered “Neuro-Physiology!”

“Guess what…it was my FAVOURITE topic also……..so tell me something about neuro transmitters…..”

I thought, that this question-answer game is some kind of chance to fraternize with the attending….the patient was ready for going into the operation room and we drove him into it on the stretcher, the patient had to be turned sideways and the OR-nurses asked me to help them because the patient was heavy…

I was not concerned about the patient, I was still nervous and trying to “impress” the attending by telling him something he already knew so I did not concentrate on what I did.

Still shaking and talking, I stepped on the other side of the table…as I noticed two small hands grabbing me from behind and pulling me aside…

The leading OR-Nurse (a real doberman…for sure!) pulled me down to her level and shouted in my face “YOU IDIOT, YOU JUST TOUCHED THE STERILE NURSES AND CONTAMINATED THE WHOLE STERILE FIELD INCLUUUDING THE INSTRUMENTS…15 MINUTES OF WORK!”

I just ran into the sterile field…while still trying to “impress” the attending…I saw a smile through is OR-mask…he paused and said:

“Well young-gun…I’ll give you three advices for your career in this department….1)Don’t think that you can raise any level of excitement from the attending physician with 20+ years experience in intensive care medicine by telling him middle-school-basic-knowledge….2)Get away from the sterile field, it is NONE of our business and 3)This was VERY funny and ohhh yes…..potassium is not a neuro transmitter, it is an electrolyte!”

He pointed to the door and I took up the invitation of leaving the crimescene;)

Afterlife of this story:

• The leading OR Nurse wasn’t that mad at all, she thought I was some paramedic doing internship…
• I worked with this particular attending physician for a long time after this event, and I enjoyed every minute…never met such a brilliant and excellent physician and TRUE MEDICAL PRACTITIONER (a rare case today!)

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

At on of my first rotations I worked at an interdisciplinary ward with 28 beds, every possible subject except GYN/OB was present at that ward and the working demanded a high level of flexibility and a quick switch.

It was a not to busy early shift, no highly dependent patients and we had some time to actually do some “indoctrination”.

My training nurse at that day was Elke (Name is changed to protect the person). She was very tough, very strict, very fast and very punctual. Working with her was frustrating because she always did everything, and I mean everything with true perfection!

The truth to be talked….I was afraid of her because her outburts involved high noise level and general re-assignment to do some fucknut business (like cleaning something). There was NO point to discuss with her - NEVER DISCUSS WITH HER. I was at the same shift and part of the ward with my classmate Nadia who shared the same level of fear with me.

It was time for morning rounds, and she assigned us to make any bed…..normally she added something like “PERFECT!; 1100%, or EXAMDAY-PERFECT!” but this time she just said “Well, you two just make the beds I’ll make the rest”

We were very….frightened because bed making is the ultimate nazi-skill of nurses. You have to make it in a way, that you can play pool-billiard on that bed and it has to look PERFECT. But there are 100 of different variations how to make the bed.

Well, we had the time and I entered a room with very fit patients and rushed them out of the bed, my plan was to make it and satisfy Elke…

I tried it the first time with the fear of Elke tearing it apart in quite some time and…it was ok but not 1000% perfect…I tried it again, but by the third time it was…reasonable good.

Next bed, I also needed three complete tries to make it succesfull…by the way I heard the rolling of the nurses - trolley and the clacking of the stethoscopes as it stopped RIGHT in front of my room….beeing so nervous I pulled the blanket and I had to re-adjust the blanket…

Then Elke entered the room, with some strange and strict expression in her face….

“Well sweetheart, it is very nice that you want to do the beds to actually impress me, but I completed four rooms with doing everything including bed-making in the time you need to make two beds…….”

I said FUCK NO in my brain as I saw her pulling the last bed apart….but she was doing it very “easy” just pulling it straight, adjust the pillow and the blanket and finished nothing comparable to my perfect tries…while she was doing it she told me:
“Knock off this perfect bed making shit sweetheart…the patient will went back into the bed in two minutes and it’ll look the same!” 

Further story:

I had some trouble with this particular nurse, but I re-united with her several weeks ago and it was a privilege to work with her and learn more in one day that I learned in one week on another ward. One of the best nurses I’ve ever met!”

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

Sang Kim RN
Cardiac Telemetry Nurse
Snowboarder

Terry Misener RN, PhD
Dean, School of Nursing
Retired Lieutenant Colonel, U.S. Army

Yuri Chavez RN, CRNA
Nurse Anesthetist
2:54 LA Marathon

Roland Jomerson RN
Post Anesthesia Recovery Nurse
Decorated Vietnam Combat Medic and Retired Major, U.S. Army

Don Mucciprosso RN
Poison Specialist Nurse
Harley Rider

Walter Moore, Jr. RN
Intensive Care Unit Nurse
U.S. Navy Seal Team One

Bill Maddalena SN
Student Nurse
3rd Degree Black Belt Kenpo

L. Rey Ariola RN
Cardiology Nurse
Rugby Right Prop

Jason Scott Carrick SN
Student Nurse
Basketball Power Forward
For more men in nursing!

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

I just saw a link in one of my favourite medical blogs about a free youtube lecture from Harvard university, and the theme was very interesting to…

WHAT IS THE RIGHT THING TO DO?

Why do I take this lecture?
As a nurse I’m always obligated to moral decisions. One of the biggest question is which patient is more in need of care and which patient needs more attention. I have to oversee different aspects not only medical and I’m the one who can/will or cannot/won’t switch buttons which open or close the pathways of an individual not known or personally related to me. I have done maybe thousand decisions in my little career and I will do many more. This subject is called prioritizing.

Many of you would think, that rational reasons like numbers or common guidelines are helping me throughout the daily moral deciding. Sometimes they might help you, but in many cases they are just confusing you and every nurse on duty will let the “nurses 7th sense” get involved, which sometimes tells you the different or just to re-focus.

Let’s take a look at this

http://www.justiceharvard.org/

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

It has been almost 2 years from now on which I spent at the nursing school, it’s been a hassle sometimes but it has been a great value to me, especially my teachers (In germany they are not professors, Nursing is not an academic subject if you want to be registered, you have to so some kind of 3-year-training-program without any bachelor or anything else) and the people I spent my time with. My part-examination which is a test-run for the final tests are over today, it’s been hard especially the practical part was something that bugs me even today.

I did my thesis paper about the history of washing patients and the view of nurses by nurses…my thesis paper was great and it pointed out the middle of the downfall in german history of nursing education.

Today I wrote a test about the part III…a subject which is in most of the cases responsible for a failure in the registration process…containing nursing science, methods of science, law and nursing, nursing process, nursing theorys and so on…the test itself was the summary of all the things that really pissed me off during my school.

Grab some bits:

• The quality of sometimes very important subjects (e.g. intramuscular injections) in comparison to side-subjects like “hate and anger management” vary. In my humble opinion, injections are very important tasks since we can get sued for malpractice in such cases. What we got for this topic? Two pages of a leg which we had to colour out to mark the muscle and nerves and one very bad copy about the procedure of the injection. The rest was stupid, unreflective story-telling of this particular teacher which then stated “I really have no experience in injections”. The first time I injected intramuscular I was advised by my clinical instructor to look at my school notes, but in fact I never had something comparable.
• The best statement of our tutor if we complain about certain aspects is “This is impossible, I cannot think that they missed…” and in many (not all) cases this was the last response in such topics.
• Our teachers and our tests refer to the National Expert Standards or Nursing Practice which are guidelines how to handle certain aspects of our work. They are some kind of a golden rule. In 2 years we all speak about these standards, we all refer to these standards but we NEVER actually had them in front of us. We all speak about a cloudy guideline which nobody ever read and nobody ever handed out to us.
• We all have to do a care-plan for our practical exam. As much as I see the effort and the importance of a care-plan for patients, the step from theory to practice is not well planned because:
  - There is only a handful of nurses which are actually able to do a care plan
  - The few nurses who can do a care-plan do it after a curriculum of 1985
  - Even if they can do a care - plan…they don’t do it because they hate doing it
  - Even the clinical instructors who are trained to train us and who review our care-plans have no idea how to really do this.
  - I personally don’t know any teacher who did a care - plan after the 2004 guidelines.
  - Summary: The law arrogates something that nobody really can do and will do, and asks for a very good care plan which we will never learn from
  
• It is ridiculous to ask the students to buy a book, from which they will need 4 pages…especially if you have to pay 40€ for 4 pages.
• The particular teacher with little competence did a two - day seminar about diabetes mellitus type 1 and type 2. The main focus was on Type 1 Diabetes (because one of the sons has Type 1 Diabetes) which I only encountered twice in my whole practice and the therapy of Type 2 diabetes (over 75% of all internal-medicine patients have diabetes type 2) was the handout of a script from 1995 with medications given and the explanation of outdated insuline-pens. In some of our PBL - Classes, the teacher asked us about the therapy-scheme of Diabetes Type 2 and guess what, only a few interested classmates GUESSED the right answer.
• Sometimes I see a shifted main - focus. We went deeper in such fields as obstrietics, neonatal care and pediatric nursing then in other subjects. These fields require a vast ammount of special training, we still have to know something about this but it absolutely unecessary to know more about ped’s nursing than internal or geriatric nursing which is our main focus.

Well, given the fact that we don’t have the classic - class - attending courses anymore and given the fact that we have problem based learning for the whole third year I see some improvement…

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

I actually really enjoy this channel and channel author, but this seminar about checking the neurologic status is something that made me laugh even about myself and some nursing procedures, thanks for enlighting me.

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]

Ped’s rotation, I’ve been assigned to a pediatric ward with 18 beds and all pediatric aspects including some interdisciplinary beds (pediatric trauma/orthopedic surgery)

Due to the summer vacation in my part of germany, not many children get sick. The admission-rate is far low, the ammount of work you have to do is enjoyable small and everybody says, it is the last time you get so much time for your patients.

Todays lateshift statistics

Patients in my direct care: 3/4
Diagnoses:

• 16 year old girl with  suspected commotio cerebri
  (Biggest nursing problems: Beeing herself; Electrolyte inbalance)
• 3 year old boy with suspected commotio –> subarachnoidal bleeding –> commotio
  (Biggest nursing problems: Stabilizing the patient, monitoring the patient
• 9 year old,heavily disabled child with pneumonia suffering seizures
  (Biggest nursing problems: Handling perfusors and infusion-pumps without getting the I.V. blocked)
• 14 year old girl with abdominal pain –> suspected appendicitis –> ovarial cyst
  (Biggest nursing problems: Communicate with the patient, Pain management

Punctual at 13:30 the new patients arrived from one to each other, which wasn’t good for our staff settings. Our pediatric clinic is half shut down and there is only one pediatrician in the lateshift. The chief of pediatrics is usualy avaiable but far to busy for doing things the intern has to handle.

Commotio cerebri, which was the main actor starring in our todays shift is a diagnose you have to handle very carefully! It is nothing popular among nurses because the patient needs to be monitored frequently (hour per hour, in acute care every 15minutes with complete monitoring and pupil check which is very unpleasant during night) and the patient does not like this. The problem with commotio is its quickness, if symptomes of a brain-bleeding occur, they occur very quick and hump over each other. If you see a dilated pupil or a pupil difference, the other symptoms like speech problems or neurologic symptoms are in a quick reach. I personally saw a pupil difference twice only, and in one case it was hard to see. Today was the third time and I felt the child factor. If you see a lovely 3 year old boy with pupil difference, you react different than on adults. I cannot explain this, because it was a mistery for me and it still is.

The boy needed and emergency MRI and CCT, which revealed nothing special, the next tryout was meningitis, the following lumbar puncture was scene of agony and misery because he was something different than cooperative. The final diagnosis is still not given, and maybe it wont be given anyday.

My ICU like doing was interupted by my other patient, which is highly depenent and seriosly ill.The perfusors and infusion pumps need to be monitored frequently and this patient was particular bitchy about I.V. lines (Which are very hard to get on children, I learned this very hard) because if they were not blocked with heparine they got clotted in minutes, which is something you need to avoid if you know how hard it is to get a needle in this patient.

The next hard rule of pedi-nursing is: You always got two patients..the child and the mother/father which are more agitated and more full of problems. Children are a product of their parents ability to teach and guide, children are not responsible for their parental-induced faults, but they got many years to deal with it so they become not such a bunch of idiots like their parents…a mission many will not archieve.

After 5pm the whole workflow was gone…everything done

Stephan

["If liberty means anything at all it means the right to tell people what they do not want to hear!"]