No, really - what is your EMERGENCY?

This used to be the journal of a nursing student at a prestigious 4 year university that will still remain unnamed. This is now the journal of a Registered Nurse working in an Emergency Department in a major US city. All names have been changed to protect the stupid and the mean. There is no educational value in this journal, sometimes it will be downright mean and catty - this is where I come to vent!

Tuesday, August 02, 2005

You need thumbs

Things I have learned the past couple of weeks:

1. You need both of your thumbs. We had a patient with both amputated on the same day.

2. Some interns are nice and understand their limitations. Most are not and need daily reminders that 4 years in medical school doesn't teach you everything. We just got the new herd of fresh graduates, some of them are arrogant and dumb.

3. If you are a resident and your patient is circling the drain and you don't know what is wrong, it might behoove you to listen to the nurses who have been working in the ICU for 20 years. They just might know what they are talking about.

4. Even if the pulmonary fellow tells you it is ok, you cannot leave a Swan-Ganz catheter in your patient's right ventricle. They will go into v-tach. And if they are already compromised, it just might kill them.

5. If your patient has a penile implant, it makes it very easy to put on a condom cath.

6. Butt cream made with stoma adhesive paste does not work as well as that made with stoma adhesive powder.

7. If you are putting a rectal pouch on someone, it helps if you warm up the wafer first.

8. You cannot bolus feed through a Dubhoff tube. I didn't do this, but I heard of someone who did.

Addendum:

9. If you are an intern, don't piss off the nurses on your first day, this will make your residency a painful experience. Don't talk to them like they are idiots, they went to school also to get their degree. Chances are they have more experience than you have years. Respect runs both ways and the "MD" after your name doesn't entitle you to some. It is kind of like an officer/enlisted relationship. As an officer, your enlisted can make or break you, and the same can be true of nurses and doctors. Nurses wouldn't do anything to endanger their patients, but they can make the new doc's life very difficult.

2 Comments:

  • At 2:35 PM, Blogger Kevin said…

    speak english!

    What's stoma?
    What's a rectal pouch? Like a colostomy bag? Wafer? Is that like a vanilla cream?
    Bolus? Dubhoff?

    I have a feeling being an intern is like being a 2nd LT or an Ensign. In theory you know everything about your new career, but in reality you know nothing.

    We both know people who have handled that well, and others who haven't. Dr's are probably the same way.

     
  • At 10:05 PM, Blogger Yolanda said…

    Stoma: when they pull some of the intestine out through the abdomen for someone whose GI track doesn't work right. Adhesive powder is for attaching the bag to the skin.

    Rectal pouch: a bag similar to a colostomy bag that is attached to the rectum to catch diarrhea. We use them with patients who have profuse, uncontrollable diarrhea and are at risk for skin breakdown. Bottomline (no pun intended), if you can get them to stay on, they can help prevent ulcers on their butt.

    Wafer: the pliable part of the colostomy bag that you put the adhesive on. It warms up with body heat and molds better to curves and folds in the flesh.

    Bolus: all the fluid in one injection as opposed to a continuous flow.

    Dubhoff: a specific type of tube that normally goes in the nose down the back of the throat.

    And yes, you are correct in your assessment of interns. They are book smart, but not necessarily patient smart. The best ones realize this and ask for help. There are a lot of ways to do that, you don't have to admit that you are retarded, just ask for some experienced opinions. Just a side note, one of our favorite interns is a former enlisted Marine.

     

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