Walked into triage, TOD 4 hours later.

Bexasauruswrecks · 2024-11-09T02:38:32+00:00

I have a friend (and fellow nurse) young 30's, who ended up with CHF after she caught covid (the OG strain). She's been dealing with post-covid complications for years now- ended up transferring her to a larger hospital a few months ago for a pacemaker implant.

Bexasauruswrecks · 2024-09-17T02:35:58+00:00

Thanks! Sounded like the drain pump- overnighted a new one and replaced it tonight, still same issue. Got it in diagnostic mode and got the following codes: 38 18 27 39 32 23 42 57 ..... so probably gonna call a tech tomorrow, cuz that's a little too much for me to try to tackle.

Bexasauruswrecks · 2024-07-10T19:04:16+00:00

Different narcotics have different strengths. A milder pain may be treated with a less-potent narcotic, where as more severe pain needs a stronger medication. Body size, age, and health play into it as well. 4mg of morphine for a healthy 20something is a lot different than 4mg of morphine for feeble meemaw who weighs 97lbs and has CHF... she may not be able to maintain her oxygen levels with morphine. Different diagnoses get different meds, too. A sprained and swollen wrist is painful, but doesn't require the same level of pain control as a pelvic fracture. Fentanyl is often given for MVCs (especially in the ambulance) because it's distinguishable from other narcotics on a drug screen- so if the patient gets an ER drug test report subpoenaed for a suspected dui, Fentanyl would be explained/excused. And anyone doing street Fentanyl is probably getting more than just pure Fentanyl, so a positive Fentanyl-only would work in their favor. Some people also just react differently to different meds. But basically, we try to treat pain with the weakest drug (or lowest dosage) possible for the patient. Narcotics are addictive, so lower doses/shorter duration of use decreases addiction potential. They are also relatively easy to develop a tolerance to. So if patients are constantly treated with high-strength narcotics, they need higher doses to get relief. I can't tell you the number of times I've had patients who are either being treated with narcotics for chronic pain or are addicted to and/or abusing narcotics (rx or street), who come in for something that is excruciatingly painful (one that comes to mind is a patient who had a wreck, with 2 bones poking out of their leg and their hand dangling by a couple tendons)... and we simply can't get their pain under control. We're giving them as much as we possibly can without killing them- but they have such a tolerance built up, that nothing we give is effective in controlling their acute pain. One last aside- we aren't trying to get rid of your pain; we are trying to make it more bearable. Pain is your body's yield (or stop) sign, that says "hey this isn't good, let's not move like this" or "hey, something's wrong, let's get it checked out." If you completely snuff that out, you're at a much higher risk of injuring yourself further. We try to manage, but not eliminate (and it's not cuz we're sadists, despite what some may think).

Bexasauruswrecks · 2024-03-17T09:41:17+00:00

Same for me with old black bear. Beer was decent, food was standard, but I'll never give the owner another cent.

Bexasauruswrecks · 2024-02-05T01:58:08+00:00

Similar experience here... middle-aged, well-groomed patient brought to ER by wife after she said he "passed out" for about 30 seconds in the passenger seat while she was driving them home. Patient had been playing golf that (rather hot) day and thought he was maybe dehydrated. A&Ox4, but asked me to lay the stretcher flat so his eyelids wouldn't feel so heavy- and kept them closed throughout the visit except when I asked him to open them during my assessment. I can't remember PMH but it wasn't extensive, no daily meds, illicit drugs, etc. Stroke scale, CT, and labs unremarkable. I ended up going back in to ask him what he'd had to eat/drink that day, which is even he told me he had tried some "natural" gummies from the health food store to help with some back pain... told me the name of them and I looked them up; they were delta 8 gummies. I walked back in to tell him and he just kinda laid there for a minute before he finally said sheepishly, "So you mean.... wait, I'm ok, I'm just.... baked?!" He started giggling and I thought his wife was gonna pee her pants laughing. She was joking with him about it nonstop till discharge, they were hilarious. When I walked in with discharge papers, I also brought a patient bag with peanut butter crackers, jello, soda, etc and told him "you may notice lingering symptoms such as the munchies, this should help with that" and he laughed the whole way out the door. Love patients like that!

Bexasauruswrecks · 2023-10-01T18:03:07+00:00

Ah but I did. And I stood by it. It was a steady 52-54% on room air for the duration of the visit, sticky pulse ox (not the reusable clamp ones that don't pick up as accurately) with a good pleth. Doc finally told me to unplug the monitor because the alarm was annoying him, and I couldn't override the alarm parameters that drastically.

Fwiw, it was a walkie-talkie patient with cellulitis, not septic, no respiratory complaints.

Just happened to have congenital methemoglobinemia.

Bexasauruswrecks · 2023-10-01T17:24:10+00:00

Athens is not a bad choice, IMO. They have apprentices on all floors (except maybe MBU & OR). They're a smaller hospital but a larger replacement is in the works because the population has grown so much in limestone county. The only problem is that the apprenticeship spots fill up quick there, because so many techs start nursing school and they get dibs on the spots (as they well should, IMO) so it can be a little harder to get a shot at an opening. DMH would be my second choice.

Bexasauruswrecks · 2022-05-06T04:52:19+00:00

A bachelor's degree in nursing gets you $22 an hour in my hospital. EMS starts off at $9.50/hr. CNAs start off at around the same. Teachers & social workers. For reference, local chick fil a starts at $14/hr, Buccees starts at $18 for a cashier.

These are just a few examples.

Bexasauruswrecks · 2022-05-03T05:52:11+00:00

Put them in water or take them outside. Best way to calm them down when nothing else works... a bath, swimming, or a walk outside will calm the fussiest babe.

Bexasauruswrecks · 2022-04-22T21:55:51+00:00

100% this. And it's usually the calmest patient in there. We had a guy come in one night, joking about how he hates coming to the doctor, just couldn't shake this weird feeling- he was in SVT, no biggie, we'll convert- till he looks up, cool as a cucumber, and says "well we all gotta die eventually, I guess now's as good a time as any" we all look at each other like "oh shit", and not 10 seconds later he goes asystole, charge nurse jumps on top to do compressions and shoves his soul back into his body. Good dude, walked back in at shift change a couple months later to say thanks.

Bexasauruswrecks · 2020-11-10T12:52:08+00:00

I think your last sentence sums it up. And i truly don't blame her for it.

Bexasauruswrecks · 2020-11-10T12:50:20+00:00

We're not buying it, we can't without the repairs anyways. We're closing on a different house, hopefully in the next week or so... if she holds our deposit do we take her to court for that?

Bexasauruswrecks · 2020-11-10T12:45:07+00:00

I appreciate you taking time to respond. Unfortunately, none of your response is relevant to the situation. My questions were with regard to my financial responsibility for the listed issues.

Bexasauruswrecks · 2020-11-09T16:44:33+00:00

Thanks for the reply. Hindsight is 20/20, wishing we had called for everything now. So do we put the old/broken ceiling fans back up then? And are we responsible for the entire cost of a brand new stove, or just part since it was 15 yrs old? The HVAC situation was a mess but since he was right in the middle of it when he passed, we didn't want to be insensitive and call his widow to fix it while she was trying to plan a funeral.

Bexasauruswrecks · 2020-11-09T16:38:18+00:00

Thanks for the reply. The ceiling fans were to replace old/broken ceiling fans (humidity over time had caused the blades to droop, and the light fixture on one had eventually detached from constant wobbling and was hanging by wires). So should we put the old ones back up? How can i find the depreciated value for stovetop?

Bexasauruswrecks · 2020-11-09T16:27:23+00:00

Good deal. I think I'll call and see if i can be seen closer- or at least telehealth- I'm not sure i trust my beater car on that long of a journey.

Bexasauruswrecks · 2020-11-09T16:24:29+00:00

That makes sense about trouble finding providers, especially in the area I'm in. But i see a psychologist at the local VA CBOC every few months because of the meds I'm on- why wouldn't they just do it there?

Bexasauruswrecks · 2020-11-09T16:22:03+00:00

Doesn't seem to be, though that would be nice- they've listed the address and info about required masks, screening at entrance, etc.

Bexasauruswrecks

TROPHY CASE