Yesterday's shift was good, here are the blogworthy parts.
A little 6 year old girl who had trapped her fingers in the door. She needed to have her fingernail removed and then it was sewn back on. The child was fantastic, the play therapist had prepared her so well and she was fairly calm throughout. Half way through she got distracted from 'Where's Wally' and remembered what was happening... "Have you started yet? Have you started yet?" At this point they'd just taken her fingernail off and she'd not even noticed! Hurray for ring blocks, entonox and 'Where's Wally?'. I'm not keen on nail-related things so I thought it best I watched to try and get over it!
Unfortunately It was almost 2.30, I'd not had lunch, I was feeling a little weak and shaky to start with and standing up in this very hot and stuffy room I came over all "funny". I had to leave the room and sit down as I thought I was going to faint! I was shaking, my head was swimming and I felt sick, I barely made it over to the chair! I had to ask someone to get me a drink of water, but after 5 minutes I was fine.
That "coming over all funny" has only happened two other times during my training, on both occasions I was overdue for lunch and standing up in a very stuffy room. It's not the sight of whatever its happening itself, but the combination of factors. It's good to learn from these things and know what situations to avoid. I've seen far worse, gruesome things and not been bothered because I'd already eaten and the room was comfortable! It's also nothing to be ashamed of, it happens to everyone and it is far better to leave the room and keel over!
Other noteworthy things:
A 15 year old backseat passenger in 30mph car accident, she wasn't wearing her seat belt and was very lucky not to have serious injuries. Her brother had been driving the car and was later arrested.
A stabbing! An adult patient being brought in by helicopter, I was there to observe and I can tell you if was a very disappointing stabbing! One wound to the back, not even bleeding that much! The bloke was sitting up, talking, joking. Very unexciting! Good for him I suppose, though!
Bronchiolitic babies have such a horrible, rasping cry. We had a very sick 6 month old who they were considering intubating because his blood gasses were not improving with treatment. He had previously been intubated for the same condition 3 months ago. They decided to try him on CPAP first, he didn't like it at all but fortunately the play therapist turned up with some flashy, musical toys which settled him a little. When I left he was still in resus with a respiration rate of about 95-100 with a lot of recession and nasal flaring, I expect he will have been intbated because he would tire very quickly with that effort of breathing.
Glossary of terms (for those who are interested!):
Bronchiolitis - a viral respiratory infection of the small airways (bronchioles) that predominantly affects babies under 9 months of age and particularly in the winter months. It is the most common serious respiratory illness among babies <12months.
Blood Gasses - A blood test that gives very quick results on the pH (level of acidity/alkalinity), the level of gasses in the blood, such as carbon dioxide and oxygen, and metabolic results such glucose or lactate.
CPAP - Continual Positive Airway Pressure, a form of non-invasive ventilation that helps maintain a degree of inflation in the lungs to make breathing easier. It the same principle as when you blow up a balloon; once there is a little air in it already it is easier to put more in.
Recession and nasal flaring - both of these are visible signs of increased work of breathing, I couldn't find any decent pictures of this, but simplistically underneath the ribs (subcostal) and between the ribs (intercostal) the muscles retract in on exhalation and the skin visibily moves "in", this also happens sternally.
Respiration rate - the amount of breaths taken in one minutes, in his age group the rate should be between 30-40.
Where's Wally? - A series of picture books where you have to locate Wally in the midst a crowd of people/pirates/astronauts/circus performers/etc etc
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2 comments:
I was totally shocked when my mum "came over all funny" one time.
Being a mother of 7 she's seen everything; it was not unusual for her to be confronted with one of her sons walking in with his head split open and covered in blood, or with a 12 inch gash in his arm - and she'd just calmly clean up the blood to see what the real damage was underneath before deciding what action needed to be taken next.
Well one day she was at the dentist with my sister and at the sight of a little bit of blood she nearly passed out! But it was nothing compared to what she'd seen before! Turns out she hadn't eaten either.
It's definitely soemthing to do with not eating, standing up and stuffy rooms, I've heard other nurses report the same. That said, nails really aren't my strong point!
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