Well, a quick little update before I move onto the more serious matter of the Meme. One more day left of placement and that's it, kinda scary that I'll no longer be a student. The job, they're being so slack and I still haven't been given an official yes but I'm 99% sure I have it, they're just taking their time, I'll be contacting them on Wednesday to get an update. I've just got a temporary, part time admin job at my university to give me some extra cash for the next month.
And onto the meme.
Three Things That Scare Me:
1. Being out of control
2. Getting old
3. Being dependent on others
(These three are all interlinked.)
Three People Who Make Me Laugh: (only three?)
1. My brother
2. Poppy
3. My boyfriend
Three Things I Love:
1. My boyfriend, my friends and my family (I know, it's cheating!)
2. My job
3. Singing
Three Things I Hate:
1. My figure/my weight
2. People who walk slowly down the middle of the pavement, like they have no purpose in life, so that you can't overtake them
3. Other people seeing when I'm not in control
Three Things I Don't Understand:
1. Cruelty
2. People not caring about the state of the world and what is around them
3. Bengali - it would have helped me the last 3 years if I had!
Three Things On My Desk: (Well, next to me anyway)
1. A bottle of bubble mixture
2. A foundation makeup brush
3. My tattoo aftercare balm
Three Things I'm Doing Right Now:
1. Watching Heroes
2. Looking at Benefit make up online
3. Chewing my fingers
Three Things I Want To Do Before I Die:
1. Visit Cambodia
2. Have children
3. Learn to speak another language
Three Things I Can Do:
1. Play the trumpet - though I've not played in years
2. The string trick!
3. Knit - though not very well!
Three Things I Can't Do:
1. Juggle
2. Drive
3. Rolls my 'r's
Three Things I Think You Should Listen To:
1. Yourself
2. Your friends and family
3. Children
Three Things You Should Never Listen To:
1. People who want to destroy you
2. Your insecurities
3. That stranger in the club who tries to tell you you have a curvature of the spine - it's just an excuse to put his arm around you
Three Things I'd Like To Learn:
1. Learn another language
2. To drive
3. To play the piano so I can accompany my own singing
Three Favourite Foods: (I can’t do the “favourites”)
1. Pizza
2. Pasta
3. Chinese
Three Worst Foods
1. Dodgy sea creatures with tentacley bits - it's just wrong
2. Olives
3. Very hot, spicy food
Three Shows I Watched As A Kid: (but there were so many)
1. Scooby Doo
2. The Sooty Show
3. Ballykissangel (I was a little older!)
Three Wonderful People to Inflict My Meme On:
I have no one to inflict this on, no one else reads my blog! But if you are reading, feel free to leave a comment answering the questions :)
Monday, April 30, 2007
Tuesday, April 17, 2007
Easy IO
Well I was supposed to hear today about my job, but didn't receive a phonecall. The third referee I asked them to contact hasn't been contacted so it gives me a good excuse to call tomorrow and find out what's happening.
Had a really good resus yesterday, a baby with a heart defect that came in blue and with a horrible blood gas, very acidotic. Was transferred to a PICU at another hospital, but for a while it didn't look like he'd make it.
They used a machine called an Easy IO, it essentially drills an intraosseous (IO) needle in, instead of you having to twist it in yourself, really good bit of kit - makes it a lot easier and is much securer.
An IO needle is one that goes into the bone and into the marrow, it's used in emergency situations when you are unable to gain venous access (You just whack it in the child's leg below the knee and start twisting/corkscrewing it in). Sounds pretty painful, and isn't the nicest sight to watch, but the children are usually so unwell by this point that they're unconscious.
I also had a little look at an open chest - that was pretty cool, and not like what I expected. I wasn't able to get a close look though so couldn't see any of the chest organs. Whenever there is an open chest everyone is the hospital turns up to have a look as it's quite unusual.
I looked after a teenyweeny baby today, was a born a few weeks early but had a really low bow weight and has various other problems including cardiac and renal. I find the littlelittle babies a bit scary, they're so tiny and fragile; I always find holding them awkward, I feel like I'm juggling spindly arms and legs and a huge floppy head.
Had a really good resus yesterday, a baby with a heart defect that came in blue and with a horrible blood gas, very acidotic. Was transferred to a PICU at another hospital, but for a while it didn't look like he'd make it.
They used a machine called an Easy IO, it essentially drills an intraosseous (IO) needle in, instead of you having to twist it in yourself, really good bit of kit - makes it a lot easier and is much securer.
An IO needle is one that goes into the bone and into the marrow, it's used in emergency situations when you are unable to gain venous access (You just whack it in the child's leg below the knee and start twisting/corkscrewing it in). Sounds pretty painful, and isn't the nicest sight to watch, but the children are usually so unwell by this point that they're unconscious.
I also had a little look at an open chest - that was pretty cool, and not like what I expected. I wasn't able to get a close look though so couldn't see any of the chest organs. Whenever there is an open chest everyone is the hospital turns up to have a look as it's quite unusual.
I looked after a teenyweeny baby today, was a born a few weeks early but had a really low bow weight and has various other problems including cardiac and renal. I find the littlelittle babies a bit scary, they're so tiny and fragile; I always find holding them awkward, I feel like I'm juggling spindly arms and legs and a huge floppy head.
Thursday, April 12, 2007
Head For Heights
I'm fairly sure that the few readers I have will already havebeen directed to this link, but just in case...
Head For Heights
I had a placement at Richard House Children's Hospice in my second year. At the time it was very under funded, having jsut lost lottery funding, and they were making a lot of staff redundancies. It was underused, because of lack of money, but the children that did use it had a wonderful time and it clearly made a difference to their lives and the lives of thier families. This is such a worthwhile cause so please jsut take the time to look at the links and have a read.
Head For Heights
I had a placement at Richard House Children's Hospice in my second year. At the time it was very under funded, having jsut lost lottery funding, and they were making a lot of staff redundancies. It was underused, because of lack of money, but the children that did use it had a wonderful time and it clearly made a difference to their lives and the lives of thier families. This is such a worthwhile cause so please jsut take the time to look at the links and have a read.
Tuesday, April 10, 2007
Band 5 Interview questions
So this is a list of Band 5 Interview questions based on those my collegaues and I have been asked, and those I had been prepared for. I'll update this when I remember more.
Questions
Tell me something interesting about yourself
Tell me something about your training so far
Why do you want to work for this department
Why do you want to take part ina rotation programme
What do you think the changes will be when moving from student to staff nurse
How do you feel about the change from student to staff nurse
How do you maintain professional boundaries with patients and other staff
What is the MDT and what does it mean
Describe two elements of the NSF
What were some of the reccomedations made by Lord Laming's report
What was the most challenging part of training to be a nurse
What criticism have you received and how have you learned from it
Talk about two situations that you have felt vulnerable in
What is clinical governence/What is your role in clinical governence
What is your role in risk management
What piece of literature/research have you read and how it has changed your practice
What makes a good communicator
Why might a neonate be admitted to intensive care or special care
What is family centred care
What skills are necessary for good team work
Scenarios
You walk into a cubicle and see a nurse slapping a child, what do you do?
A 15 year old already consented by her parents to have an orthopaedic operation is now refusing to have it done and she tells you that she is pregnant. What would you do?
You notice a bruise on the back of a child when examining them. What would you do?
You go to collect a patient from theatre, what would you prepare before collecting the child and what would you do when collecting them?
You are admitting an 18month old with ?pneumonia from A&E what would you need to prepare before their arrival and what would you need to do on their arrival.
Patient prioritisation scenario
3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
Questions
Tell me something interesting about yourself
Tell me something about your training so far
Why do you want to work for this department
Why do you want to take part ina rotation programme
What do you think the changes will be when moving from student to staff nurse
How do you feel about the change from student to staff nurse
How do you maintain professional boundaries with patients and other staff
What is the MDT and what does it mean
Describe two elements of the NSF
What were some of the reccomedations made by Lord Laming's report
What was the most challenging part of training to be a nurse
What criticism have you received and how have you learned from it
Talk about two situations that you have felt vulnerable in
What is clinical governence/What is your role in clinical governence
What is your role in risk management
What piece of literature/research have you read and how it has changed your practice
What makes a good communicator
Why might a neonate be admitted to intensive care or special care
What is family centred care
What skills are necessary for good team work
Scenarios
You walk into a cubicle and see a nurse slapping a child, what do you do?
A 15 year old already consented by her parents to have an orthopaedic operation is now refusing to have it done and she tells you that she is pregnant. What would you do?
You notice a bruise on the back of a child when examining them. What would you do?
You go to collect a patient from theatre, what would you prepare before collecting the child and what would you do when collecting them?
You are admitting an 18month old with ?pneumonia from A&E what would you need to prepare before their arrival and what would you need to do on their arrival.
Patient prioritisation scenario
3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
Megan's Law and Iraq
So as I said earlier, I was going to rant about two articles I saw in the Metro.
Firstly the introduction of a trial of "Megan's Law". Basically, parents will be able to find out if a convicted sex offender lives in their street/on their school route and how many, but they won't be told their names or addressed. Well what is the point? How is it going to help the situation in any way? (I'm not suggesting we tell people who they are).
How will knowing a convicted sex offender lives in your area change your actions? Will you not let your children out ever? Well that's impractical and not good for the children and their development. Will you stop your 7 year old playing unsupervised in the street? Well I'm not sure they should be allowed to do that anyway. Will you teach your children to be streetwise, not to talk to strangers etc? Well shouldn't you be doing that anyway? All I can see it causing is panic and knee jerk reaction. And what if someone suspects they know who it is? Lynch mobbing. Plus there's all the sex offenders who haven't had a conviction of course.
The second part of today's rant. Iraq. I read today about protests in Iraq at the continued American presence 4 years after Saddam's regime ended. I won't get started on my feelings about that, the part that really got me was a military spokesperson saying that this is great, it's freedom of speech, how wonderful it is for the Iraqi people to be able to do that, they wouldn't have been able to do it under Saddam.
So self righteous, thank goodness the Americans (and the British come to that) were there to give back the Iraqi people freedom of speech, freedom to protest. Of course we will ignore completely what they are saying and want they want for their own country, but that's okay because we're letting them say it. Which is so very different from not allowing them to say it at all.
Firstly the introduction of a trial of "Megan's Law". Basically, parents will be able to find out if a convicted sex offender lives in their street/on their school route and how many, but they won't be told their names or addressed. Well what is the point? How is it going to help the situation in any way? (I'm not suggesting we tell people who they are).
How will knowing a convicted sex offender lives in your area change your actions? Will you not let your children out ever? Well that's impractical and not good for the children and their development. Will you stop your 7 year old playing unsupervised in the street? Well I'm not sure they should be allowed to do that anyway. Will you teach your children to be streetwise, not to talk to strangers etc? Well shouldn't you be doing that anyway? All I can see it causing is panic and knee jerk reaction. And what if someone suspects they know who it is? Lynch mobbing. Plus there's all the sex offenders who haven't had a conviction of course.
The second part of today's rant. Iraq. I read today about protests in Iraq at the continued American presence 4 years after Saddam's regime ended. I won't get started on my feelings about that, the part that really got me was a military spokesperson saying that this is great, it's freedom of speech, how wonderful it is for the Iraqi people to be able to do that, they wouldn't have been able to do it under Saddam.
So self righteous, thank goodness the Americans (and the British come to that) were there to give back the Iraqi people freedom of speech, freedom to protest. Of course we will ignore completely what they are saying and want they want for their own country, but that's okay because we're letting them say it. Which is so very different from not allowing them to say it at all.
:D
I have a job!
:D
The interview was last week, and I thought it was a really difficult, high pressured interview and although I had been well prepared by one of the Sisters in placement I really wasn't sure how it went. A friend also went and said she found the same, very difficult questions and very intense.
I got a phone call today saying unofficially I would be offered it next week when my references had come through.
:D
I'm adding a new resourcey type post for Band 5 interview questions based on the ones I and my friends have had and that I have been prepped for.
I was away in Cornwall for a few days with my family, travelled back by coach over last night and did a presentation today in university, which went well. It was a really good break, the weather was beautiful and I've not had a holiday with my family since the summer so it was good to spend time with them too.
I'm going to post a political/general rant in a bit, regarding two articles I had read in the Metro. I bet you can hardly wait!
:D
The interview was last week, and I thought it was a really difficult, high pressured interview and although I had been well prepared by one of the Sisters in placement I really wasn't sure how it went. A friend also went and said she found the same, very difficult questions and very intense.
I got a phone call today saying unofficially I would be offered it next week when my references had come through.
:D
I'm adding a new resourcey type post for Band 5 interview questions based on the ones I and my friends have had and that I have been prepped for.
I was away in Cornwall for a few days with my family, travelled back by coach over last night and did a presentation today in university, which went well. It was a really good break, the weather was beautiful and I've not had a holiday with my family since the summer so it was good to spend time with them too.
I'm going to post a political/general rant in a bit, regarding two articles I had read in the Metro. I bet you can hardly wait!
Sunday, April 01, 2007
Productive
Well. I have had some really good shifts recently. I'm really feeling like a (fairly) productive member of the team. I'm able to do so much more than when I started; looking after patients who are a little more unwell and going to be admitted, assess/triage. I have shifts to make up, and will be doing an extra 6. On one hand I wish I didn't have time to make up on the other I am learning so much from this placement, so much more than I would have if I had made up the shifts elsewhere, or not taken the time at all.
We've not had any really interesting cases recently. I've seen a couple of good dislocated fingers, fingers bent in strange positions. I did a dressing on a 2 year old who had ripped two of their finger nails off... owwww... I'm not good with nails.
I may just be easily amused, or having a giggly day, but had a few funny conversations with parents who speak bad English (as most of our parents do). It makes it so challenging sometimes, but it can also be funny.
A child came in, mum started out by telling us he'd had an operation on his nose a few months ago (that turned out to be a tonsillectomy) so we assumed, naturally, that there was some problem related to this. No, he'd fallen over and bumped his forehead.
Nurse: "How did it happen?"
Mum: "Today"
Nurse: "No, what happened, how did he do it?"
Mum: "Today"
After about 6 different phrasings of the question we established how it had happened.
Nurse: "Has he had any medicines today?"
Mum: "No"
Nurse: "No Paracetamol? Calpol?"
Mum: "Yes"
Nurse: "At what time?" *points to the clock*
Mum: "2-3"
Nurse: "Which is it, 2 or 3?"
Mum: "1"
We eventually, once again after asking several times, that he'd had 1 teaspoon at 2pm. I really do just find these conversations amusing sometimes.
One thing that really annoys me, and please if ever you see a doctor doing this tell them not to, they stab a child (with a needle) and miss the vein so they use an alcohol wipe to press on it to stop the bleeding. You're already hurting and distressing the child, must you rub alcohol into the wound? It stings! It only takes a little organisation to bring gauze over, it's just so unnecessary, and does make me cross.
Finally, I have a job interview on Wednesday for a job I applied for back in January. I'd heard nothing, and to be honest I thought it was a rubbish application, so I didn't think I'd been shortlisted. I don't really know a lot about the job, the advert wasn't very specific about the clinical area, but that gives me something to ask about on the day. Later that night I'm catching a coach down to Cornwall to join my holidaying family for a long weekend.
We've not had any really interesting cases recently. I've seen a couple of good dislocated fingers, fingers bent in strange positions. I did a dressing on a 2 year old who had ripped two of their finger nails off... owwww... I'm not good with nails.
I may just be easily amused, or having a giggly day, but had a few funny conversations with parents who speak bad English (as most of our parents do). It makes it so challenging sometimes, but it can also be funny.
A child came in, mum started out by telling us he'd had an operation on his nose a few months ago (that turned out to be a tonsillectomy) so we assumed, naturally, that there was some problem related to this. No, he'd fallen over and bumped his forehead.
Nurse: "How did it happen?"
Mum: "Today"
Nurse: "No, what happened, how did he do it?"
Mum: "Today"
After about 6 different phrasings of the question we established how it had happened.
Nurse: "Has he had any medicines today?"
Mum: "No"
Nurse: "No Paracetamol? Calpol?"
Mum: "Yes"
Nurse: "At what time?" *points to the clock*
Mum: "2-3"
Nurse: "Which is it, 2 or 3?"
Mum: "1"
We eventually, once again after asking several times, that he'd had 1 teaspoon at 2pm. I really do just find these conversations amusing sometimes.
One thing that really annoys me, and please if ever you see a doctor doing this tell them not to, they stab a child (with a needle) and miss the vein so they use an alcohol wipe to press on it to stop the bleeding. You're already hurting and distressing the child, must you rub alcohol into the wound? It stings! It only takes a little organisation to bring gauze over, it's just so unnecessary, and does make me cross.
Finally, I have a job interview on Wednesday for a job I applied for back in January. I'd heard nothing, and to be honest I thought it was a rubbish application, so I didn't think I'd been shortlisted. I don't really know a lot about the job, the advert wasn't very specific about the clinical area, but that gives me something to ask about on the day. Later that night I'm catching a coach down to Cornwall to join my holidaying family for a long weekend.
Tuesday, March 27, 2007
Something I said
I was assessing a teenager who had, a number of years ago, had all thier fingers/thumbs amputated at the knuckle. I knew this from looking at the patient notes, and also from looking at his hands and the scarring - he had no fingers.
Part way through the assessment, after taking the history, I went to take his physical observations, including his pulse. I went into autopilot, started unfolding my pulse-oximeter cable and said...
"Can I borrow a finger please"
I was mortified. The patient didn't have a sense of humour and didn't make a joke out of it to save me (Darn him! I thought later I should have said "Ah, it looks like we've already had them" but I don't think he was the laughing kind).
Instead I fumbled my way through with...
"Or, we could use a toe..." (I later read more of his notes and discovered he'd had a partial foot amputations too)
"Or I could just stop being so lazy and do a manual pulse. That's the problem with these machines, you get so used to using them that you become lazy and use them even when you don't have to"
Ramble. Ramble. Just keep on digging Angela.
Part way through the assessment, after taking the history, I went to take his physical observations, including his pulse. I went into autopilot, started unfolding my pulse-oximeter cable and said...
"Can I borrow a finger please"
I was mortified. The patient didn't have a sense of humour and didn't make a joke out of it to save me (Darn him! I thought later I should have said "Ah, it looks like we've already had them" but I don't think he was the laughing kind).
Instead I fumbled my way through with...
"Or, we could use a toe..." (I later read more of his notes and discovered he'd had a partial foot amputations too)
"Or I could just stop being so lazy and do a manual pulse. That's the problem with these machines, you get so used to using them that you become lazy and use them even when you don't have to"
Ramble. Ramble. Just keep on digging Angela.
Tuesday, March 20, 2007
Monday, March 19, 2007
Demanding day
I've had a couple of interesting shifts. Yesterday was tiring, both emotionally and physically and I came home feeling rather weary. It wasn't a bad day; I learned a lot but it was demanding.
We had a 13 year old epileptic who hadn't had a seizure in 4 years and had been off her medication for a year. She had a seizure on a tube station yesterday. A lovely family, she was very upset and worried that this would be the start of her having regular seizures and needing medication again. Her mother was being optimistic for her, but I knew she was very shaken by the incident. Initially she had thought she was alone on the station which must have been frightening for her, but some passers by stopped to help. Her mother said how nice and friendly we were, and I think they were both feeling much better about things by the time they left the department.
Last week I held a 5 week old baby for a lumbar puncture, I'd only seen one before and it was my first time holding, with another nurse to give me a hand. Last night the last 25 minutes of my shift were spent holding a 4 month old, my first solo hold as the department was pretty busy. It took 3 attempts, the fist 2 by an inexperienced doctor and the 3rd by her supervising doctor. It was physically very demanding to hold the baby in that position for that length of time and the baby was obviously very distressed and it is very difficult to comfort when you're having to wrap your arms around the head/neck and legs/back to hold them in a curved position. Mum wasn't present, and when we handed him back was very understanding and calm which made it easier, but I came away feeling exhausted, physically and mentally.
We had a toddler who had squirted persil washing liquid in her eyes and needed irrigation. That was another interesting one to watch. It involved swaddling the kicking, screaming child and laying her on a bed with her head slightly tipped over the edge, and running 500mls of Normal Saline into her eyes which we needed to prise open. It is incredible how strongly a person cold hold their eyes closed. It isn't painful, but it is unpleasant, the nurse was explaining she'd had to to do it to a doctor recently who had got blood in her eye and she really struggled with it, so it's much harder on a child who is too young to understand and comply.
We had an incredibly brave 9 year old who had fallen off a scooter and hurt his elbow. When he came in it was swollen and deformed. The assessment nurse called me over to ask what I thought, it was kinda like "No.. that's definitely not quite right, something is going on there" but it was hard to precisely explain. After a while it swelled more and became clearer. He ended up having broken his elbow bone, and bother his radius and ulnar and was going to need orthopaedic surgery to fix it.
The other great case we had was a 5 year old who came in with a petechial rash and a purpuric rash, a great example as I had seen neither before. The purpuric rash is the one commonly associated with meningitis. The child had meningitic symptoms but was very well, obviously it couldn't be ruled out so tests were being run for that. Another differential diagnosis was Henoch-Schonlein purpura Henoch-Schonlein Purpura (HSP). Petechial spots are caused by minor bleeding under the skin, broken capillary blood vessels, I have noticed them on myself occasionally after I've been carrying a heavy bag over my shoulder or my wrist, they are sometimes seen on the face after excessive coughing.
Well this has been a bit of a long ramble. One other thing before I finish. In my second year I worked on a respiratory ward and really enjoyed it. I was told at the time that when I was qualified if I wanted a job the Sister would be happy to have me. I spoke to one of the Sisters yesterday who had mentored me at the time and she said she couldn't guarantee anything but thought they were still under their quota for nurses and that I should email the senior sister and let her know I'm still interested. I've done that today, so as the Swedes say I shall be holding my thumbs.
We had a 13 year old epileptic who hadn't had a seizure in 4 years and had been off her medication for a year. She had a seizure on a tube station yesterday. A lovely family, she was very upset and worried that this would be the start of her having regular seizures and needing medication again. Her mother was being optimistic for her, but I knew she was very shaken by the incident. Initially she had thought she was alone on the station which must have been frightening for her, but some passers by stopped to help. Her mother said how nice and friendly we were, and I think they were both feeling much better about things by the time they left the department.
Last week I held a 5 week old baby for a lumbar puncture, I'd only seen one before and it was my first time holding, with another nurse to give me a hand. Last night the last 25 minutes of my shift were spent holding a 4 month old, my first solo hold as the department was pretty busy. It took 3 attempts, the fist 2 by an inexperienced doctor and the 3rd by her supervising doctor. It was physically very demanding to hold the baby in that position for that length of time and the baby was obviously very distressed and it is very difficult to comfort when you're having to wrap your arms around the head/neck and legs/back to hold them in a curved position. Mum wasn't present, and when we handed him back was very understanding and calm which made it easier, but I came away feeling exhausted, physically and mentally.
We had a toddler who had squirted persil washing liquid in her eyes and needed irrigation. That was another interesting one to watch. It involved swaddling the kicking, screaming child and laying her on a bed with her head slightly tipped over the edge, and running 500mls of Normal Saline into her eyes which we needed to prise open. It is incredible how strongly a person cold hold their eyes closed. It isn't painful, but it is unpleasant, the nurse was explaining she'd had to to do it to a doctor recently who had got blood in her eye and she really struggled with it, so it's much harder on a child who is too young to understand and comply.
We had an incredibly brave 9 year old who had fallen off a scooter and hurt his elbow. When he came in it was swollen and deformed. The assessment nurse called me over to ask what I thought, it was kinda like "No.. that's definitely not quite right, something is going on there" but it was hard to precisely explain. After a while it swelled more and became clearer. He ended up having broken his elbow bone, and bother his radius and ulnar and was going to need orthopaedic surgery to fix it.
The other great case we had was a 5 year old who came in with a petechial rash and a purpuric rash, a great example as I had seen neither before. The purpuric rash is the one commonly associated with meningitis. The child had meningitic symptoms but was very well, obviously it couldn't be ruled out so tests were being run for that. Another differential diagnosis was Henoch-Schonlein purpura Henoch-Schonlein Purpura (HSP). Petechial spots are caused by minor bleeding under the skin, broken capillary blood vessels, I have noticed them on myself occasionally after I've been carrying a heavy bag over my shoulder or my wrist, they are sometimes seen on the face after excessive coughing.
Well this has been a bit of a long ramble. One other thing before I finish. In my second year I worked on a respiratory ward and really enjoyed it. I was told at the time that when I was qualified if I wanted a job the Sister would be happy to have me. I spoke to one of the Sisters yesterday who had mentored me at the time and she said she couldn't guarantee anything but thought they were still under their quota for nurses and that I should email the senior sister and let her know I'm still interested. I've done that today, so as the Swedes say I shall be holding my thumbs.
Thursday, March 15, 2007
Some good ones.
We've had some good ones recently.
Possibly thebest worst reason for bringing your child to A&E. A 13 year old was brought in by his parents because he'd put something into his ear... three years ago. Why did they wait so long to come in? He'd only just told them. He had no history of ear problems and unsurprisingly there was nothing still left in his ear.
We had a 15 year old brought in from school yesterday by LAS because he was vomiting. Turns out he'd smoked some cannabis on the way to school. He was looking pretty rough and feeling quite sorry for himself. Guess he won't be doing that again in a hurry.
A 2 month old was brought in because he hadn't slept in the last 3 days, at all. (Yeah, right.) So presumably the parents haven't slept in the last 3 days either? Or have at least taken it in shifts so can observe their son's lack of sleep.
We have a television in the waiting room that we can play children's films on, one of the Registrars was walking through and suggested that we should change the channel as "My daughter is a prostitute" on Jeremy Kyle might not be the most appropriate viewing! Sometimes I'm surprised at what makes day time television and what is shown after the watershed.
Possibly the
We had a 15 year old brought in from school yesterday by LAS because he was vomiting. Turns out he'd smoked some cannabis on the way to school. He was looking pretty rough and feeling quite sorry for himself. Guess he won't be doing that again in a hurry.
A 2 month old was brought in because he hadn't slept in the last 3 days, at all. (Yeah, right.) So presumably the parents haven't slept in the last 3 days either? Or have at least taken it in shifts so can observe their son's lack of sleep.
We have a television in the waiting room that we can play children's films on, one of the Registrars was walking through and suggested that we should change the channel as "My daughter is a prostitute" on Jeremy Kyle might not be the most appropriate viewing! Sometimes I'm surprised at what makes day time television and what is shown after the watershed.
Tuesday, March 06, 2007
Almost there
I feel that I should post as I have neglected my blog for so long!
My placement is going really well, I have only 4 and a half weeks left but have discovered I need to make up another 6 shifts that I owe. I have very nearly finished my Portfolio essay and now it feels the end is in sight! By the end of April I should have all my work submitted and my hours done.
I'm trying to think if we've had any interesting cases recently. There was a little boy who had swallowed a 5pence coin yesterday, his younger brother had put it in the back of his mouth and whilst his mum tried to remove it he swallowed it! We used a metal detector to locate it, but as this method is currently being audited we had to confirm with x-ray. It was in his stomach and not causing any problems so nature is left to take its course. Fortunatly it was only a 5pence piece and not a 50 pence!
We had an unpleasant child yesterday, about 4 years old, who decided to hit me in the face and knock my (new) glasses onto the floor and then kicked me. He wasn't frightened, in pain or struggling to get away, just a naughty little boy who refused to apologise and smiled everytime he was told off. Mum assured us he didn't get away with it at home (yeah right) as he continued trying to hit and kick me as I fitted his collar and cuff (a foamy sling for soft tissue injuries).
The NMC is visiting our clinical area next week to audit the student placement experience/education and I've been asked to work that day, they're also auditing a clinical area I've worked in previously. It will be easy to provide a good report for my current area, they're brilliant, but not so easy for the other. It was a children's hospice that had recently lost its funding, there were a lot of redundancies being made and the service was very under used because of financial problems, it meant there was often nothing to do on the placement as there were few or no patients. I did learn some things, but most of my time was spent doing nothing at all, I think with funding it had the potential to be a very good clinical area.
My placement is going really well, I have only 4 and a half weeks left but have discovered I need to make up another 6 shifts that I owe. I have very nearly finished my Portfolio essay and now it feels the end is in sight! By the end of April I should have all my work submitted and my hours done.
I'm trying to think if we've had any interesting cases recently. There was a little boy who had swallowed a 5pence coin yesterday, his younger brother had put it in the back of his mouth and whilst his mum tried to remove it he swallowed it! We used a metal detector to locate it, but as this method is currently being audited we had to confirm with x-ray. It was in his stomach and not causing any problems so nature is left to take its course. Fortunatly it was only a 5pence piece and not a 50 pence!
We had an unpleasant child yesterday, about 4 years old, who decided to hit me in the face and knock my (new) glasses onto the floor and then kicked me. He wasn't frightened, in pain or struggling to get away, just a naughty little boy who refused to apologise and smiled everytime he was told off. Mum assured us he didn't get away with it at home (yeah right) as he continued trying to hit and kick me as I fitted his collar and cuff (a foamy sling for soft tissue injuries).
The NMC is visiting our clinical area next week to audit the student placement experience/education and I've been asked to work that day, they're also auditing a clinical area I've worked in previously. It will be easy to provide a good report for my current area, they're brilliant, but not so easy for the other. It was a children's hospice that had recently lost its funding, there were a lot of redundancies being made and the service was very under used because of financial problems, it meant there was often nothing to do on the placement as there were few or no patients. I did learn some things, but most of my time was spent doing nothing at all, I think with funding it had the potential to be a very good clinical area.
Friday, February 23, 2007
A laugh
Well I heard today that I didn't get the job, however I am being put onto a reserve list because currently the A&E department aren't taking many poeple on rotation and are under pressure to accept more but haven't yet given an answer. So I have to wait now, if I've not heard by the 19th March I have to assume I was unsuccessful.
I'm getting new glasses. Exciting.
Work has been okay. I can't think of anything particularly that has leapt out at me and compellled me to write over the last few shifts. I've been lazy about writing here, sorry!
So, for those of us who need a laugh.
Giggling Quads and Dad at the Comedy Barn
Other people laughter is contagious!
I'm getting new glasses. Exciting.
Work has been okay. I can't think of anything particularly that has leapt out at me and compellled me to write over the last few shifts. I've been lazy about writing here, sorry!
So, for those of us who need a laugh.
Giggling Quads and Dad at the Comedy Barn
Other people laughter is contagious!
Friday, February 16, 2007
Interview
I had my interview today for the job I really want. There was a short maths test, a written patient prioritisation question and then the interview consisted of lots of different nursing scenarios and questions about what I would do.
The maths test: I'm good at maths, it's never been a problem for me during my training, and the test wasn't difficult. I made a couple of stupid errors that I corrected when I noticed (like there are 4 3's in 12, not 3 as I originally put) but at first on two easyeasy questions I really struggled. I knew the answer in my head easily, but you have to show your working and I went a bit brain-blank when I tried that. Got there in the end.
The prioritisation scenario: 3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
After that in the interview I was asked questions such as 'Why do you want to apply for a rotation programme?' 'What do you understand to be the meaning on clinical governance?' 'What child related legislation/policy have you read recently?' and then I was given a variety of scenarios and asked what I would do.
I didn't at any point think "Oh my goodness, I can't answer that!" though there were some that I struggled with through lack of experience, but they were very helpful and would prompt me. I kicked myself when I came out remembering loads of things I could have said, but I think that's normal. It's a bit of an anti climax really and I couldn't say whether it went well or not, I just don't know. I suppose it wasn't disastrous!
One really off-putting thing was that all 3 of my interviewers were making notes and they had these forms with tick boxes and at times I could see boxes unchecked so would know there was something else I needed to say but just couldn't think of it!
I refuse to think about it now, I can't change anything. I'll hear wednesday at the earliest.
The maths test: I'm good at maths, it's never been a problem for me during my training, and the test wasn't difficult. I made a couple of stupid errors that I corrected when I noticed (like there are 4 3's in 12, not 3 as I originally put) but at first on two easyeasy questions I really struggled. I knew the answer in my head easily, but you have to show your working and I went a bit brain-blank when I tried that. Got there in the end.
The prioritisation scenario: 3 patients you have to look after.
A 4 year newly diagnosed insulin dependent diabetic who required regular BM's and insulin
An 8 year old asthmatic stable over night but still requiring 4 hourly nebulisers and a dose of prednisalone
A newborn baby in withdrawal requiring morphine injections. The parents aren't present. (I think that baby was in withdrawal, I'm suddenly having a panic that that was an assumption I made)
Q1: After receiving handover what are the first things you would do
Q2: In which order would you prioritise your patient and why
After that in the interview I was asked questions such as 'Why do you want to apply for a rotation programme?' 'What do you understand to be the meaning on clinical governance?' 'What child related legislation/policy have you read recently?' and then I was given a variety of scenarios and asked what I would do.
- A 15 year old already consented by her parents to have an orthopaedic operation is now refusing to have it done and she tells you that she is pregnant. What would you do?
- You notice a bruise on the back of a child when examining them. What would you do?
- You go to collect a patient from theatre, what would you prepare before collecting the child and what would you do when collecting them?
- You are admitting an 18month old with ?pneumonia from A&E what would you need to prepare before their arrival and what would you need to do on their arrival.
I didn't at any point think "Oh my goodness, I can't answer that!" though there were some that I struggled with through lack of experience, but they were very helpful and would prompt me. I kicked myself when I came out remembering loads of things I could have said, but I think that's normal. It's a bit of an anti climax really and I couldn't say whether it went well or not, I just don't know. I suppose it wasn't disastrous!
One really off-putting thing was that all 3 of my interviewers were making notes and they had these forms with tick boxes and at times I could see boxes unchecked so would know there was something else I needed to say but just couldn't think of it!
I refuse to think about it now, I can't change anything. I'll hear wednesday at the earliest.
Thursday, February 15, 2007
X-Rays and eyeballs
I feel pretty rubbish at the moment and I don't look so good either, I've taken on my deathly pale shade as opposed to merely unhealthily pale! I think I'm jsut overly tired so I shall be off to bed shortly, but first I thought I'd write about an interesting one we had today.
A 6 year old boy playing with his cousin accidentally was stabbed in the eye with a bic biro. He came to A&E and you could just see there was something really not right about this child's eye - it looked pierced/broken, it's quite difficult to describe but it was not a smooth surface. Turns out the pen has pierced his cornea, he's lost most of the sight in that eye and is going to theatre tonight to try and save his eye and restore some of the vision. But this kid was just amazing. He was so calm and quiet, probably alittle bit in shock to be honest, but even as time went by he was still so calm. If only all our children were like that!
The only other thing I wanted to blog about today was the insitence some people have on X-Rays, people really do like them. We had one parent today he kept insisting on getting a second x-ray for his son. He has ben x-rayed a week ago for a foot injury, there were no broken bones so it was diagnosed as a ligament injury which can be quite painful. They were reviewed this week and he keps asking for an X-Ray to be done, we explained we'd already done one and there were no breaks and then he'd ask for another one! So the consultant patiently explained (for about the 5th time) that there would be no change, there were no broken bones and the treatment was just to get one with it and get mobilising (and stop being such a wuss he said to me later!).
I have been in countless situations before where poeple are asking for X-Rays for things that don't need to be X-Rayed and where the management of them won't change regardless of an X-Ray result.
My oven is beeping, but I shall write another post sometime about the belief that medicine should be able to do soemthing about everything and that we should have a pill to fix anything.
A 6 year old boy playing with his cousin accidentally was stabbed in the eye with a bic biro. He came to A&E and you could just see there was something really not right about this child's eye - it looked pierced/broken, it's quite difficult to describe but it was not a smooth surface. Turns out the pen has pierced his cornea, he's lost most of the sight in that eye and is going to theatre tonight to try and save his eye and restore some of the vision. But this kid was just amazing. He was so calm and quiet, probably alittle bit in shock to be honest, but even as time went by he was still so calm. If only all our children were like that!
The only other thing I wanted to blog about today was the insitence some people have on X-Rays, people really do like them. We had one parent today he kept insisting on getting a second x-ray for his son. He has ben x-rayed a week ago for a foot injury, there were no broken bones so it was diagnosed as a ligament injury which can be quite painful. They were reviewed this week and he keps asking for an X-Ray to be done, we explained we'd already done one and there were no breaks and then he'd ask for another one! So the consultant patiently explained (for about the 5th time) that there would be no change, there were no broken bones and the treatment was just to get one with it and get mobilising (and stop being such a wuss he said to me later!).
I have been in countless situations before where poeple are asking for X-Rays for things that don't need to be X-Rayed and where the management of them won't change regardless of an X-Ray result.
My oven is beeping, but I shall write another post sometime about the belief that medicine should be able to do soemthing about everything and that we should have a pill to fix anything.
Wednesday, February 14, 2007
An Inch
I can feel a lengthy(ish) post coming on. That's what happens when I don't post for days.
Finally, I'd like to recommend the film V for Vendetta, it was originally a comic book series (I've not read it). It is superb. I don't think the plot summary does it justice and I find myself unable to adequately explain the storyline, but I would highly recommend it. This excerpt is taken from Valerie's autobiography in the film.
"But I'd only told them the truth. Was that so selfish? Our integrity sells for so little, but it is all we really have. It is the very last inch of us. But within that inch we are free....I shall die here. Every inch of me shall perish. Every inch, but one. An inch. It is small and it is fragile and it is the only thing in the world worth having. We must never lose it or give it away. We must never let them take it from us."
- The state of the word - Don't you ever just despair? The world seems to have gone mad around me. The news is so thoroughly depressing and infuriating. I was feeling quite down about it the other night as I walked home. I was thinking maybe I should emigrate somewhere nice and work there, but I expect every country has its problems. Also, it's not just England and it's news, but the whole world's! I think I need t find an ice little island somewhere remote!
- Our young people - How have we failed them so badly? We had a 14 year old in resus the other day having been stabbed, because he'd looked at someone the wrong way and refused to give over his phone. Why do our young people think it is acceptable to do that? I was reading the news about Peckham. I just cannot understand it. We have failed these people so terribly when they feel it necessary to carry knives/guns for protection, or when they think it is acceptable to shoot someone in their bed when they're sleeping.
One of the boys at my mother's centre today had brought in a machete and an axe (she is the headteacher of a Pupil Referral Unit for excluded secondary aged pupils). What these kids don't' seem to understand is that there are only two outcomes to that situation. They end in up prison for possession or killing someone, or their own weapon is used on them and they end up dead. Knives aren't any form of protection, they present more threat than these boys know. - Fight or flight - You don't know what you would do if someone demanded your phone/iPod/money form you in the street and threatened violence, you don't know until that situation. I don't know how I would respond. I hope that I wouldn't just hand things over. I wonder if this is a wise course of action, it could see me wounded or at worst killed, but I can't help the feeling that it's the right thing to do. A mobile phone isn't worth dying for, but what about the principles? Freedom? Integrity? We work hard for what we have, why should someone be able to come along and just take it from us? Why should we be subject to violence and have to be afraid to walk the streets at night, to use our mobile phones or listen to our iPods? It's through fear that these people win, and it's a form of terrorism. I don't blame someone for not standing up to them, what use is freedom if you're not alive to enjoy it? On the other hand, if we always take that attitude we will never see change, it's like many of the other fights for out rights and our freedoms that we have seen through history.
- I looked after a girl with a brain tumour this week. She was lovely. She felt absolutely rotten but she was still polite and courteous. After gave her some IV hydrocortisone she picked up tremendously. Her brain tumour was non malignant and ha been operated on 5 years previously, it's now increasing in size again and being observed. The length they had to go to get diagnosed is scary, understandable to an extent, but still scary. I mentioned how lovely she was, I often find with the chronically ill patients that they can be very rude and demanding, particularly the sickle cell patients, but she was so polite it made her a pleasure to look after.
- Yesterday I helped distract a Sickler, not sure how old he was, maybe 8? He was writhing around in pain and crying out whilst his mother sat there and ignored him. It took very little to distract him, we played Where's Wally and he forget about his pain (apart from when the doctor came back in) and then we played with bubbles and he was quite chirpy. I know this is a situation his mother will have been in before and I try not to be judgemental but it is so frustrating to see a distressed child in pain being completely ignored by his mother. No words of comfort, no hugs, nothing. As I said he was easily distracted and it really wouldn't have taken a lot from her to comfort him, he just wanted some attention, he was feeling rotten. Maybe it's a cultural thing (Most Sickle Cell patients m Britain are of African or Caribbean descent) but it's still difficult to understand/accept. For information on Sickle Cell visit The Sickle Cell Society
- In other news... I slaved over my Portfolio yesterday and have made it look pretty impressive to my own surprise, so that is ready to take to interview. I feel like I'm getting on top of things, which is good as I'd been feeling completely out of control and I'm a little bit of a control freak.
Finally, I'd like to recommend the film V for Vendetta, it was originally a comic book series (I've not read it). It is superb. I don't think the plot summary does it justice and I find myself unable to adequately explain the storyline, but I would highly recommend it. This excerpt is taken from Valerie's autobiography in the film.
"But I'd only told them the truth. Was that so selfish? Our integrity sells for so little, but it is all we really have. It is the very last inch of us. But within that inch we are free....I shall die here. Every inch of me shall perish. Every inch, but one. An inch. It is small and it is fragile and it is the only thing in the world worth having. We must never lose it or give it away. We must never let them take it from us."
Friday, February 09, 2007
The latest installment
Once again there are plenty of things I can write about. But I need to have a whinge, as I am so disappointed and upset.
My final Portfolio essay was due in in the beginning of January, I sought advice from the programme leader who emailed me saying:
"Deferring your Portfolio essay will not be a disadvantage providing you pass it the first time when you submit on the 2nd att date. If you need to resubmit it it can delay you finishing..."
I also had a conversation prior to this email where she said it's only a problem if you don't pass it on the first attempt. Well now I have found out I won't get my results until the 29th of May. 6 weeks after my course finishes. 6 weeks where I can't start working as a nurse because I won't be qualified. If I had been told this when I sought the deferral I would not have taken it, and now there's nothing I can do. I just have to hope my delayed start date won't affect my chances of finding a job. I am so cross/upset about it.
In other matters, my placement is going well. I'm now unsure about whether I have hours to make up or not, not that it matters now as I'm not finishing on time anyway. As if I didn't have enough to worry about with finishing work and finding a job.
I know this is all incredibly self centred of me, other people have far worse troubles. Like the mother of the 18month old who had to be resuscitated and transferred to Intensive Care. Or the woman in adults on Wednesday who had an accident at work involving her hand and an industrial food blender that resulted in the loss the fingers on her dominant hand.
I'm most upset because I feel I was misled, it wasn't a decision made given all the facts.
My final Portfolio essay was due in in the beginning of January, I sought advice from the programme leader who emailed me saying:
"Deferring your Portfolio essay will not be a disadvantage providing you pass it the first time when you submit on the 2nd att date. If you need to resubmit it it can delay you finishing..."
I also had a conversation prior to this email where she said it's only a problem if you don't pass it on the first attempt. Well now I have found out I won't get my results until the 29th of May. 6 weeks after my course finishes. 6 weeks where I can't start working as a nurse because I won't be qualified. If I had been told this when I sought the deferral I would not have taken it, and now there's nothing I can do. I just have to hope my delayed start date won't affect my chances of finding a job. I am so cross/upset about it.
In other matters, my placement is going well. I'm now unsure about whether I have hours to make up or not, not that it matters now as I'm not finishing on time anyway. As if I didn't have enough to worry about with finishing work and finding a job.
I know this is all incredibly self centred of me, other people have far worse troubles. Like the mother of the 18month old who had to be resuscitated and transferred to Intensive Care. Or the woman in adults on Wednesday who had an accident at work involving her hand and an industrial food blender that resulted in the loss the fingers on her dominant hand.
I'm most upset because I feel I was misled, it wasn't a decision made given all the facts.
Saturday, February 03, 2007
Nights
Right, where to start? I feel like I've been AWOL for weeks. Firstly, I have a job interview on the 16th of February, my first nursing interview and for a job I would really like. I've got some preparation I need to do for that, including writing my portfolio (that I was supposed to have maintained as I went along).
I've found out that I shouldn't have any time to make up at the end of the placement which is a relief, one step closer.
Nights have been good. The first was horrible as I'd been up since 11am and started working a 8pm that night, we literally had about 10 patients all night so it dragged and I have no idea how I made it through! The second one was much better after a good day's sleep and looking after my own (lovely) patient until 3am. The third flew by and now I'm trying to adjust my nocturnal pattern.
We have the most amazing doors in our A&E department. They seem to miraculous cure children.
[Mum] He's been crying inconsolably for hours.
[Baby] *giggle* *gurgle* *smile*
[Nurse] He's a lot happier now, must be our magic doors.
[Mum] Really, he wasn't like this an hour ago.
At which point the parent usually makes an embarrassed apology and we tell them not to worry we'll check them out anyway. Invariably, as they have no other symptoms than crying, it's because they had a tummy ache or there's is nothing detectably wrong with them.
We had one 3 year old brought in in the early hours of the morning, she'd had an ear infection and been spiking temperatures for a week that were well managed at home, but the previous night it had spiked really high and had not been controlled so the family called the LAS. When they arrived they handed over that she'd had a temperature of 40.4DegC with them. With us it was 36.4. The explanation? In the last 10 hours mum had give 6 doses of paracetamol as "it wasn't working". Fortunate they did call the LAS and come in really or I think they would have continued to overdose their child. So we did some health promotion, sang ibuprofen's praises and sent them over to the out of hours GP.
We often try to stream patients to the Walk In Centre during the day, and our of hours GP at night, when they present with something that is neither an accident nor an emergency, we have criteria for doing this. During the day the department can be quite busy and it's far better they are seen in a more appropriate setting. At night the department is often very quiet, and for many hours empty, but we will still stream the patient tot he out of hours GP. If the GP is busy we will sometimes see them in the department, they are quite flexible.
On the one hand I feel we should just see them anyway if we're not busy, why send them somewhere else where they may have to wait when we have a doctor sitting reading a magazine. On the other hand I feel that it's an important issue of education. People use the A&E department inappropriately and will continue to do so if we just accept everything that turns up.
We had an 11 year old Sickle Cell patient turn up in crisis around 20.30. She had only taken paracetamol at home, without much effect and was scoring her pain at 7/10. Sickle cell patients have a pain relief protocol that is followed in hospital and at home. She should also have been given Ibuprofen and Codeine at home but her mother hadn't and just brought her in instead demanding stronger pain killers to be prescribed. What did we do? We referred to haematology (as all SC patients automatically are) and gave ibuprofen and codeine.
2 hours later she reported that her pain was a lot better. The haematology Registrar was busy with a very sick patient on the ward and had not yet been down. The mother decided to self discharge. But throughout the 2 hours they were there she complained constantly and demanded pain relief (that wasn't needed) and wanted to know why she wasn't being seen and said her other daughter had school the next day and she couldn't be waiting around in A&E all night. Essentially she was blaming us for something that was her own fault; she could have (and should have) been at home doing exactly what we were doing. We suspect she was trying to get in and out of the department with stronger pain killers early so they didn't have to come back in the middle of the night. Incidentally she didn't return that night. It is unfortunate that the Reg was busy elsewhere (how inconsiderate of the ward patient to be so ill!), but it was her own fault that she was waiting in the department for that time when she could have been treating her at home, instead she blamed us loudly in front of all the other patients.
I'll leave it there as this is getting to be a long, ranty entry. I'm sure there have been other blogworthy things but I shall save those for another time.
I've found out that I shouldn't have any time to make up at the end of the placement which is a relief, one step closer.
Nights have been good. The first was horrible as I'd been up since 11am and started working a 8pm that night, we literally had about 10 patients all night so it dragged and I have no idea how I made it through! The second one was much better after a good day's sleep and looking after my own (lovely) patient until 3am. The third flew by and now I'm trying to adjust my nocturnal pattern.
We have the most amazing doors in our A&E department. They seem to miraculous cure children.
[Mum] He's been crying inconsolably for hours.
[Baby] *giggle* *gurgle* *smile*
[Nurse] He's a lot happier now, must be our magic doors.
[Mum] Really, he wasn't like this an hour ago.
At which point the parent usually makes an embarrassed apology and we tell them not to worry we'll check them out anyway. Invariably, as they have no other symptoms than crying, it's because they had a tummy ache or there's is nothing detectably wrong with them.
We had one 3 year old brought in in the early hours of the morning, she'd had an ear infection and been spiking temperatures for a week that were well managed at home, but the previous night it had spiked really high and had not been controlled so the family called the LAS. When they arrived they handed over that she'd had a temperature of 40.4DegC with them. With us it was 36.4. The explanation? In the last 10 hours mum had give 6 doses of paracetamol as "it wasn't working". Fortunate they did call the LAS and come in really or I think they would have continued to overdose their child. So we did some health promotion, sang ibuprofen's praises and sent them over to the out of hours GP.
We often try to stream patients to the Walk In Centre during the day, and our of hours GP at night, when they present with something that is neither an accident nor an emergency, we have criteria for doing this. During the day the department can be quite busy and it's far better they are seen in a more appropriate setting. At night the department is often very quiet, and for many hours empty, but we will still stream the patient tot he out of hours GP. If the GP is busy we will sometimes see them in the department, they are quite flexible.
On the one hand I feel we should just see them anyway if we're not busy, why send them somewhere else where they may have to wait when we have a doctor sitting reading a magazine. On the other hand I feel that it's an important issue of education. People use the A&E department inappropriately and will continue to do so if we just accept everything that turns up.
We had an 11 year old Sickle Cell patient turn up in crisis around 20.30. She had only taken paracetamol at home, without much effect and was scoring her pain at 7/10. Sickle cell patients have a pain relief protocol that is followed in hospital and at home. She should also have been given Ibuprofen and Codeine at home but her mother hadn't and just brought her in instead demanding stronger pain killers to be prescribed. What did we do? We referred to haematology (as all SC patients automatically are) and gave ibuprofen and codeine.
2 hours later she reported that her pain was a lot better. The haematology Registrar was busy with a very sick patient on the ward and had not yet been down. The mother decided to self discharge. But throughout the 2 hours they were there she complained constantly and demanded pain relief (that wasn't needed) and wanted to know why she wasn't being seen and said her other daughter had school the next day and she couldn't be waiting around in A&E all night. Essentially she was blaming us for something that was her own fault; she could have (and should have) been at home doing exactly what we were doing. We suspect she was trying to get in and out of the department with stronger pain killers early so they didn't have to come back in the middle of the night. Incidentally she didn't return that night. It is unfortunate that the Reg was busy elsewhere (how inconsiderate of the ward patient to be so ill!), but it was her own fault that she was waiting in the department for that time when she could have been treating her at home, instead she blamed us loudly in front of all the other patients.
I'll leave it there as this is getting to be a long, ranty entry. I'm sure there have been other blogworthy things but I shall save those for another time.
Tuesday, January 30, 2007
Still going
I am still alive and well, sorry for dropping off the face of the planet. I'm on nights at the moment, one down two to go, I'll update this when I'm feeling a bit more human.
Sunday, January 21, 2007
Cardiac Arrest
There were several things I had to write about from my last two days at work. Had I updated when I came home on Friday I would have, but something happened first thing on yesterday's shift that will dominate this blog entry.
I was in resus checking the paediatric bay when a call came in that a cardiac arrest was on its way. The patient was a 62 year old male who had had chest pain for 3 hours. When the LAS got to him he looked very unwell so they got him in the ambulance and left straight for hospital whilst the daughter got changed, the undertone from this was that she didn't seem to realise it was serious. Just before they arrived he had a cardiac arrest and was in PEA (Pulseless Electriacl Activity) on arrival. I asked to observe the resuscitation as I have had no experience with a cardiac arrest.
After one cycle of chest compressions (from a very clever machine that looks a bit like a baby gym with a toilet plunger head hanging below) and ventilation (he was intubated and attached to a ventilator) they got a pulse back and began to try and stabilise him with a whole host of drugs. The team worked efficiently gaining venous access, taking blood tests, inserting a blood pressure monitoring line, observing his vital signs and administering medication. They were switching between two main drugs in an attempt to stabilise his blood pressure as it seesawed between high and low. By this point the family had arrived and been informed that he was a in a critical but stable condition.
He oxygen saturations were dropping and the ventilator was unable to maintain them so they began to bag him and breathe for him, he was making his own respiratory effort but it wasn't adequate. He has pulmonary oedema, probably caused by heart failure, and his lungs were filled with fluid and it was only by bagging him that they could maintain his saturations, though this also began to be less effective.
Then he arrested again, the compression machine was strapped on and they began compression/ventilation cycles again. One of his sons arrived in the room to watch, and even as this machine was forcing his chest up and down I heard the son say "Is it serious?", at this point he still had no concept of how unwell his father was, or perhaps it was the shock. They were unable to restart his heart and the decision was made after almost an hour of attempts to cease; his heart was too badly damaged, his lungs wouldn't inflate because of the fluid and he had been hypoxic at too many points not to have damaged his brain.
I excused myself at this point as the family came in to be with him, it took several explanations for them to understand that he had died and there was nothing they could do. Then the wailing began.
In university someone once told me that it is one of the most privileged positions to be in, being with someone when they die. Although this situation isn't exactly what they meant I understand it. It was incredible to see the human body in its final moments and how it fights to save itself. The team worked so well, they deal with this regularly. It wasn't dignified, but everyone in that room fought, including the patient, to save a life.
It doesn't upset me, whatever I feel is insignificant to the loss that family feels. It was sobering, but I do consider it a privilege. We talk about the wonder of birth, death in its own way is just as amazing. Dying is a part of life, I'm not suggesting we be happy about it or necessarily celebrate it, but I think I have a healthy respect for it.
I was in resus checking the paediatric bay when a call came in that a cardiac arrest was on its way. The patient was a 62 year old male who had had chest pain for 3 hours. When the LAS got to him he looked very unwell so they got him in the ambulance and left straight for hospital whilst the daughter got changed, the undertone from this was that she didn't seem to realise it was serious. Just before they arrived he had a cardiac arrest and was in PEA (Pulseless Electriacl Activity) on arrival. I asked to observe the resuscitation as I have had no experience with a cardiac arrest.
After one cycle of chest compressions (from a very clever machine that looks a bit like a baby gym with a toilet plunger head hanging below) and ventilation (he was intubated and attached to a ventilator) they got a pulse back and began to try and stabilise him with a whole host of drugs. The team worked efficiently gaining venous access, taking blood tests, inserting a blood pressure monitoring line, observing his vital signs and administering medication. They were switching between two main drugs in an attempt to stabilise his blood pressure as it seesawed between high and low. By this point the family had arrived and been informed that he was a in a critical but stable condition.
He oxygen saturations were dropping and the ventilator was unable to maintain them so they began to bag him and breathe for him, he was making his own respiratory effort but it wasn't adequate. He has pulmonary oedema, probably caused by heart failure, and his lungs were filled with fluid and it was only by bagging him that they could maintain his saturations, though this also began to be less effective.
Then he arrested again, the compression machine was strapped on and they began compression/ventilation cycles again. One of his sons arrived in the room to watch, and even as this machine was forcing his chest up and down I heard the son say "Is it serious?", at this point he still had no concept of how unwell his father was, or perhaps it was the shock. They were unable to restart his heart and the decision was made after almost an hour of attempts to cease; his heart was too badly damaged, his lungs wouldn't inflate because of the fluid and he had been hypoxic at too many points not to have damaged his brain.
I excused myself at this point as the family came in to be with him, it took several explanations for them to understand that he had died and there was nothing they could do. Then the wailing began.
In university someone once told me that it is one of the most privileged positions to be in, being with someone when they die. Although this situation isn't exactly what they meant I understand it. It was incredible to see the human body in its final moments and how it fights to save itself. The team worked so well, they deal with this regularly. It wasn't dignified, but everyone in that room fought, including the patient, to save a life.
It doesn't upset me, whatever I feel is insignificant to the loss that family feels. It was sobering, but I do consider it a privilege. We talk about the wonder of birth, death in its own way is just as amazing. Dying is a part of life, I'm not suggesting we be happy about it or necessarily celebrate it, but I think I have a healthy respect for it.
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