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The Mysteriously “Alarming” Pacemaker Case

I received this email from a dear friend of mine recently:

So,  for the last 2 1/2 weeks my husband and I have been seranaded with alarm tones every day.  We thought it was the new alarm system we had installed (it does a lot of automatic things we have since disabled), then we thought it was the smoke detectors…a new ringtone on our iPhone?… the battery charger on his new bike…his computer when his e-mail was hijacked?…the battery on my bike mileage computer?…my new alarm clock?…the refrigerator ice maker?…the clothes dryer? …everyday we checked everything, and everyday we thought we had found and fixed the culprit, until the next morning when we would hear it again!

It was not until yesterday morning when we figured it out… can you guess?

It was coming from my husband’s chest!  The battery on his pacemaker/AICD was alarming to let us know that he was just about out of juice!  Four years ago they told us we would hear that when the battery got low, but that was a very long time ago…and it just didn’t sound like it was coming from him!  We sent a modem transmission, and the doctor called back to say, “come on in!”

After talking with my friend later, I found out that her husband had his pacemaker replaced and all is well.  It took about 2 weeks to figure out where the alarm was coming from, since it only sounded once a day and only for about 20 seconds at that.  My friend expressed disbelief that it was so hard to determine that it was coming from her husband but surmised that going through body tissues helped the sound disperse enough to make it a mystery!

This left me wondering if any of Dr. Wes’ patients have had similar trouble with figuring out that their chests were alarming!

*This blog post was originally published at code blog - tales of a nurse*

Panic Attacks And The Nurse Who Witnessed Her Son’s Near Death Experience

My son accidentally ingested peanut butter yesterday.  He’s allergic.

He’s done this once before, which is when we found out about the allergy.  He had some really awful hives 3 hours after he ate that small bite of peanut butter sandwich but that was all.  His allergist told me that it would most likely never get worse than that.

He managed to eat some more yesterday.  I braced myself for the hives to come, and we dosed him with Benadryl.  An hour later he vomited.  The pediatrician’s advice nurse advised me to take him to the ER.  At the time I thought it was overkill.  He wasn’t having any breathing difficulties beyond the cough he already had (he has a cold).  He definitely wasn’t acting quite right, though, so off we went. Read more »

*This blog post was originally published at code blog - tales of a nurse*

Caring Bridge: Using The Internet To Monitor Your Loved One’s Health/Hospital Status

When Beth found out that her husband had cancer, a friend suggested that she look into creating a page on CaringBridge.org.  As she puts it, “CaringBridge became a tool to help us communicate with others.”

I spoke with Sona Mehring last week, who is the owner of CaringBridge.  The site started as a simple webpage for a friend of Sona’s who was going through a difficult pregnancy.  Sona and her friends used the site to keep friends and family informed of updates, keeping everyone in the loop without having to make several phone calls each day. Read more »

*This blog post was originally published at code blog - tales of a nurse*

Dignity And Pain

I took care of an elderly man recently.  He’d been dealing with multiple medical problems for almost 30 years.  Despite being in some very significant pain, he still made eye contact, still said “please” and “thank you.”

He wasn’t faking the pain.  He was very stoic, but I could tell he was hurting.  That tight-lipped grimace, the tachycardia, not moving a muscle unless it was absolutely necessary.  Still, manners prevailed.

My colleagues and I went above and beyond for him and his family.  There’s just something about being polite to others that makes those others want to help you and help you and help you some more.

I’m not saying that we don’t want to help those that aren’t overly polite.  It was just nice to be treated, well, so nicely.  I wouldn’t expect everyone in severe pain to maintain such decorum.  Every once in awhile you just click with a patient and it makes being a nurse so enjoyable. Read more »

*This blog post was originally published at code blog - tales of a nurse*

When Your Significant Other Overrides Your Living Will

He knew she was angry with him.

“Whenever I come to see her, I reach out and take her hand, but she looks away.”

Husband and wife for well over 50 years, they had been through a lot.  They met in another country in another time, and to hear him tell it, it almost seemed fated that they’d end up together.  Since then, they’d moved many times, raised a family, supported each other through myriad illnesses.  They were growing old together.

Unfortunately, “growing old together” doesn’t always work out like we hope it will.  Diseases and illnesses ravage our bodies; dementia ravages our brains.  She’d long ago given up on their little garden in the backyard.  It was her favorite hobby, but she couldn’t manage it anymore. Read more »

*This blog post was originally published at code blog - tales of a nurse*

Nursing Student Expelled For Blogging

When University of Louisville nursing student Nina Yoder blogged about her experience watching a patient give birth in a post entitled “How I Witnessed the Miracle of Life,” she may have thought she was just blowing off some steam. Well her school saw things very differently.

When school officials read Yoder’s post, which included a description of the baby as a “creep” and “a wrinkly, bluish creature, all Picasso-like and weird, ugly as hell, covered in god knows what, screeching and waving its tentacles in the air,” they moved to expel her from school by calling her into an office, searching her for weapons (apparently because Yoder had separately blogged about her support for the Second Amendment), and informing her she was no longer enrolled at the school. Read more »

*This blog post was originally published at code blog - tales of a nurse*

The Many Faces Of Code Blue

Just over a month ago, our unit had several H1N1 flu patients.  And they were sick.  Really really sick.  They were also fairly young - 30’s to 50’s.  I wondered at the time why the media hullabaloo about the flu had died down when I was seeing more and more patients in my unit who had it.

Last time I worked there was only 1 flu patient and they weren’t too sick (yet?) to require a ventilator.  I was really glad to see the decrease in this particular patient population.  I won’t lie - it’s frightening to be a nurse caring for someone with a highly communicable disease.  Masks, gloves, gowns are all provided by the hospital, but I can’t ever shake the feeling that I’ve somehow come in contact with it despite these precautions.

And what of the times that we admit patients and don’t know they have a communicable disease?  At least one coworker I know of contracted H1N1 from taking care of a patient who had it before we knew they had it.

I’m sure she was quite shook up - every single patient who turned up positive for the flu in our unit in that time period ended up literally fighting for their lives on a ventilator.

The most harrowing patient we had was a woman in her 30’s who was pregnant.   Like the other patients, every time she coughed on the vent, her oxygen saturations would decrease to the 80’s and would take a long time to come back up.  Unlike the others, though, she was so fragile that sometimes merely coughing on the vent caused her to go into asystole.

I’m somewhat jaded about coding people at this stage in my career.  I remember, as a brand new ICU nurse, talking to a well-seasoned ICU nurse.  She said that hearing “code blue” being announced overhead didn’t give her any kind of adrenalin rush anymore.  At that time, I couldn’t imagine being in that frame of mind.  Being new, I was expected to go to every code blue that was called so as to get experience.  My heart started going into SVT at simply hearing the word “code.”  If the word “blue” came after I practically had to defib myself before running off to defibrillate the patient.

I eventually got to a place where I could fairly confidently go run a code without freaking out.  I’ve been an ICU RN for 11 years.  In those 11 years, there have been some awful codes.  Two stand out in my mind, and the absolute worst was on the pediatric floor.  When I heard “code blue, pediatrics” overhead, my first (naive) thought was, “little kids code???”  My second thought was to wonder if it was really an adult overflow patient.  Sometimes the gyn surgeries went to the pediatric floor if there was no more room on the surgical floors.  You know, maybe one of them got a little too much morphine and the nurse called a code.  A little Narcan, a few bagged breaths and everyone would sigh with relief and go on with their day.

No such luck.  After running full speed up 3 flights of stairs, I arrived at the room that had the most people spilling out of it only to find a bald, thin 5 year old in the bed.  I thought I was going to be sick.  PICU nurses - bless you all.  I could not do that for any length of time.

She didn’t make it.  Having been a nurse for a couple of years at that point, my naivety about the world already had a few chips and cracks in it.  But on that day a huge chunk fell out.

Since then I’ve come to be more like that seasoned ICU nurse that I spoke with so early in my career.  Along with the semi-jaded “oh crap, a code blue” comes a confidence in one’s abilities, so it’s not all bad.

However, watching that woman go into asystole, knowing that we would have to crash c-section her if she stayed in it?  That took me back to the days when I was new and inexperienced.  I’ve never seen anything like that happen.  Although I was perfectly comfortable with my (pre-arranged) personal role, the overall situation would be completely new to me.

Although HIPAA prevents me from saying much more, I will say that I did not have to experience that situation; not because I was off when it happened but simply because it never happened.

If it had, it surely would have made my top 3.

*This blog post was originally published at code blog - tales of a nurse*

I Don’t Know How You Can Do This

Or the other statements, “I could never do this” and “It takes a special person to be able to do this.”

These words are usually uttered by family members who walk into an ICU room to see me calmly managing a patient on drips and vent, hooked up to monitors and other various tubes and wires.  I’m sure these words are spoken many many times every day all over the world.

I appreciate hearing it, but it always makes me think of the jobs that I could never do. Sure, there are lots of jobs that I’d simply be unhappy doing, but there are a few that I’d almost rather starve than do.

I could never be a dentist or hygienist.  I cannot handle dealing with teeth.  If I see that my intubated patient has a loose tooth, I’m done for.

I could never be an exterminator.  In fact, I was talking to an exterminator the other day (If you don’t live in California, you are probably not aware that it is, in fact, resting atop a gigantic ant hill).  He was friendly and chatty and I myself mentioned that I don’t know how he was able to do what he does because I literally shiver with disgust at the mere PICTURE of a large bug.  He then asked what I did and I replied that I was a nurse.  He looked at me for a moment and said that the site of blood completely freaks him out.  There’s no way he’d ever work in the medical field.

Within my own profession, I can imagine doing almost any type of nursing.  That isn’t to say that I’d enjoy it or even be good at it.  But there is one branch of nursing that I will never go into.  There is one patient population that I cannot even begin to cope with taking care of, and that is burn patients.  I don’t know how you can cause someone so much pain day in and day out, even if it’s in the name of healing.   Any burn unit nurses out there?  How on earth do you work in such a unit?

What are some jobs that you could never do?

*This blog post was originally published at code blog - tales of a nurse*

Aspirin: Desperate Times Call For Desperate Measures

This story was related to me from a coworker:

I was taking care of a man who was on bipap.  (Bipap is a form fitting mask that goes over the mouth and nose to help augment breathing.  It has successfully been used numerous times in place of intubating patients and putting them on ventilators.)  He was becoming restless and tired of the mask.  I had to wait for the doctor to come and see him, though, before I could remove it.

Due to his medical condition, it was very important that he get an aspirin that day.  Since I couldn’t give it to him by mouth (because of the mask), I had to explain to him that I’d need to give it rectally as a suppository.

He nodded his consent and I proceeded to give the aspirin.

A short while later, the doctor came to see the patient and agreed that we could take the bipap mask off for awhile.  I happily entered the patients room to take the mask off… and before it was even off his face, he stuck his finger in the air and said,

“FOR THE RECORD, that is a hell of a way to take an aspirin!!”

It’s a hell of a way to give one, too.

*This blog post was originally published at Gina Rybolt, RN’s Code Blog.*

A Patient Outwits His Doctor

One of our patients came off sedation and was extubated.

A few hours later, the doctor came by to assess the patient’s mental status.  He asked,

“How old are you, Mr. Smith?”

The patient replied, “I was born in 1924.”

It wasn’t really the answer the doc was looking for, so he asked again,

“But how old are you?”

And the patient looked up at the doctor and said,

You do the math.”

**This post originally appeared at Gina Rybolt’s CodeBlog.**

Latest Interviews

Health Tips For Back-To-School

I was lucky enough to be asked by one of the local TV stations to talk about some back-to-school issues when it comes to health. I don t know about where you re at but most of the local schools around here started yesterday August rd Keeping up-to-date on immunizations…

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“Medical Self-Care” And The Doc Tom Interview

Next in our series of posts about our founder Doc Tom. Previous time capsules and Come ye economics buffs and algebra fans Get out your pencils and solve for x n and XX Whatever else the year XX is remembered for it will without a doubt go down in history…

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Latest Cartoon

cardiaccath

Here’s a cartoon I created a few years back. Enjoy!

- Dr. Val

*This blog post was originally published at Science-Based Medicine*

See all cartoons »

Latest Book Reviews

A Biomedical Look At Spaceflight

Book review by Dan Buckland Dan Buckland is an editor at Medgadget and an MD PhD student at Harvard Med MIT whose thesis deals with diagnosing back injury in spaceflight using ultrasound. Mary Roach author of previous entertaining books Bonk a history of sex research and Stiff a history of…

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UTI and “Eat, Pray, Love”

I really didn t expect to like Eat Pray Love. In fact since its publication in I’d been avoiding it like the plague. Typical new-agey Oprah-y girly-book I thought. Nothing in it to speak to me. Then I saw the trailer for the movie and I was hooked probably because…

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Will Science Succeed With An Anti-Aging Revolution?

Wouldn’t it be great if we could find a way to prolong our lives and to keep us healthy right up to the end Ponce de León never found that Fountain of Youth but science is still looking. What are the chances science will succeed How’s it doing so far…

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