Fire Works, I'm Riding Now, & Scoliosis Tour

It's been a while since I blogged. I've been crazy busy. In my last post I was still trying to wear contacts so I could pass my physical to be cleared for duty. A lot has happened. It's official: I am a wimp when it comes to removing contact lenses from my eye. I can put them in, just not take them out. It's the whole squeezing my eye ball thing. Just doesn't thrill me. Needless to say I didn't make it out of the eye drs. with them.

However, good news! The medical director called me and the occ. health doc. I saw was going by an old standard which has since changed. You are allowed to wear glasses now and still pass the physical. I wish he would have shared that earlier with the doc that did my physical and before I tried to do the whole contact lens thing. Oh, well. Water under the bridge, because now I'm cleared and have already started riding.

I did my first ride along last weekend. We took the ambulance and were on standby at a community event. It was a blast. I got to ride in the ambulance to the event (yes I'm new enough that I still get a kick out of this!).

We didn't do a whole lot. Checked an elderly gentleman's blood sugar who felt pretty woozy (it was fine at 112). He smelled like he'd been drinking, which of course he denied. He didn't appear inebriated and was fully oriented. He hadn't eaten in 7 hours, it was very warm outside, and he was wearing a coat. Go figure. I'd be woozy too. He refused transport to the hospital so we had him sign a refusal form. We advised him to have something to drink (WATER!), keep his coat off, and get some food in him. His wife said she would make sure he did. We really thought we'd see him again before the night was over (we didn't).

The only other care we gave was a bandaid to a child with a scrape. Another child had a splinter. That's about it.

The event was packed with people of all ages. At the end of the evening there was a fireworks display. No one else needed care and were not needed to transport anyone so we just hung out with the firefighters next to our fire engines and got to have a front row seat of the fireworks.

No medical fireworks for my first ride along, just the real kind of fireworks. I do my next event tomorrow night. I will be staffing an aide tent at a large community fair.

Tonight starts my new class, Advanced Pathophysiology. It ought to be pretty interesting. We will eventually be working with cadavers and studying how disease processes affect body organs.

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And my BIG, BIG news: I've got an interview next week for my dream position. ED Fellowship Program at a Level 1 Trauma Center. They only take 10 applicants and they are interviewing now for a position in October. I've been told the competition is fierce, as this is the only Level 1 Trauma Center in the immediate vicinity. I've been out of nursing for a while, but I'm hoping that my EMT certification, training, and all the classes I've taken over the last year will help me land it. I'm also taking an RN refresher course this summer. And I did my EMT clinicals in thier Level 1 ED. So, I'm hoping that will weigh heavily in my favor. We shall see. I'm going to give it my best shot. Stay tuned on that front.......

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Last but not least. My daughter's scoloisis surgery is on for June. We took a tour last night of the unit she will be on. The nurse who gave the tour was wonderful!!! She comes in on her days off to give them and she is very passsionate about it. Eleven years ago she went through the same thing at the same hospital, same doctor, with her own daughter. She went over what to expect each day of hospitalization. She also gave us a notebook that she put together with the help of staff and a former young patient that had gone through this two yrs ago at this same hospital. Needless to say my husband & I were very impressed as was my daughter. I'm so glad we went. I think it made her feel better knowing where she will be and much more about the process.

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If you're intersted in medical blogs head over to Parallel Universes - Grand Rounds are up over at Dr. Emer's site. Check it out!

Conact Lenses Are On Order

I went to my ophthalmologist last Thursday and she said no reason I can't wear soft contact lenses. My eye exam went fine other than being 20/200 or worse without correction. So I have contact lenses on order. They'll be in this coming week. All I need now is to learn how to get over putting them on my eyeball. I'm telling myself to get over it, it's just something I have to do. I'm approaching it from that angle. And if I want to volunteer, I really don't have a choice. That's pretty good incentive right there.

Another incentive is I get to go pick up my EMT gear sometime next week as well. I'll be picking up my EMT pants, jacket, helmet, and a "PIC" kit (personal infection control) - kind of like a fanny pack with EMT shears, mask, disposable sleeves, etc.). I was also just given rescue department shirts with my name & EMT-B on them. I'm excited. I can't wait to start riding.

On another note, happy Mother's Day to all the mothers out there!

Contact Lenses are in my future (I guess)

I just found out about my physical and it’s what I thought, I got a Class C because of my uncorrected vision. So I have two choices: either get Lasik (out of the question because of cost and everything else that goes along with it), or get soft contact lenses. Oh, I guess I have one other option. Forget the whole volunteer EMT thing completely, which I don’t really want to do.

So, I guess I will try to get soft contact lenses. I need to wear them for at least a month without problems and have my ophthalmologist sign off on a form saying I’ve worn them for a month. I tried contact lenses about 6-7 years ago, but couldn’t get past the whole putting something on top of my eyeball issue. I’m an RN and not much bothers me, but I’m squeamish when it comes to my own eyes. Maybe it will be better this time since I have a big incentive to make this work, which I really didn’t have before. The eye doctor has to say I can wear soft lenses and not hard contact lenses because hard ones are not acceptable to be cleared to volunteer. I think I would be a good candidate for the soft ones.

Oh, well I guess I’ll see on Thursday when I have an appointment with my eye doctor. It takes a few days to a week to order contact lenses and then I need to go back in for fitting, learn how to wear them, etc. Which means I won’t be riding until at least 2nd week of June, which is right around the time when my daughter will be having her surgery for scoliosis. Man, I’m bummed!! One part of me is asking is this really worth it, how many hoops do you have to jump through to be a little volunteer EMT? You’d think I was trying to be a Navy Seal or something (which has the same uncorrected vision standard as my county I might add). I still want to be a volunteer. I’ve invested a lot of time in it and I didn’t join just to do Bingo (the rescue dept's main fundraiser). So I guess I’ll just keep at it (trying to satisfy the county I mean).

OK, so does anyone have any suggestions for getting over my squeamishness of putting something on my eyeball and my very strong blink reflex? I'd appreciate any advice. Thanks!

Next Change of Shift is up!

Ahhhh! I'm sitting here drinking a cup of coffee and enjoying the next edition of Change of Shift. Check it out over at life in the nhs. Julie has used a "May Day" theme.

http://lifeinthenhs.wordpress.com/2008/05/01/change-of-shift-volume-2-number-22/

Enjoy! Oh, and Happy May Day!

What's wrong with wearing glasses???

Well, still waiting to find out if my vision is acceptable to the powers that be or not. Funny, I'm an RN and can work in any hospital in the state. And I want to give of some of my free time to serve my community by volunteering as an EMT-B (which I already possess) with the local volunteer fire & rescue department. With glasses I'm 20/20. GEEEEEZZZ. I'm not trying to become a fighter pilot here. I'm not even going to be doing suppression(fire fighting). I'm just doing EMS-only (ambulance). Yes, I know I need glasses. DUH! That's why I wear them. And they're not coke bottle glasses either! I can see without them, but just not very clearly. Which is why I wear them and will continue to wear them.

I did some checking on the web and do you know the NAVY SEALS have the same uncorrected vision standard as the department I want to volunteer with. Um, last time I checked being a Navy Seal is just a wee bit more arduous than a volunteer EMT!

OK. So can you tell I'm just a little annoyed. And, oh yeah, I can't stand waiting around to find out my fate!

Stay tuned..... while I try to stay patient..................
I need a skim vanilla latte!

Summer schedule and scoliosis surgery

It's been a while since my last blog. I've been sooooo busy. I finished my in-station volunteer fire department training. I had my test last night and passed. For the last three weeks it has been a busy schedule of fire department station level classes Tues. & Thurs. nights. In between those two nights I've had my ECG recognition class on Wednesdays. Not to mention the monthly fire department meeting on one of those Mondays. 4 kids, helping with homework, son's soccer (practices and games),daughter's clarinet lessons,etc,etc,etc. I'm probably preaching to the choir here, 'cuz I know we all seem to have busy, hectic schedules these days.

The only thing I still need before I can start ride-alongs is the results of my physical back. And to be honest, I'm worried about my vision. I passed everything else including the stress test, pulmonary function test, etc. but I did horrible on the vision. My vision corrected with glasses is perfect, 20/20, but without glasses not so good. Apparently there is an uncorrected vision minimum. I'm not sure what it is, I tried finding it online but to no avail. I can understand a minimum for fire fighting because you need to wear a mask with a SCBA (self-contained breathing apparatus) and you can't get a tight seal with glasses. Not sure if contacts (which I don't wear) would be acceptable. However, I'm doing EMT-only. I always wear my glasses and I was planning on carrying a spare pair for a backup when I ride. I will be so upset if I fail the vision and get rejected from volunteering!!!!!!!!!

I've put so much time into this - 75+ volunteer hours since March. The EMT course I took will directly pertain to working in the ED so it wasn't a waste, but still I really want to volunteer as an EMT. I guess I will just wait and see. I probably will find out in another week and 1/2.

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Anyway, getting back to schedules...It's been a little nutty lately. Thank God for my husband who's very understanding and supportive. I couldn't do it without him. I've decided not to take the summer class, Abnormal Pathophysiology, that I was thinking about taking. It would be an awesome class and you'd get to work with cadavers, but I'm also taking an RN refresher class this summer starting in early June. I also just found out my daughter will need surgery in mid-June for scoliosis. It's a rough surgery. I wish she didn't have to go through it, but there's really no other choice. Her curve has gotten progressively worse and the bracing is not working at all. So she will be getting the surgery. Fortunately the surgery is easier than it used to be. They've come a long way.

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I'm still hoping to return to nursing this fall when our youngest son goes to Kindergarten. It looks like I will need to do nights when I return because his school/county has decided not to switch to full-day kindergarten like they had originally planned. This means he will be getting out of school 10:40 am on Mondays and 12:45 pm the rest of the week. Which means I will most likely need to work nights. I was thinking about working 12 hr days and then switching to nights during the summers (to be home with the kids while they're out of school). Looks like I will need to do nights from the start.

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One more week of ECG class left and then the final. I need to go read a few more chapters and review for the final. I'm having a hard time getting motivated. I'd rather read the latest edition of Change of Shift. Check it out over at Nurse Sean's place. Here's the link:

http://nursesean.com/http:/nursesean.com/musings/change-of-shift-volume-two-number-21.htm

I'm looking forward to reading it myself. Now, if I can just find the time.......

Decisions, Fire, and Extinguishers

Well I signed up for advanced pathophysiology today. I haven't totally made up my mind I want to take it. It will be a summer course. I am already going to be taking an online nurse refresher class for 7 weeks, 2 of which will be clinicals in hospital. I don't know.... I've been taking one or two classes a semester since last spring. It's a lot with 4 kids and providing full-time daycare.

However, this particular class is only offered in the evenings during the summer. The rest of the year it is offered middle of afternoon, which would be tough with the kids schedule. Plus, I'm planning to return to nursing this fall. I think advanced patho would be another great class to have under my belt as a review before returning to nursing.

I will be glad when I finally do return to nursing. I can't wait for this fall.

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On another note, last Sunday was interesting. I got to shoot off fire extinguishers in Level 1 training at the fire academy. I'm volunteering as an EMS-only member, but you still get to learn some basics like the extinguishers. We got to fill the water extinguishers with a hose and then use an air compressor to put in enough pressure. Then we hiked up a small hill with same water extinguishers, as well as CO2 and dry chemical extinguishers. We were going to test out which extinguisher should be used for different fires by first choosing the wrong extinguisher for the job and seeing what happens.

Our two instructors built two fires - one was a combustible fire and the other a diesel fuel fire. We watched as they gave a demonstration on which extinguisher to use with which fire.

The CO2 and dry chemical did not work on the fire of combustibles (hay, wood, etc.). They would put the intense top flames out but as soon as the wind kicked up it would flare right up again just as high and intense as before. Then they tried the water extinguisher and it put the fire out very quickly. Then we got to squirt our water extinguishers at the fire to finish it off - by then it was only smoldering.

Next our instructors used the water extinguisher on the diesel fuel fire. All it did was make the fire shoot up and intensify. It intensified so much that we felt the heat blast - we were some 15 yards away. The CO2 did not do much - it only coated the flames, which hardly were affected. We also got to shoot off the CO2 and the dry chem.

Long story short, look at the labels on your fire extinguisher and decide what type of fire you're dealing with to know which extinguisher to use. Lay public, call 911.

It made for an interesting morning. It was one of the more interesting training classes so far.

Gotta go. I have more training tonight. This is "in-station level" . Looking forward it.

Self-inflicted GSW to the head - ETA < 2 min

The last EMT clinical I had was also at a Level 1 Trauma ED. As I said in my last post I made it through my first heart attack patient and my first cardiac arrest and active participation in CPR compressions, a Code Blue. (If you missed it, you can check it out here at: http://rnagain.blogspot.com/2008/03/why-ed-nursing-why-volunteer-as-emt.html )
The other thing I wondered was how will I do seeing a major trauma. This particular clinical helped answer that.

I was able to observe a medivac helicopter bring in a patient with a self-inflicted GSW (gun shot wound) to the head. I went with my preceptor up to the roof after learning the medivac's ETA was less than 2 minutes. We watched as the helicopter landed in front of us on the helicopter pad. I rode down in the elevator with the patient, other ED techs and the flight paramedics. We went straight into the trauma room where the trauma team awaited gloved and gowned up. It looked like an operating room. The patient had put a .22 in his mouth and pulled the trigger. The exit wound was just superior to the right occipital area. It must have missed his brain stem because his heart was still beating but only at about 32 beats a minute, he was not breathing on his own. His Glasgow Coma Scale was 3 (the lowest possible). The charge nurse started telling the extra people in the room to leave, including my preceptor. My preceptor went to bat for me and asked if I could stay and observe since I was there to learn. I held my breath as the charge nurse looked at me for a few seconds and then said, "OK". I could have hugged my preceptor!

The trauma team unwrapped his head to assess the damage and I saw gray matter up close and personal. There was also small pieces of brain matter on the backboard and stretcher and of course blood. I was fascinated as I watched the trauma nurses, trauma attending, trauma residents, respiratory therapist, ICU nurse (usually an ICU nurse comes down for Level 1 trauma cases to help titrate emergency IV meds), ED charge nurse, recording nurses, flight paramedics, and many others work on this patient. He was stabilized as much as possible and sent to CT scan. If he made it through CT scan depending on what it showed he would go to either the OR or the trauma ICU.

At one point the charge nurse came and asked was I ok. I said I was fine. In my mind I was actually saying, "are you kidding, this is amazing!" Please don't get me wrong, a self-inflicted GSW is anything but awesome - but when you are only doing a 4 hour (at a time) clinical you rarely get to see this kind of Level 1 trauma. It is a great learning experience for trauma medicine.

I don’t know what ever happened to the patient. I wish I did. My clinical shift ended shortly after he was transferred to CT. Most of the ED staff I talked to later didn’t think he had much chance, but that didn’t stop them from giving a 110% and doing everything they medically could for the patient. You never know and miracles still do happen. I knew for sure right then I wanted to be an ED nurse and work in emergency medicine. I know this sounds hokey, but on the way home from one of my clinicals the song lyrics "this is what I want to be. Finally I see, why it means so much to me [sans bad language]". And I smiled and said yes, this is what I want to be.

I had worried about seeing trauma, but I had seen gray matter and wasn’t fazed, but instead fascinated. I knew I have a long way to go, seeing it and being able to treat it are vastly different I realize. But at least I could handle the sight of gray matter and some intense injuries. I think I was hooked after that clinical. It's why I decided to also volunteer with our volunteer fire and rescue department. I joined in February. I'm still in training and not able to ride yet - hopefully by the end of April/May.

Well it's getting late here on the east coast. I probably should be studying about PR intervals and sinus arrhythmias right now. Got a quiz next class.

Until next post....

Why ED nursing? Why volunteer as an EMT?

Well, the short answer, the one I say most often when asked, is to prepare me for (hopefully) becoming an ED nurse when I return to nursing this fall and to serve the community. Both of which are 100% true, but neither are the whole story.

I recently had to write a service learning project paper for my Anatomy & Physiology (A&P) II class on what personal value volunteering had to us. I'll share a part of what I wrote because it answers the questions above pretty well.

In answer to the questions above - for me it’s very personal. Eight years ago, I watched my Dad die in front of me of a heart attack with no warning in a small community ER after being taken there by ambulance. It was the day before Father’s Day. There was nothing they could do. At that time I had been out of nursing for over 5 years to be home caring for my children and doing daycare in my home. I had been out of nursing for some time and didn’t hardly know what questions to ask and what the current protocols were for an MI (heart attack). I didn’t like that feeling. I’m glad I at least had the chance to be with him and talk to him during his last hour on this earth and was there to try to comfort my mom. I’m a firm believer in when God says it’s time to go, it’s time to go. It was still tough though. I think right then and there I made an unconscious decision that when I returned to nursing I wanted to be in emergency medicine and work in the emergency department.

Last year I started actively preparing for a return to the nursing field taking refresher classes in anatomy & physiology, and pharmacology. And since I had a strong interest in working in the emergency department I also took EMT-Basic to gain emergency medicine experience. Even though I had worked before as a nurse in the hospital, I wondered if I could do emergency medicine and if I could handle the trauma cases and even more how I would handle my first heart attack patient. I didn’t have to wait long to find out.

My very first clinical during EMT class I arrived at the local ED (emergency department) to find a very busy ED staff delivering care to a man having a heart attack. He was about my dad’s age when my dad had his heart attack. I helped the ED staff get him ready for transport to a Level 1 ED and more specifically to their hospital's cath lab. I handled it just fine. In the heat of the moment you really do go on automatic pilot and just do what you are trained to do. I believe the man ended up doing ok. His heart attack was fortunately caught very early.

I was also a little worried about how I would handle my first full cardiac arrest and CPR since my dad’s heart attack. Again, I didn’t have long to wait. My very next clinical was at a Level 1 Trauma ED. During the clinical the preceptor I was working with told me to come with her because they were about to call a “code”. Most know what that means, but basically that’s when a person stops breathing and their heart stops. Calling a code in an ED gets a whole lot of people in the room real quick. On the way to the room in the back of my mind I thought of my dad. I had seen him undergoing CPR compressions in the ED in an unsuccessful attempt to save his life.

When we entered the room they had indeed called a code. The ER doc was there directing the action. The respiratory therapist was bagging the patient (providing artificial respiration with an ambu bag). A medical resident was inserting a femoral central line. Nurses were administering emergency medications from the crash cart, and monitoring the ECG. And a medical tech was doing CPR compressions on the patient’s chest. My preceptor asked if I had ever done compressions and I said no but I’m CPR trained and allowed to do them. She told the tech that was doing compressions to switch places with me and let me do the compressions. And so I did CPR compressions on a real person for the first time in my life.

I learned later she was a healthy 85 year old and had come to the ED after a fall to be sure she hadn't broken her pelvis. She had just gotten back from X-ray and went downhill fast. Even though I had been a nurse for 5 years before leaving nursing to be home with my kids I had never actually done compressions. I did compressions for a while before switching with someone else so they could take over. One thing they don't tell you in CPR class - you're going to break ribs even if you do compressions perfectly and don't be surprised when you hear cracking. Doing compressions can be exhausting and it’s good to switch often if personnel are available to ensure adequate compressions are being given. Again, you go on automatic pilot and don’t even think about all the emotions. You just look at the patient in front of you and do all you can. Unfortunately, the patient ended up dying after about 20 minutes of CPR and many doses of epinephrine and other emergency medication. I said a little prayer for the patient and the family silently in my mind when it was all over. I know what it’s like to suddenly lose a family member in the ED. I was glad I could be there to at least try to help the patient.

My other worry was would I be able to handle seeing a major trauma. Again I didn't have long to wait. The very next clinical I found out as a medivac helicopter was en route with a Level 1 trauma....

More of that in the next post...
----Jen

Intro

Howdy,

I'm new to the blogosphere world. I've enjoyed reading other blogs mostly nursing blogs like emergiblog and pixelRN and many more. I love the Change of Shift posts. In case you've never seen them here's a link: http://www.emergiblog.com/ Kim has many links on her website to nursing, medical and other blogs. I highly recommend it to anyone remotely interested in the zaniness of medicine.

As mentioned above, I'm headed back to nursing. I can't wait! I've been out 12 years. I'm taking an ECG recognition class now and just finishing up online Anatomy & Physiology (A&P) II up. Last summer I took online Pharmacology and A&P I. Last fall I finished up taking an EMS class and am now an EMT-Basic. Can I say it's a lot harder to take college classes being married, with 4 kids, working full-time, and being just a little older than when I did this the first time around?! I'm actually making far better grades now than when I did this 20 years ago. It's just harder to find the time to study.

I recently joined a volunteer fire & rescue squad and am in training (read: even more classes) now to become a fully qualified EMT. Oh yeah, and my son's soccer starts next week. Oh, joy! It's actually a blast. I'm looking so forward to being back in the working world this fall. I hope to get into an ED fellowship program this fall at our local hospital's Level 1 Trauma ED.

Well, more later. I gotta go study how long the P wave, QRS complex, PR interval is, etc, etc, etc. I also need to finish posting what I did for my volunteer service learning project for my
A&P class. I volunteered at my fire station's Bingo night of all things!

I plan to post soon about my EMT clinicals at some of my local hospital's ED's. They were anything but boring. Stay tuned...

Later,
Jen