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....
Thursday, March 27, 2008
Tuesday, March 25, 2008
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
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
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
Subscribe to:
Posts (Atom)