Friday, December 24, 2010

Merry Christmas!!

So much for being back... Well I am back at my home for my Christmas holiday. Thus there is a huge lack of hospital related antics in my life.

The only moderately interesting thing is that I am considering pursuing a career in home care. This seems kind of absurd especially considering I haven't done my home care rotation yet and don't even know what it is like. I am doing a job shadow over my christmas holiday - so maybe I'll have some antics from that.

I have one semester left to go of the program and I am excited and nervous!

Anyway - sorry about the lack of ridiculousness - my life is boring.

Merry Christmas!!!

Tuesday, December 14, 2010

I'm Back!!

So sorry for my long absence - a variety of factors (mainly exhaustion) contributed to my lack of desire to write something when I got home every night.

To catch up let me tell you about my most disturbing patients of the last week.

Patient 1 is a 13 month old female. For a few days she had massive diarrhea. This apparently caused a urinary tract infection - which her parents did not notice. She was urinating pus. They still did not notice. Good work asshole parents. By the time this little kid was brought into emergency she was basically dead. An RT was called over to collect a venous gas sample and while he was waiting for this he had a very bad feeling and grabbed the pediatric bagger. What ensued was a full code. The child went into cardiac arrest and compressions were performed and she was intubated. The doctor thought that she was so shut down and septic that once they began to give her fluids the toxins in her blood just circulated fully and caused major havoc in her body. She was airlifted a larger center - and I have no idea what happened to her. Some people should not have kids.

Patient 2 is a 35 year old alcoholic. She came in via a rural EMS unit and was direct admitted into our ICU. This patient was suffering from esophageal varices which was basically resulting in her bleeding out. It was the worst blood gas result I have ever seen. pH of 6.8, Bicarb of 5 and Lactate of 17. I am sure she will die. We were so sure that she would code that my preceptor and myself strategically placed waterproof gowns, faceshields and N95 masks near the room so we could protect ourselves quickly when the situation arose. I have never seen so much blood pouring from someone.

She didn't die on our shift anyway.

Monday, December 6, 2010

More Adventures in ECGs

Ok. Apparently around Christmas-time things slow down a lot at the hospital. I have had more overly-personal conversations with people in the RT staff lounge in the past week, than in the past 6 months. There has been a lot of gossip also - I will never be able to look the ER unit clerk in the eye again.

I Have been waiting for one of my patients to die. I was so sure it would happen over the weekend that I wrote her code status right on her card (we track patients with cards that we pass back and forth during report. I'm not kidding), less some irritating good-doer would wander by and start CPR unwittingly.

Since I have nothing to do I volunteer to do most ECGs. The most recent hilarious one involved me trying to convince a delusional patient with a catheter in to "just let it go." Which was not successful - she complained the whole time. Then as I was just finishing up she let me know that she needed a coffee. She was still so drugged from surgery she couldn't even open her eyes.  I did what any good RT would do... I told her I would let her nurse know just as soon as I finished up.

Friday, December 3, 2010

Adventures in ECGs

I am back on wards - this generally means boring times for. I volunteer to do all of the ECGs.

Today I volunteered do someone else's ECG. On a 92 year old lady.

First I had to pry her dentures out of her hands.

Then I had to peel her previously giant breast off of her chest to place the ECG leads.

Then I lost my ECG lead sticker under her previously giant breast.

The entire process took entirely longer than it should have.

Wednesday, December 1, 2010

Ammendment...

I would just like to say that I think trachs are just fine. My previous post was in regards to trachs that I see in the hospital that are oozing grossness.

I know that there are many people who have trachs that are not gross and oozing disgustingness and are helping them to live a better life. So please no one with a trach take any offense to my previous post.

In other news. A new website has been brought to my attention. Full moon comics. This guy is drawing/writing up some comics with an RT flavor. It's a great idea :)

Thursday, November 25, 2010

Trachs

Trachs are nasty things. I don't particularly care for them, but for someone who is facing longterm ventilation (anything greater than 10 days in my hospital) they are actually a good solution. They provide access to the lungs and a stable airway without damaging the cord and trachea. You can ventilate through them, and unlike endotracheal tubes, they don't come out as soon as you discontinue the vent. There is another weaning process you must go through to get rid of the trach. First they must be plugged for a period of time to see if a person can breathe through their upper airway. Sometimes this involves going to a smaller size trach before we start the plugging trials. The end result is to hopefully pull the trach out and have the human resume breathing through the mouth/nose area.


I pulled out a trach today. It was going well until I realized there were still some sutures in place. No wonder the guy looked like he was about to punch me in the face. Ouch. Eventually we worked out that minor detail and the guy got kicked out of the ICU and onto the floors. Seems to be doing fine.

Remember the guy who made me cry on Sunday night? I worked with his wife all day yesterday and today. I thought it might be a bit awkward, but she's super nice. The only thing that really got me was this:

  • I attended a delivery with RT who made me cry. I said I wasn't going to suction because the baby sounded fine, and I was pretty sure we tried not to do that if we didn't have to. He told me that was nonsense and we should suction every baby.
  • I attend a delivery today with RT's wife (also an RT). I asked if we should suction and she told me that that was silly, we are trying not to suction babies anymore. WTF. ARGH. Ok. So I don't, and then the baby is seriously not breathing and the laryngoscope is out and the tube is ready to go in and in walks the pediatrician who says STOP. He walks over, suctions the baby, who starts screaming and everything is fine.  
Also. Today was kind of a gong show. It started at 7:01 (1 minute after report finished) with a stat ABG. At 8:11 we intubated this person who was in Status Epilepticus. At 9:00 we intubated a very old man whose code status is NO CPR, but intubation is ok. Sigh. Life doesn't make sense. And on and on it went. 

Wednesday, November 24, 2010

More Resources - For ECGs

On the request of a reader I have compiled a list of some good resources for ECG interpretation.



Peace out. 

Monday, November 22, 2010

Good Resource for RTs

I was forwarded this link today and I thought it was worth sharing.

- http://www.respiratoryresource.ca -

It has several links to current articles as well as a blog section for updates. There are videos and also the author is starting to set up webinars.

A good resource for any respiratory therapist (student or otherwise) who is trying to stay current and knowledgeable.

Sunday, November 21, 2010

Peon RT is a whiny girl

I just worked 7 straight days. And the last 2 I worked with a therapist that I have never worked with before. I am just setting the stage for a possible emotionally stressed out respiratory therapy student - like on the edge of a breakdown.

First I would just like to say that my last day in the OR was amazing. So amazing that I would definitely consider working in an OR (definitely a busier OR where the RT had a much better role, instead of the stocking stuff monkey) or possibly even training to be an anesthesia assistant. I did 5 intubations on my last day and every single one of them went awesomely.  I loved every moment of it. We had one guy come in for surgery (dental surgery of all things) that had already had two heart valves replaced - and the surgeon did not even think he was a candidate for prophylactic antibiotics. An infection in heart valves pretty much equals certain death. So that was awesome. I went to endless boring c-sections. Boring. I found out that a mango allergy is a possible  indicator for a latex allergy. I had no idea - thank god there were some lost looking nursing students standing around who knew that, so I didn't have to look like an idiot. And I generally dealt with fat people's tongues in the way of my laryngoscope.

Then because of poor scheduling on my part and a desperate need to keep up with the endless amount of hours I have to get in before April, I worked Saturday and Sunday as well. I have been outside in -25 degree Celsius (-13 degree F) every day at 6 AM for a week. I trudge along, dressed warmly on the top (toque, mitts, neck warmer, hoody and winter coat) and very poorly on the bottom (runners - my boots were forgotten at home, and my scrub pants). As a result when I get to work every day my legs feel like flaming burning hell-fire legs. And my ankles turn all red and get a little swollen. I am pretty sure it is frost bite. I usually recover by 8 o'clock rounds.

This weekend I attempted my first art-line. I failed. It was on a guy who had overdosed on anti-freeze. Right, because that is something that you can just drink for a good time. Man that room smelled so bad. He was being watched by security. In their infinite wisdom they sent up what appeared to be a 16 year old girl to watch over this gigantic guy. The fumes coming off of him were making her intoxicated I am pretty sure. Anyway, he didn't even flinch when I repeatedly stabbed him trying to get the line. My preceptor got it right away. 10 minutes later antifreeze guy pulled out his art-line, oh and also his foley catheter. OUCH.

My hands are chemically burned from using that alcohol hand sanitizer for 7 straight days. Multiple times. They are all red, and then I would forget about this and squirt more sanitizer on them. Oh the burning. The burning. It's a toss up though - I have a patient who is MRSA positive. I am more concerned with making sure I burn all of that off me, than having comfortable hands - or any skin at all.

So I survive all weekend. I am working with this guy who I have never worked with before, and I thought I was being a really good sport and doing everything he wanted me to. I was extra cheerful and asked lots of questions. His one negative comment to me at the end of the day was that I am not very good at taking constructive criticism. I know this is actually not true because I have been told on many occasions that this is one of my strengths - responding well to constructive criticism. But how do you respond to something like that? I asked him what he meant, and he said that I was displaying it right now. By asking questions? I think maybe he was confusing my asking for clarification with challenging him. Anyway - we had a long conversation about it. Where he said I was quick to respond to criticism, when I should just be quiet? I am not sure. I responded the way any overtired and hormonal girl would. With tears. Awesome. Someone tells me I do not respond well to criticism and I start crying. Way to prove his point... Total downer.

Luckily I came home to some chili one of my room mates had made. It helped a bit. Then my other room mate came home and offered me some special lotion for my hands. When I was rubbing it in I noticed it smelled quite a lot like urine. Like a lot. Key ingredient is UREA. Next time I'll save a step and pee directly on my hands.


Friday, November 19, 2010

Anaesthetist's hymn

Recommended to me by the anesthetist I was working with all day - after I commented on the important job of moving the bed up and down.


Thursday, November 18, 2010

RSI meets its match.

I finally got my intubation signed off, as well as my LMA insertion. I wasn't too concerned about my LMA insertion -because who cares. Who ever uses those things except in the OR? Anyway, I decided to be pushy today and really ask for it to be signed off, because I didn't want to be all panicked tomorrow. First case this morning I asked my favorite anesthetist to sign it off and he did it! Granted it was a very smooth intubation. Nearly perfect.

Later in the day I asked another anesthetist if I could accompany her and she said yes, but I had better be quick because this one was an RSI intubation. I immediately told her I probably shouldn't be involved in this - but she laughed at me and said she was sure I would do just fine. So we went in, the patient was drugged, I put the laryngoscope in her mouth - and saw nothing. I started to panic but I've done this a few times now, landmarked and voila - a little lift and there were the cords! I put the tube in and that was that. I have never felt so amazing in my life. The anesthetist said she could tell when I finally got my view because my whole demeanour. That was a good end to my week in the OR - too bad I have to go back tomorrow.

Most idiotic things I have been asked in the operation room this week:

  • "Do you know what this is?" Question asked by RN who was trying to quiz me while pointing to the ... baby warmer. Uh yes. I know what that is. Awesome.
  • "Did you turn that on?" Question asked by anesthetist after realizing the sevo had been left on in the room. Uh no. I did not touch your anesthetic gas.
  • "Is there anyone around who can do this ECG" Yes - in fact it is the only thing I am good at. 

Tuesday, November 16, 2010

Intubate Intubate LMA

I did 2 successful intubations today and 1 LMA insertion. It was very strange, the anesthetist inserted the LMA fully inflated. The prior one I had worked with put it in deflated and then inflated it. It is so hard keeping track of all of these.

One girl that I intubated had very terrible teeth, I was so sure I was going to knock one of them out. Also, she had the highest pain tolerance ever. The Dr completely effed up the IV which went interstitial - and the girl didn't even blink. Sadly though, her entire arms were hacked up with obviously self-inflicted ones.
My second intubation was a bust. It should have been the easiest thing ever, big open mouth and perfect airway. The surgeon was hovering over me and telling me to remember this lady had children while I was intubating. I think he made me nervous. So I blew it.
The last one was a lady with no teeth. This made things excessively easy. Laryngoscope in - bam. Tube in - bam.  Bam bam.

I got to watch a pretty interesting thyroid lobectomy surgery. I watched this for a few reasons -

  • it is an interesting and disgusting surgery near the airway
  • it took a long time so I wasn't forced to do other boring OR things during this time
  • afterward we had to check and make sure the vocal cords were still working because they were so close to the laryngeal nerve. 
The downside was that I missed out on the inservice about the brand new ECG machines. Later in the day I got to use it anyway, and as it turns out it's not rocket science.

I am still working with the VERY annoyingly odd girl. Who is now getting married to her cheating bf, and maybe selling her puppy. Who pukes in the car. This came up in conversation, even though it didn't fit into the conversation. That being said, she is a very good teacher, and mostly patient. I have to remember that she is only 23. Which is bizarre. And weird. 

So. About the yoga. I have mastered one yoga move. I call it "Unconscious RT student laying on yoga mat."

Monday, November 15, 2010

Quote of the day.

This quote comes from a three year old girl who reportedly shoved something up her nose... And that was actually true - I saw it. There was an unidentified foreign body up there. Anyway. Quote, "My mommy hit my dad and cut his face. Then my daddy went away." Moments before she drifted away under the influence of sevoflurane.

I intubated twice today which was a nice confidence booster for me, since I thought I would assuredly fail. The OR is still boring as all hell though. Only 4 days to go.

Sunday, November 14, 2010

Back to the OR

I am back in the OR for a week starting tomorrow. I am not too impressed about it. I am now wishing I had just sucked it up back in July and got it over with. BLERG.

Also - my back is still SO sore from my super huge wipe-out. I am considering taking up yoga, which is something that has always made me internally rage (yes yoga makes me mad. I know it's weird - ok.)

I just finished working on a case study regarding COPD exacerbation. Now I am the one who is exacerbated. or is that exasperated. It took forever, and I find it a little frustrating to work 40+ hours a week (and by work I mean professionally volunteer) and still have to hand in assignments. When will I be making money!? When can I stop churning out these damn assignments.

Tuesday, November 9, 2010

Toaster Strudels vs BLES

What do toaster strudels and BLES have in common. Not too much.

For those that are unsure BLES is the variant of artificial surfactant we use up here for premature baby lungs. We intubate and then squirt some BLES down the tube. It is honestly a miracle drug improving lung compliance literally overnight. 

And toaster strudels. Pillsbury's answer to the poptart (which in my opinion is bland, dry and gross). I bought a box and have been eating them as a treat on my days off. When they are in the toaster you can hear the oil popping and sizzling. Every time after I eat them I get sick to my stomach. But they are so damn delicious. 

Ok. That aside, I was thinking the other day, as I warmed the frozen icing from my strudel box that this was really good practice for me. BLES needs to be warmed from freezing in your hands before you squirt it down the baby's tube. Just like the icing. 

And there you go - I have tied it all together. I must have been really tired on the day I was thinking of that.



Sunday, November 7, 2010

I am Greasy.

I did it. I knew I would eff up this stupid clock thing. So I set my phone back an hour. And then sometime in the night it set itself back another hour. So I woke up at 5.15 (pretend 5.15) and was feeling extra rested and headed to the shower. On the way to the bathroom I happened to look at a clock on one of our walls that hadn't been tampered with. 7.15. OMG OMG OMG. That meant it was really 6.15 and I had to leave in 5 minutes. This was bad on so many levels.

  1. When I work 3 days in a row I generally don't wash my hair on the second day. Just so I can sleep an extra little bit. So two days without hair washing. Gross. And greasy. 
  2. I take a LONG time to get ready in the morning, and believe me it is not because I am paying special attention to my hair and make up. I just seem to be one of those people that operates at a slower speed in the morning. So my waking up time today was actually at someone's bedside while I was doing my assessment on them. 
  3. Breakfast.
  4. Lunch
  5. and Dinner. 

In my 5 minutes of getting ready time, I got dressed, brushed my hair, threw some food in a bag and still left 5 minutes late. And then I drove to the hospital even though it is only 4 blocks away and takes 7 minutes to walk there. 

My preceptor just lets me do all of the assessments and gases in the ICU now. Which I LOVE. Of course he is nearby. And OF COURSE I can't make any vent changes without him actually directing me, but unless I am totally out to lunch he usually lets me make the decisions! I love it! I finally feel like I am hitting my groove. Unfortunately... my brain only has room for so many skills, and now that I am getting good at this critical care business my ABG skill is really plummeting. Thank god in the ICU most patients have arterial lines in. Easy gases 101. 

My patients in the ICU are suffering from major oxygenation issues right now. Both have a PaO2/FiO2 ration of less than 60. That truly SUCKS. As such both are currently being ventilated on ARDSnet protocols. Seriously their gases are nearly identical - they should be room mates. 

One of them self extubated today. This started a chain reaction of chaos. First we were paged to ICU stat, which we were sure meant that he was coding. So we ran as fast as humanly possible. On the way there I passed a wet floor sign, and just in front of me my preceptor lost his footing, but caught it and kept running. I was right behind him and totally bit it on the wet floor, landing flat on my back. He turns around and asks, "are you ok." I replied, "Go on without me." I got up, totally fine but just a bit sore and finished the race to the ICU. So Mr. Extubation was fully restrained, and fully sedated when this happened with no witnesses. I wish I could have seen this. Man, that has seriously got to hurt when you rip a fully inflated ETT cuff through your vocal cords. Anyway, re-intubation took place even though I got yelled at for being too slow with the tube. Seriously, you can't rush quality work. Someone needs to check the cuff, and get the lube ready. 

This was not the first time I got yelled at by that Dr today. Earlier we were cardioverting a ventilated patient and I suggested there was maybe not room for me between the ventilator and the bed - you know, without being electrocuted. She lost it. I am a woman in medicine and I should be prepared to do what it takes, even if it means climbing under the bed. In the end the bed got pulled out so I would fit. I am terrified of being electrocuted during a cardioversion. Surely stimulating a vagal response would be a more reliable method. 

All complaints aside - I really like working with this Dr. She speaks her mind, and truly has compassion for the patients even though she doesn't always show it. And she can be a very good teacher - but she never can remember my name. Oh well, she has months and months to learn it. 

And then... just when the fun was almost over (you know 5 pm - the time when the real fun starts). Code blue. Code blue. More running - but I was more cautious now, what with the previous injury. We coded a PEA for 15 minutes before the Dr. called it. What is a day in the ICU without at least one death. Seriously.


Helpful advice for next time - from Occupational Safety

Saturday, November 6, 2010

Airway TV

Just sharing this site I found by Smiths Medical. They have a variety of airway videos, that are generally pretty basic, but some are informative.

http://www.smiths-medical.com/education-resources/videos/airway/index.html

Also, my preceptor and myself fell victim to a false accusation which was kind of annoying. We were just entering the NICU, when (purely by coincidence) the oxygen blender on the transport isolette in their entry way started loudly alarming. We recognized that annoying screech immediately and tried to stop it as fast as we could. In the mean time, a nurse came over and informed us that a nurse in their unit suffers from MS and the sound really puts her over the edge. I'm really sorry for this lady and whatever medical problem she has.. but seriously - I don't like the sound of the blender alarm any more than the next person. And don't you think if we were going to intentionally make an alarm go off for a prolonged period of time, we would perhaps take the equipment out of the nursery!? I snapped at the nurse and tried to explain the situation. We were just innocent bystanders. What had happened is that they leave both the air and oxygen tanks on, and one had a leak. When it ran dry, then the alarm started. Actually pretty lucky.

My preceptor was performing an auger suction (a deep suction through the nose) on an awake patient in the ICU. The patient is having trouble clearing his secretions (and also badly wants cigarettes and a beer). We are really trying to keep him from being intubated again, and thus the deep suctioning. Also, as an added bonus, the patient was in a-fib when my preceptor started this suction, and the vagal response totally cardioverted him to a normal sinus rhythm. Good work.

Welcome daylight savings time (or I guess it is really good- bye daylight savings time) and hello extra hour of sleep. This is going to end badly - I am either going to be an hour late or early for work - I just know it.

Friday, November 5, 2010

Smurf Lice

First things first. I have been rewarded for my incessant snarky-ness. (snarkiness? whatever). Please recall incident involving vacutainers. I did some research and printed some stuff out for the manager to peruse. They have since approached lab with the goal of changing protocol (based on what another hospital in Canada is doing) to using an ABG syringe when the lab pulls a venous gas for us to run. It only makes sense. Air filled tubes screw up O2, CO2 and therefore also pH. Lab is pissed. They say if that is what we want we should just do art pokes. I say screw lab - why don't they just train and certify us to do venous pokes and we will be more than happy to do them all the time. Seriously. Oh anyway - the point of that was that I was rewarded with a "Patient Safety Week" water bottle. Of my very own.

And then I got pissed off at lab again today when they insisted on having a 5 ml waste syringe drawn off of our artline before the blood filled their actual little test tubes. I had already drawn my art sample, and didn't do their waste syringe. It is totally unnecessary and totally dated policy. There is no need for a waste syringe with a VAMP system. We don't use them anymore. Neither should they.

This morning I extubated all on my own for the first time. Unfortunately the excitement was dampened by the fact I had to have every piece of PPE on possible. Mask. Gown. Hair thingy. Little booties. And of course the ever-present gloves. Yes - a query lice, query bedbugs room. OMG. I am still itchy. I swear to god I have lice and bedbugs now. Disgusting. They even had double sided tape all around the doorway to prevent creepy crawly things from exiting. By the end of the day the precaution was lifted, but I still feel disgusting.

The girls covering emergency called me down to see something "cool." What they thought was peripheral cyanosis though, was really just blue paint... On the hands and around the mouth. Weird. But you can't fake methemaglobinemia. Not like you can fake acrocyanosis anyway.

I love this website - I heart guts. Plush lungs make great baby gifts everyone.

Tuesday, November 2, 2010

Vacutainer News Flash

Vacutainers are not actual literal vacuums. There is actual air inside of them.

I may or may not have gotten into a little bit of a tiff with the ICU nurses over this. Per them - vacutainers are a vacuum which contain no air.

Right - because actual vacuums suddenly magically exist on earth. OMG.


For your info. Vacutainers are just blood collection containers. They usually have an additive (ie heparin) to prevent clotting. Air is evacuated from them in order to created negative pressure, which aids in withdrawing blood from very low pressure veins. There are varying "strengths" of vacutainers depending on how much air has been withdrawn. 

Wednesday, October 27, 2010

Baby Day

Today somehow I was robbed of all the vents in ICU. Some guy is re-training in the ICU so they gave 2 vents to him. They gave me one vent and the one Nasal CPAP in the NICU (in this hospital whoever covers ICU also covers the NICU). At 7:15 AM we extubated the girl with the abscessed tonsil. At 11 AM the baby came off CPAP. Wow - a whole lot of inhalers for me to take care of.

We got called up to the floors to do a blood gas to assess for home oxygen - but by the time we got there the patient had been discharged? I guess they realized that he is already on home oxygen. Perfect.

And then we got called to dialysis to do an ABG and the poor little old man's PO2 was 40 mmHg. Yes 40. He was just sitting there talking to me plain as day.

Then because I was BORED. I ran all of the venous gases from the ER, and did some ECGs up on the floors.

I feel like I did nothing, but was busy all day.

Then the nursery exploded! I got to do 2 ECGs on newborns, 2 cap gases, attend 4 deliveries. What a day. Oh yes, all of the excitement started to happen at 5 pm. GAH.

And I feel like I was in a big hurry to give my pager away at the end of that shift. And now I am tired.

Tuesday, October 26, 2010

The ICU becomes routine.

I had the most interesting extubation today. This patient has obviously suffered extreme brain damage, even though his wife is certain he responds to her and knows what she is saying. Right. Well Mr. Flaily McFlailerson nearly bit through the tube before we had a chance to take it out. Then we barely had time to deflate the cuff before the guy practically self extubated. For the rest of the day he held his own but had to be sedated and restrained anyway. What a life this guy has ahead of him. He's a poster child for drug use gone wrong.

Then brain injury candidate #2 is breathing away at a rate of 50. All day. Because the doctor wants to do a neurological exam, so they have lifted the sedation. End result? CT Scan tomorrow morning and sedation and paralyzation for the rest of today Awesome. 82 year old vs stroke is my guess. Tomorrow will tell.

And of course... Shift change is coming in 10 minutes and we get called to the OR for a c-section. Awesome. Love the OR greens.

Wish I had something exciting to report.

I just was searching for a photo of the HT50 Transport vent which is the vent we use for internal transports and sometimes ground transports to different hospitals. I found this little web site of this kid who has congenital muscular dystrophy and her account of things in her life. Cute.
http://www.freewebs.com/girlnamedcait/trachsventsmore.htm

And last but not least...

Sunday, October 24, 2010

Exhausted!

I am done. Finally done my 4 day stretch. I have tomorrow off and then right back at it on Tuesday. This leaves tomorrow free for Grandparental Visitation. My favorite.

Anyway. I now completely excel at blood gases (knock on wood). I'm not sure when this happened, but somehow I have become good at this. I have all the steps down finally and have shaken my nervousness. So everyone at work thinks I am AWESOME. This may be a slight exaggeration, but I think that I am awesome. I walk to work now, it takes 8 minutes and the entire way there I tell myself that I am awesome and will do a great job today. It actually seems to be working even though it sounds ridiculous.

I've been giving the old lady on BiPap pep talks. Those, on the other hand, do not seem to be helping at all. I just pretend I am practicing for when my lifelong smoker of a mother is hospitalized and drowning in her own secretions all the while bitching about a life saving, albeit uncomfortable face mask. She was slightly less complainy today, or I just didn't check on her as often - I'm not too sure.

So someone disconnected themself from the ventilator today. This guy is so thrashy and he is on continuous propofol plus boluses and they can not knock that guy out. A nurse made his wife cry today by asking her to please not speak to or touch the patient. Truly. I agree.

I attended an awake intubation. Amazing and terrifying. Poor 21 year old girl with giant inflamed tonsil and a 5 mm airway. The anesthesiologist intubated over the bronchoscope. It went completely smoothly, which was shocking. My job consisted of running between the ICU and the OR for supplies (ET tube holder, bagger for transport). I try to be the most useful student that I can be in order to be loved - which is very important to me.  The pt was transported to the ICU, put on the vent on CPAP, since she was - you know - AWAKE. Later on, the doc on call - just your general run of the mill internist - put her out completely out and drained her abscessed tonsil by repeatedly poking it with an 19 gauge needle, and then pressing a suction catheter (yankauer) up against it. It was disgusting and awesome. Lord knows what will happen to her overnight.

I usually volunteer to run whatever venous gases that lab draws for us. Today all 3 of them were actually arterial. This is interesting because it is actually ILLEGAL for them to draw from an artery. And you know how much RTs love the fact that they are the arterial gas specialists. It was actually pretty entertaining watching the more senior RTs get all worked up and sending emails and calling people. Oh the rage. The rage.

The ICU really makes me love what I am doing now. It is better than the wards by about 300 million times. But I still like responding to ER calls. I'll really miss this hospital when I am done.

This is what my heart failure patient's x-ray looks like.  He should be palliative - not in the ICU.
(image from www.cardiophile.org)

Saturday, October 23, 2010

Sadness

You know how I said everyone was dying? Only one person died today.

The old lady on the BiPap is still kicking. Literally. Man is she cranky. She hates that mask with a vengeance. Then we tried a smaller size and she could open her mouth wide enough to breathe around the mask. I have never been more happy to see 6:45 roll around.

A family was waiting for one more family member to show up to say goodbye before they discontinued care. Unfortunately he showed up 5 minutes after his dad passed away on his own. That was sad. A lot of tears in the ICU today. I find it ironic that the ICU is neighbors with Labour and Delivery. Sometimes families waiting for a patient to die are just mingling in the hallway with families who are waiting for the arrival of a new baby. So weird. Anyway - I was super glad to hear that the family decided not to proceed with a full code. They said their goodbyes and that was that. I was with that patient when he was intubated. Before he was sedated he asked the doctors to do everything they could. Things change.

We did some routine stuff - conscious sedations, ECGs in psychiatry (always a treat). We ordered vietnamese food for lunch. All in all a pretty good Saturday.

Friday, October 22, 2010

Back at home.

Well on Thursday I started back at my home hospital. After 2 months of being a stranger in the hospital, without a security pass and without a clue about where I was going or who anyone was, it was quite the treat to be greeted with happiness and high fives upon my return. I felt like I had come home.

I'm in the ICU again, which is nice because previously I had more than my fill of time on the wards. This means that now I am mostly exempt from doing a billion ECGs every day. I get lots of practice with ventilators, and running blood gases. I enjoy it immensely because I feel like I am actually impacting someone's health. On the down side, everyone is dying.

Today I saw an RT put a non-rebreather mask on a flow meter that wasn't turned on. We figured it out when the sats hit the 40s. It reminded me of the time in the NICU when a little baby kept having brady after brady after brady. It turns out the oxygen tubing had been shut in the isolette door - effectively depriving him of any supplemental oxygen. Oops.

Also - I completely nailed 2 blood gases today, which was a boost for my confidence completely. I applied BiPap to a lady (who hated it and bitched about it the whole time). I don't know lady, what's worse - BiPap or Death.

I have a pile of days to go. Then a pile of days off. Hopefully the weekend goes smoothly!

Friday, October 15, 2010

So Basically

Here I am. Friday night and I am drunker than drunk and trying to write a paper on Transposition of the Great Vessels. This is what happens when your aorta and pulmonary artery are switched around and without surgery you are basically completely screwed.

I am done my last shift in the NICU. It wasn't too busy. The big change was that I was actually comfortable. I helped nurses lift 500 gram babies and I measured baby's heads for cpap toques like I was born to do that. I applied nasal prongs, and I stimulated a baby back from the brink of a serious brady. Man I loved those kids. This was a bit shocking considering I called in sick one day this week from a plain old case of apathy.
I assisted a mom in holding her 23 weeker infant for the VERY FIRST TIME. It was happy and depressing, as I can't help but think that this may be the only time she ever holds him alive -the prognosis is not good. We received a second Jet ventilator from Salt Lake this week in order to give this little on the same treatment that his twin is receiving.

We were a bit slow this day and spent part of the day looking up... placenta recipes. Yes that is right, some people actually eat their placenta. Gross. Well whatever - do what you want. Also some people also engage in a "lotus birth" which means you basically leave the placenta attached to the baby until it falls off. Again... whatever.

I'm not sure if I am ready to return to the land of dosing palliative senior citizens with Ventolin and Respiratory Steroids. Yes - how meaningful.

Tomorrow (totally unrelated to my respiratory life) I am going to San Francisco to watch my partner complete her very first marathon. I'll be all alone there on Saturday night and although I'd like to think I would explore the city and do something exciting, I will probably use the opportunity to catch up on sleep. (Exhausted).

A photo of a lotus birth. Seriously. Is this a bowl they received for their wedding?? A perfect placenta holding device. This is an awesome photo that I found randomly on the internets. GROSS.

Tuesday, October 12, 2010

Blerg

I worked a night shift on Friday night. There was nothing special about it, except that I was EXHAUSTED. And in the morning I had to fly away to celebrate Thanksgiving.

Also, I have looked at the hours I have completed, and the hours yet to complete, and somehow I have a severe shortage of ICU hours. I don't think that'll stop them from graduating me, but will I be good enough? Seriously. After Christmas we are meant to be good enough to work on our own, but I don't see how this will be possible. I don't know how to do anything! I'm freaking out.

I was supposed to work Tuesday, Wednesday and Thursday. Except I woke up this morning in the deepest depths. The kind of deep depths where I can't imagine why I would want to get up at 5 am, and go to a hospital that I am not all that familiar with, and stumble through things all day. The flip side of this is that I know that I still have tons of things to get signed off in my skills book - things that can only be signed off at this one hospital. But I don't care - and I do something that I NEVER do. I called in sick.

So here I sit at home. I've spent the entire day doing book keeping - actually generating some revenue for a change. I'm seriously contemplating dropping out and just having my own business from home. My mom says I am ridiculous. After I have spent so much money on school to want to quit must be so silly. What makes more sense to her is to spend all the money and then do something I may or may not like. It's a sunk cost, the money is gone so it doesn't really matter at this point.

What do I do.

Friday, October 8, 2010

Baby Blue times 2.

I had hardly been at work at all when a code blue times 2 was called. I'm not allowed to go to code blues, so I just stayed back and set up the vents for the 27 week twins which would be coming our way shortly.

So within the span of 5 hours, the twins arrived, were put on vents, received BLES (surfactant), were extubated, and put on CPAP. It was a really good experience for me because I needed practice doing all of these things, so I got all that experience times 2!

Then I was required to come along on a Tim Hortons run. Then something funny happened, because I remember laughing, but I can't remember what it was.

Goodnight.

Thursday, October 7, 2010

Fantastic Day

After suffering through 2 night shifts at the NICU I have been rewarded with a fantastic day shift. I can't really say what was so wonderful, can't put a finger on it, but the day flowed and I got to do tons of fun stuff.

I put CPAP on two little guys. I went to tons of deliveries. I played with a jet ventilator, and also the Drager Babylog in high frequency mode, which is something I didn't even know it did. Amazing.

Some lowlights include - another still birth and a baby with omphalocele. The omphalacele was actually very interesting to see, and in the end the baby is doing alright, all things considered. I provided it with free flow O2 from the bagger for more than an hour! Yay me!

And I found a really awesome picture that goes right here - but blogger is freaking out.


I saw some parents crying today, so that probably means palliative care for some little thing.

We have a baby in the NICU that was born with Idiopathic Infantile Artery Calcification, which is incredibly rare so interesting - but on the other hand usually means certain death. So that's sad too. It's so rare that I couldn't even find a wiki, so I had to settle for this weblink - wrong diagnosis.com.

And back to nights tonight.

Thursday, September 30, 2010

First Night Shift : In summary.

The guys I was working with tonight were great and a lot of fun. Someone had brought in a remote controlled helicopter, and they were fiddling around with that, and joking that the babies were so small that this helicopter could be called in for an air transport. I've learned the value of lying. For example, when someone says, "do you want to work with peds and babies when you are done school?" you always should answer in the affirmative. Even if tomorrow someone asked me the opposite question ie: do I want to work with senior citizens, the answer is always yes. Whatever they are doing is obviously where I want to work. Please teach me.

The baby who was at the previous hospital (mom and dad are first cousins, weird joint problem) is at this hospital, so I got to check in on her. I didn't read the chart so I don't know what the problem is with the joints yet, but when I arrived she was just arriving back from surgery (colostomy omg). Add to the long list of this child's problems - born without an anus.

By 3 am I was wandering around like a zombie. Besides some monitorings, and setting up a new transcutaneous monitor there was not a lot going on. The new monitor correlated the CO2 to the arterial gas within 1 mmHg. That is amazing.

Brand New SenTec Digital Monitor. Fancy.

I passed a mirror and was excited to see another student wearing red. Then I realized it was me. Sad times.


At 4 am we were called to a delivery. It was still born, and later the RT I was with said it was the worst looking baby he had ever seen. Its head was kind of mushy, and it's skin was peeling off. It had no eyes. It was so sad. They starting to code it anyway. They intubated, did compressions, administered Epi, and put in a UVC. Which of course made no difference. The parents had no idea this was coming and watching their shock and grief was sickening. Dad kept saying "WTF is happening," over and over again. At some point I left. The room was full of medical staff that were actually qualified, and I was just in the way. As I left the room I could hear someone wretching and vomiting.

 Shortly after this they sent me home. And now I'm off to bed. To be repeated in some form or fashion tomorrow night.

Wednesday, September 29, 2010

Nightshift

I have my first night shift in the nursery tonight. I am planning on having a good long nap this afternoon to prepare. Likely I will not be able to impress anyone with my knowledge at 3 AM, since it will have all dried up with exhaustion. Oh well, they will just have to deal with tired me.

Unrelated - I accidentally signed a credit card slip "My Name, SRT" ugh.

Monday, September 27, 2010

5 x 12 = 1 hour

I have a secret for making time go faster.

I divide up every hour into 5 minute increments. So each hour has 12 increments.

In a 12 hour shift there are 144 of these increments. I find that if I am counting down from 144, time seems to go much more quickly than if I am just counting down 12 hours. It's totally neurotic, totally in my head, and I totally would have gone mental today if I hadn't had this to fall back on.

Today I endured 8 hours of neonatal ventilation orientation. About every other machine was prefaced with "we don't use this anymore." So I wondered what the point was. Also, my security pass again does not work at this hospital. I'm left standing outside a door at the mercy of housekeepers or porters walking by.

Awesome. Just 3 more weeks.

Sunday, September 26, 2010

I am one of them.

Oh dear. I have turned into one of those people that only updates their blog once every 10 days. My goal is every other day or so, or I forget about stuff I've done and it all blends into the background of a million days of the hospital.

So. I'm already done at my first neonatal rotation. I am starting tomorrow at my second neonatal rotation. How has this happened? Where has the time gone?

At first my time at the hospital was quite terrible. I was working with a few people who hated me (for absolutely no reason - which seems to happen a lot to students). It was a completely new world in the land of neonates. Talk about completely incompetent. The only thing I was good at was monitoring every two hours. And even that was kind of iffy. On my second or third day (see what happens when I don't update frequently) a new person came on at 3 pm. A person who seems to hate life itself, or at very least life at the hospital. She does the 4 pm monitoring and then comes personally to yell at me. And I quote, "We are not just supposed to write down numbers, I have titrated infant x's oxygen, and you should have done that earlier." I apologize. It totally ruins my entire day of loveliness that I have had previous to this (I'm not sure what happened earlier that was so lovely.. maybe some cute babies were born and some cute dads cried, and then I cried too). Anyway, the next day I am all proactive, and ask the therapist if I can wean some oxygen but she says no, that the baby is chronic and I shouldn't touch the oxygen. And she also looks at me like I am very slow.

Sigh. Whatever. Update on infant x. One other RT, working the night shift turned down that kid's oxygen. And he totally tanked, and ended up needing the O2 turned waaaay up. The parents totally lost it. So yes, good idea to turn down the oxygen. I'm never touching any baby's oxygen again.

I did have a lot of really good experiences. I am a pro at taping nasal prongs to a baby's face. I am totally not scared to wipe a baby fresh from the womb free of vernix and other associated baby slime. I can suction their mouth, and even suction their little tummy out. Another skill I have is wrapping a baby up and delivering them to mom and dad.

One day we had so many little guy's in need of oxygen therapy that we had to wean one off of high flow prongs, sterilize it, move it to someone who was being weaned off of CPAP, so that we could clean that machine and put it on someone else. Seriously.

The baby was exhibiting signs of RDS, apparently caused by cholestasis in Mom. We intubated and administered BLES (surfactant). I got to bag for 45 minutes. I am still new enough that it is actually a privilege and an excitement to bag a baby for 45 minutes.  The next day she blew a pneumo, and shortly after that was being transported to our more intensive NICU at another hospital.

The most sad baby I saw the whole time was a 32 weeker. Mom and dad were first cousins. This little one was seen repeatedly by genetics. Each humerus was quite short, and the forearms were unnaturally long. It was odd. And sad. Additionally on x-ray it was evident that all of the cartilage in her joints was actually bone. They were all fused. Every time she was moved she cried. It was my only experience with the ventilator the entire time I was at the hospital. They tend not to hold onto them. The other hospital came and got her.

What is interesting is that I start at that other hospital tomorrow, so hopefully I will get to find out exactly which genetic disorder she has, and follow her for a while.

Friday, September 17, 2010

Think a little...

We go to a routine resuscitation (abbreviated resus. or.... if you are the person paging us all day - "recess"). The baby is a little whiny so we suggest that we will come back in ten to re-assess.

We come back. The nurse tells us that the baby looked a little cyanotic so she put him back on the oxygen. The baby is laying on the warmer, which is turned off. The baby is unwrapped. The baby has a simple oxygen mask on that is connect to a blender that is set at 21%.
The baby is pink and looking great. Whatever.

Also, I saw the cutest dad ever today who was cheering the mom on the whole time. Then when the baby was born he burst into tears and said, "You did it honey! She's beautiful." I was almost crying it was so cute.

Also. I am tired and want to go to bed.

Monday, September 13, 2010

Babies Babies Everywhere

The babies are so cute. So cute that I have began to love humanity again. In fact one cute little black baby (is that politically correct? Maybe I should call it African Canadian.) Anyway. He has cute little black hair that gets all tight and curly when he gets all cleaned up. I wanted to put him in my pocket and steal him. They tend to get cranky when moved though, so I probably would have gotten totally busted. Oh well, no baby-stealing for me.

Lets back up. It's Saturday at 6:30 AM. I have just arrived to the hospital and am heading to Respiratory department. Oh right, it's Saturday, so all the whole department is effing locked up and I do not have a key card to get into anywhere. UGH. This did not help my whole hate of being up early in the morning and complete dread of starting at a new hospital. At all. Eventually some cleaning staff came by and I begged them to let me in to the department. 

I made it just in time for report. 

The staff was completely awesome to me. Well for most of the day. A therapist came on later in the day who made me nervous, made me feel like an idiot, and made my hands shake. So much that I completely screwed up transferring blood from a syringe to a cap gas tube and got blood everywhere. While she glared at me.
So that sucked. A lot. And after attending a days worth of deliveries she had me wrap up a baby (like a burrito!) and guess what!? I sucked at that too!

There is a baby in the unit with Tetralogy of Fallot. Which is a super crappy congenital heart defect. 
The baby was unremarkable as far as looks go. I wouldn't have picked it out as a heart defect baby. The sats were hovering around 85, and everyone was pretty happy with that. We had a bit of a quiet afternoon and we were able to do some research. My preceptor recommending a very good website for congenital heart defects. Nemours apparently is a heart center somewhere in the States - and it has some good info and I liked it a lot. Visual stuff is always helpful. And heart defects are always confusing - and hard to remember. Left to right, right to left. I don't know.

Also, I saw some opthamologists checking baby eyeballs for ROP. It was the most barbaric horrific thing I've ever seen, but apparently this hospital has amazing stats for ROP. 


Poor little button.


I also saw a little fellow with Prader Willi, and also... Asymmetrical Crying Facies. Seriously it was a crazy time. 

So that was day 1. On day 2 I was so much more confident. I was right in there at the deliveries cleaning the baby off, suctioning the mouth and nose, and filling out the paper work for the APGARS. It was much better and man - those babies are so cute. But the screaming that goes on in those rooms does not make me eager to start growing a baby anytime soon. And I was totally hormonal and cried at almost every delivery. Awesome. Good thing I was wearing a mask in some of them.

One little guy that I remember in particular was born with a pretty severe cleft palate. He was such a small little guy, and he was so mad, but when he settled down he was the cutest little boy I saw all weekend. Dad was pretty stunned I think, but took so many photos, and the staff couldn't keep their hands off this handsome devil. That was my favorite event of the whole weekend.

And then we watched About a Boy, and Ferris Buellers Day Off. And then they FINALLY let me go home early. 

The end. 

PS - Apparently Elvis had Asymmetric Crying Facies. FYI.


Favorite Movie of All Time

Tuesday, September 7, 2010

Babyland

So it's started again. Today I had my 8 hour orientation to the Level 2 nursery I'll be in for the next 3 weeks. I say three weeks, but really it amounts to all of 7 shifts.

I'm with one of my good school friends on this rotation so that helps a lot, but I still am not loving it. First I got to see the Arabella CPAP. Then I got to see a delivery, which I didn't even know I was attending, but then there I was in a gown cleaning off a slimy baby. I actually felt pretty bad, because had I known, I would have let my buddy go instead of me. He still hasn't seen a delivery! Good thing I re-memorized all of NRP (ha!) because in the afternoon we were subjected to several scenarios involving neonatal resuscitation. I have never intubated a baby dummy to suction for meconium so many times.

I saw the preceptor who made me feel like crap last year on one of my 4 hour rotations. I don't think she remembered me, but it is hard to say. It is just so different from the main hospital I am in, where everyone chats and is friendly. At this hospital, the students huddle at one end of the room and whisper, and the preceptors are at the other end - all whispering as well. Totally awesome. Also - I can't find anything. I didn't go to the bathroom all day, because I was too shy to ask where it was.

I found out that one of my other classmates has dropped out of the program. It wasn't too much of a shocker, but still kind of sad to hear someone leaving the program this far into it. This is the second of my classmates to leave the program during the practicum phase. Also, one of my fellow bloggers has also abandoned his RT dreams, with the plan of going back to his previous IT life.  I won't lie - I have contemplated it myself. I just imagine the money I could be making, instead of volunteering in a hospital for 12 months, and it is very tempting. Still, I think I just need to keep my head down and finish out this time. I might feel differently about everything when I'm not a student anymore. And when I'm not a student anymore, and not in the middle of all this, then I can make an educated and unbiased decision.

One of the worst things about this practicum year is the school component. It is never ending. Online discussions (which are more like research papers), classroom days, online quizzes, and always a big exam at the end. JUST LEAVE ME ALONE ALREADY. As an added bonus, between this semester and next I need to write a gagillion page research paper about "something interesting." Also, it needs to be presented to my "colleagues" (I'm pretty sure that they should only be called colleagues when we are all getting paid - otherwise, I am just the peon) in the form of a poster presentation. That's right, I need to cut things out, and glue them to a poster, and then present it. All kindergarten and like. I can hardly wait. It sounds exactly like my worst nightmare. I have until November to select a topic. If anyone knows of any "interesting" respiratory topics that could easily be converted into a thoughtful and engaging art project - please comment.

Fetal Circulation - Nobody's friend. 

Friday, September 3, 2010

Dread

I am home. Finally.

After another day of delays.. Yes, they checked us in at 5 AM, and then didn't bother to tell us that our flight was delayed to 4 pm. Thanks. Thanks a lot LAN. So we spent another day at a ridiculously nice hotel, and flew out that evening. Which meant we had to stay in Miami. Then we couldn't get a flight out of Miami, so we had to take the train to Fort Lauderdale and fly from there. I was so confused I acutally forgot what city I was in.

Anyway. We finally got home to our goofy cats.

Now, I have 3 days left until I have to orient to the special care nursery. And honestly I don't want to.

I do not want to go to a new hospital with all new staff and learn all new things. I don't really want to work with little babies. I have already seen enough births and c-sections. I remember when I thought these things were amazing and a MIRACLE and the GIFT OF LIFE. Well that is so last month.

I do not want to wear red anymore. I would work in Starbucks instead of going to the hospital again.

Post-holiday blues much?

Sunday, August 29, 2010

Trapped in Quito.

Although we arrived at the airport 2.5 hours prior to our flight, the airport gods have worked against us. Due to some technical problems we were not able to get onto our flight.

We found this out after waiting a significant time in a line that was not moving. A LAN employee stood near us and made a proclamation. With all my amazing Spanish skills I was able to pick out one word. "Cancelar" Or something like that.

We were given 2 options, as far as I could understand it anyway. We could fly instead to Lima, then Punta Cana, then Miami (arriving at 10pm). This option was not desirable to me, as I only have enough Ativan for 3 flights. The second option was a $500 voucher for LAN, a hotel, and meals until the next flight tomorrow. We obviously picked option B. This seemed like it would be simple. It was not.

Stage 1 - Get moved from giant queue to smaller queue (because we volunteered to fly tomorrow)

Stage 2 - Wait 15ish minutes to speak to an agent who tells us we can´t fly today. Thanks agent. Even though I actually really ended up liking the agent. She re-schedules our flight for tomorrow. Perfect. Now about my $500 dollars

Stage 3 - Walk to a different office/counter where we wait 30-40 minutes for our vouchers. Its no ordinary line up. It is filled with angry Spanish speakers and crying children. People keep butting in line, and we have no idea what is going on, because my idea of speaking Spanish involves adding the "o" sound to the end of English words. It was a bit frustrating, but eventually we got it sorted out. We have to sign something, which I am semi-convinced is a slavery contract. Now about my hotel. And transportation to the hotel. And what will I eat all day. Etc.

Stage 4 - We are instructed to "step aside" and wait for the magical LAN employee who bears the booklet full of vouchers for hotel stays. This takes lord knows how much longer. She writes an illegible hotel name on a voucher, ticks off a few meals, writes that we are both eligible for a 3 minute phone call and then instructs us that to arrange transport we should.... Go to the main check in counter. Again. I am skeptical.

Stage 5 - Waiting for the transportation. We do this completely out of principle because a taxi ride practically anywhere is only 3 to 6 dollars, depending on your haggling skills. But we wait anyway. We go back to the counter, where madness is ensuing. There is actually people shouting at the staff. This always seems completely retarded to me, because yelling is really going to help you out. Anyway we ask someone about the transportation and they ask us to wait. Which we do for an hour. I then employ my new tactic, which is "stand in the middle of everything and be completely in the way." Then we are actually addressed, and asked to wait in a different spot. I entertain myself by weighing myself on the luggage scale (68 KG with backpack) and commiserating with those around me. We wait and wait.

Stage 6 - The previous agent who I have come to love takes us outside to where hotel transportation should come get us. She looks like she could cry at any minute and is obviously prolonging going back into the hell that is the LAN check-in. The bus arrives! She tells us we will have to wait 30 minutes for it to leave, because we are the only ones outside and there are a bajillion people who need to get moved to this hotel. Which I am not sure exists, and think it may actually be the LAN cargo hold.

Stage 7 - The bus refuses to wait! Yay us! We travel the short distance to a VERY VERY nice hotel, which we are all awkward and weird in, wearing our dirty and torn travel clothes.

Total time for this to take place. 3 Hours.

What follows is free breakfast, a massage (that I pay for), a steam room, a sauna, a nap, a free lunch (somewhat awkward, what with my awesome Spanish) and a completely relaxing day in Quito. In a hotel in Quito anyway.

(please note: what you see is a bouquet of live roses)


Home tomorrow. Hopefully.

Friday, August 27, 2010

Otavalo: The Market

Even though I have skipped past Banos (white water rafting, and horse back riding), and Cuenca - an amazing colonial city, I will never catch up, so I might as well just move on.

We have stayed at the most amazing Hacienda (farm) every. It is about a billion years old, and the rooms are amazing, and have hot water and the piece de resistance - a fire place! Like an actual, you put wood in and light er up, fireplace. I was in heaven. We spent 2 nights there. On the second day we took advantage of a mountain biking adventure. We have never mountain biked before, so it seems like a great idea. We drove up to the highest point humans can go on Cayambe Mountain (4,800 meters). We were on the equator line and were freezing, and surrounded by blowing snow. And then we biked down 2,000 meters. Before starting we had joked about having a camera on our helmet that snapped a photo whenever we pulled on the brakes... Truth be told, it would have been more like a movie, since I pulled on the brakes the entire time. All the way down. 2,000 meters over 36 km is very steep. They fed us sandwhiches, sandwhiches that tasted like the gift of life. Then we hurtled the rest of the way down. It was on a road that was "paved" with coarse cobbled stone. Pretend you are operating a jack hammer. Now imagine doing that on a bike, because that is what it felt like. Today I can hardly move!

Luckily today was a travel day. We moved from the Hacienda to Otavalo.

Really all we have time to do in Otavalo (we are here less than 24 hours) is the market, which is purportedly the best in South America... So in the 4 hours that we have been here we have purchased
  • Panama Hat (produced in Ecuador, EXPORTED to Panama)
  • Alpaca Blanket
  • Alpaca Socks
  • Wooden ring for my thumb
  • Rug for the kitchen
What did we need of all of this? Likely only the socks. I have just stopped myself from buying another sweater (I am up to 4 already) and a second rug, and a small model alpaca, and a little rug made of Alpaca (which, I swear to god, the cats will love). I am now wondering which of my current backpack contents will need to be left behind in order to fit in all these new family members.

Also in the market a very shrunken old lady approached us, talked to us in Spanish, and then as far as I can tell put a curse on Jen.

Other random facts. I am in an internet cafe. How do they afford to run in Ecuador? Technology is expensive, and the internet is cheap to access. In addition, I have seen my first bar of soap on a stick since Korea. Don´t think it´s about to break through to Canada anytime soon.

Monday, August 23, 2010

Ecuador - The adventure Continues

Papallacta was everything I would hope it would be and more. We spent one luxurious night in the hot pools, had delightful cheap (like all food in Ecuador) dinner, and loved our first stop on the trip. In fact, we wished it had been more than one night.

In the morning the trouble started. We started taking Malarone (the supposed best anti-malaria medication) since we would be entering the malaria zone the next day. In the morning I ate the most disgusting breakfast I have ever had in my life. I don´t know why I ate it, but I did. It was (my best description follows) eggs, sausage, bread chunks immersed in a soup of red sauce. The best way that I can describe the red sauce is to call to mind tinned spaghetti, or alphagetti.

 What follows is the most violent vomiting I have ever experienced... out the window of the bus. The roads in Ecuador are somewhat windy - you know, what with it being in the Andes mountains and all. Public transportation is great, but when I got on the bus, I didn´t have a seat. I had to stand for a while. Then I started feeling a bit sicker. Then I asked Jen what I should do if I was going to throw up. She suggested emptying out our chip bags and using those and vomit bags. I suspected the vomit volume was going to exceed 3,  50 gram bags. I was right. Instead at the last minute, I traded Jen for the window seat. We pushed the window open as far as it would go, and I proceeded to vomit as hard as I ever have while 40 Ecuadorians cheered. Thanks guys.

We arrived in Tena - which for us was essentially the gateway to the Amazon. I had to ride for 40 more minutes on a gravel road in a truck, not improving the feeling I was having really. Upon arriving, I tried to be sociable, failed, hid in my room, came out for 5 minutes at dinner, and continued to throw up... and wait for it... have explosive diarrhea AT THE SAME TIME. Thank you Ecuadorian food poisoning. Love love love.

Next day we visited a rescue zoo center - Amazoonica (which is a lovely place that you can volunteer at). I forced myself to go (45+ minutes on bumpy gravel roads, followed by 30 minuted boat (think motorized canoe) ride). Yes, great idea. I love animals. I love monkeys. I love not puking more. When we got back to the lodge there was some sort of vegatable potato soup served. As far as I am concerned it was the healing soup of the Amazon gods. That was my turn around.

Ok - so after two nights at Shangrila - the amazon jungle lodge, we moved on to a community stay. Yes, a community in the Amazon. You know, where they don´t have electricity. Let me summarize the trip, since i am running out of internet time here.
  • bamboo hut with holes in the walls big enough that when we woke up there was a stray dog under Jen´s bed
  • 6 hour trek through the jungle... in gumboots. 
  • Tilapia served whole - with the head. I called that dish "fish with a face."
  • Favorite quote from our guide on our first night, when we were going to bed at 8 pm, since it gets dark at 6.30. ¨"Might as well go to bed, nothing else to do. You can cry, you can scream - but no one can hear you."
  • 100% DEET did not even begin to deter the bugs. Not even close. You should see all the bites on my legs. The malarone continues, even though it makes me nauseous every day.
This pretty much concludes my time in the Amazon, except for I have to mention Merido, the Ecuadorian flea bitten, mutt. I loved that dog. I fed her food under the table, even though I am sure it offended everyone and probably made her sick. Loved her.


Ok. That actually does not even bring me up to speed. After that we spent 2 days in Baños, and now have been in Cuenca for a day. If I could spend another day anywhere, it would Baños for sure. But more on those adventures later.

Short flight to Quito tomorrow evening. Still have Cayambe and Otovalo to go! Andean sweaters for everyone!

Sunday, August 15, 2010

Off we go to the Amazon!

Yesterday we had a self guided tour of Quito. Self guided in that we were in a taxi and the hotel guy told him where to go. $17!

We saw the Virgin of Quito. Constructed by the same guy who made the Eiffel Tower.
(Picture not my own)

We also saw the San Francisco Church (Which is the oldest church in South America) and some other churches and museums. Then the altitude kicked the crap out of us, and we had a 3 hour nap!!

We met with the group last night and they seem like a fun bunch of people. 

Today we are off to the Papallacta Hot Springs where we will be sleeping in a cabin with a hot spring outside the front door. This sounds like my kind of holiday!!



Again, I have obviously stolen this photo, since I haven´t been there yet, but I hope this is where we are staying!!!

Adios!

Friday, August 13, 2010

Quito!

We almost did not leave on the holiday. Last minute we were informed of the risks of flying to a high altitude if you suffer from epilepsy. The day before we were to depart I was told that i needed a letter signed by a doctor. I started bawling because that was not possible. Just not possible, but then they recanted and said I could sign a release of health on my own. Of course making my health insurance null and void as far as I can tell... Then Jen convinced them to let us go on a different trip. Last minute. Totally against every policy they have. And then we decided to risk it and travel as planned. 

As such, I have arrived in lovely Quito! At least it looked lovely in the dark, from the taxi cab. We had the easiest day of travel ever.

Toronto to Miami was slightly delayed, but no problems getting the bag and then rechecking through to Quito. Time to spare!

First impression of LAN airways.... Fantastic. They have a personal entertainment system, games, tv, movies, zou know - whatever.  Blankets and meals and wine oh my!

Still can not come close to beating the awesome service we received on westjet to Toronto - hello compd drinks. But I would definitely fly LAN again.

Our hotel is relatively nice. It was $80 per night compared to the average $6 to $10 all around us. I am still looking for the key to the safe. Wifi is included though, which is a nice perk. Also free breakfast, which is probably our favorite thing of life.

The worst part of the day was when the US customs man in Toronto made Jen cry.
Ativan was definitely the hero of the day, keeping me subdued on all flights and through all turbulence. Hurray!

Wednesday, August 11, 2010

Happy Holidays

I intended to get some posts ready ahead of time, but I didn't. I can't believe I am leaving tomorrow and am in a total panic!

When I get back I will just have 1 week before I am in the special care nursery taking care of little babes! :)

Back on August 31st with many tales and adventures of Ecuador !

Saturday, August 7, 2010

Done and Done

First semester of my practicum year is over! Already! I can't believe it.

I was thinking today about how much I have changed already. When I started at this hospital I couldn't find anything. I remember the first day - I sat on a chair in the atrium of the hospital, until one of my classmates showed up. And then we asked information for directions to the Respiratory Department. Yes, it was that pathetic. I stumbled through my first weeks on the wards, and eventually became comfortable doing assessments on patients, assessing their oxygen needs, doing 3 billion ECGs, administering respiratory meds, and calming panicked nurses. Some of the time. I also was able to attend traumas, conscious sedations, and cardiac arrests (to name a few) in the Emergency Department. I now know exactly what needs to be set up before we start, and I can do a conscious sedation on my own (even though it is illegal - it happened just yesterday). I don't look like a deer in the headlights when someone asks me for something in the middle of a code.

Just when I was getting comfortable with all of that, I started my rotation in the ICU - very late in the semester compared to my classmate. I was so nervous, uncomfortable, lost and just plain useless - all over again. It improved. I can independently monitor and assess the patients now. I am comfortable asking the nurses questions and they ask me questions about the ventilator, and most of the time I can answer them. When I started running ABGs on the analyzer I was a nervous mess. I couldn't even transfer a sample into a capillary tube. Now it is just a matter of routine and happens dozens of times a day. I draw gas after gas after gas. I look at it. We make ventilator changes. The doctors ask us what we think should be done - ventilation wise. I love being a part of that process. I am finally comfortable with a few of the doctors to ask questions, clarify med orders, and just plain old get my hands dirty in the ICU. Of all the places in the hospital ICU is still where I am most unsure, but I have a ton of time left to learn in the next two semester.

The best thing about the ICU is that I am actually using things that I learned in school. The therapists and nurses that work in that are are specialized and have to stay on top of those skills.

Updates:

Code story from two days ago. We coded a 30 year old approximately 10 minutes after shift report. It was chaos. I got to do CPR for the first time ever. The bed was too high and the patient was too far over. My arms could have gone forever but I got the WORST leg cramps ever from being on my tippy toes and doing compressions for the longest 2 minutes of my life. There just happened to be a ton of nursing students around that day (which was nice because they were newer than me, so I felt like I knew something). The students all gloved up and got in a line up to do compressions. This resulted in me not having to do compressions again, but instead being the runner for everything my preceptor needed. Compressions continued for 25 minutes. She did not make it. Her nurse, who is always very tough, went home early that day.

Yesterday I was setting up for a conscious sedation (because my preceptor was with another apneic patient from the previous conscious sedations - lots of cardioversions happening). I had just got the oxygen mask on the patient when the nurse says, "Propofol's in." Um. WTF, I am wearing bright red, it is obvious I am not a real Respiratory Therapist. Anyway, what could I do but a jaw thrust? So I dealt with the situation at hand, and it was over a few minutes later. My precepter waltzes in and says, "Oh good, you got this all set up, when are they starting?" She was PISSED. I don't know, something about losing her license if something went awry.

And now today. Happy story first. Patient who I thought would never get off the vent, is in fact on the wards now! Hurray!

Then I got to do my first apnea test today. That is a test to assess for brain death. Essentially you disconnect the vent, and stick a suction catheter which is attached to an O2 flowmeter down the ETT. Hopefully they breathe. Our patient did, which meant he failed the apnea test, and is now back on the vent. Now I will never know what ends up happening with him. I hate that.

I'm moving out of my dorm room tomorrow. I won't miss it. I will however miss this spectacular view.

Friday, August 6, 2010

Coded

I just got back from a lovely walk in a park made up of only wilderness.

I am now too tired to write about the 25 minute code, or the conscious sedation I attended on my own (much to the chagrin of my preceptor). There was also a NICU nurse who wanted to use nasal prongs at 1/4 lpm on a blender because the 100% oxygen was too much for the baby. Ever hear about entrainment? That kid was probably only getting 22 or 23% oxygen anyway. Yes, lets add the blender, then they for sure won't get above 21%. Why do his sats suck!? Or how about the CT visit where the CT tech dropped the transport vent on the patients head, and then dropped the oxygen tank on the ground, before nearly extubating the patient. It was truly awesome. No, I am too tired to go into it into very much detail at all.




Instead I am going to read in bed. 

So far I find this to be a very good and captivating book.













Tomorrow is my last shift and I will be the only student on. I really hope this does not translate into endless ECGs. I really should be exempt since I am in the ICU, but I am working with the string of RTs who really really love to "share their workload" with the students. Truthfully I love ECGs and I love even more the freedom that I am given when working with these therapists. I feel like they really trust me to not kill anyone. Which is a good feeling.

Then tomorrow night my tasks are as follows:

  •  Update blog with more details on stories mentioned above
  •  Update blog with anything exciting that happens tomorrow
  •  Pack
  •  Read
  •  Sleep

6 days until Ecuador. I am freaking out. 


Tuesday, August 3, 2010

Life

I love Life cereal. I have nearly eaten an entire box in one weekend.

Other than that, I have been home hanging out. We went to a couple BBQ's on the weekend, endured some torrential down pours. We painted the bedroom and the office, and I have full come to terms with the fact that I hate nothing more than painting. There is still furniture and belongings strewn all about the house and I have no motivation to put it away.

I had to go to school for unbearable "debrief" day today. In the morning we sit through a few lectures, and then in the afternoon today we had a special treat. We got to tour an OR in a hospital I won't work at and have 3 different people there lecture us. One station was arterial lines, another was about an anesthesia machine, and the last was about difficult airway equipment. I tried to stay positive, but it was really really boring. I don't learn well by just listening to someone yak about something. Also they use a different anesthesia machine than my home hospital, so that was all a little irrelevant as well. And no offense to the airway lady, but you don't get into your 3rd year of RT school without seeing an OPA or an LMA. This is not news.

I found out that one of my classmates has dropped out. This is surprising and sad. I can't imagine doing this much of the program and then changing your mind (not to say I haven't thought about it daily for the past 2 years).  On the other hand it is one less person to compete for a job with later. So that's good I guess.

Back to the ICU on Thursday. 3 shifts to go and then off to ECUADOR. OMG.

In closing here is an interesting article about being below average -  Get Smarter by Realizing You're Not That Great. I'm practicing this every day now.

Thursday, July 29, 2010

OMG OMG OMG

Just when I have almost lost faith in the ICU the day completely explodes and saves the internet from my personal life!

Yesterday was so slow, that someone called in sick, and we couldn't find anyone to come in. Still totally fine. Then the other student started puking - sent home. Mid-afternoon I was sent to Tim Horton's for treats. Totally fine - nothing happening, no crises.

Queue Today.

We started the day with 1 intubated adult and 1 intubated baby (32 weeks - so just tiny enough.)

First thing we get called to do a stat ABG on a patient we extubated yesterday. For the record I did not think she was with it enough to be extubated, but I don't get a say in things that happen. At 4 AM an RT was called because she wasn't looking great and they put her on BiPap. BiPap is great if your patient isn't obstructing. When we did the gas the pH was 6.9 and the CO2 was 110!! OMG, no one noticed this? Seriously. I wonder.

So there we go - intubation. Head count - 2 intubated adults. We also had to put an art line in, and my preceptor hadn't done one in quite a while, but we got the job done. We weaned to pressure support later in the day, and otherwise simply monitored this patient. Oh and I drew multiple gases off of the art line. Oh excitement. Oh the vamp.

We popped in on the baby to see if she would tolerate a switch to pressure support today, made the change and planned on extubating later in the day.

Our other intubated adult was a female with a neck mass that was compromising her airway. She was fully awake and not even restrained in any way. My preceptor the day before barged in and sxn'd her without even talking to her. She sxn'd her multiple times, and even instilled while the patient laid there patiently. Eventually after my preceptor loudly shouted to the nurse, "Can I get some sedation in here," the patient motioned to her clipboard and wrote a note saying, "Please leave me alone."
Anyway back to today. All of the ENT specialists (all 2 of them) are going on holidays so this patient was  airlifted to a bigger center today for closer monitoring by an ENT professional. Good choice. Cross this intubated patient off of our list.

Somehow this has taken all morning and I am just shoveling some salad into my mouth, when a code blue is called. As per custom, we all take off running down the hall. I lost all of the change from my pockets, but some nurse handed it into our office! So I have lost the change, and sprinted up a few flights of stairs, by the time we arrive I'm pretty much thinking they'll be coding me soon. The ICU staff turns to look at us and says, "Oh, we have this under control now." Great. No problem. However, we proceed to intubate (well assist anyway - for some reason the Docs really love doing their own intubations), and insert another artline. My preceptor is pretty freaking glad she had that practice one this morning since now a resident, the doc, the paramedics who have arrived to transport her to a cardiac center, and the transport RT are all staring at her. I totally am loving this whole time that I am being told to collect things, and run and grab things and I have no idea where any of this is. That really helps the idiot complex. Finally they take this patient away. We are back to one intubated patient!

We run over to the NICU to check on the baby.... and the NURSES have extubated. Well, whatever - this is just how they roll here.

After cleaning all of the dirty equipment (multiple vents, a bipap, and the baby vent) and doing all of the checkouts on them I think I had 30 minutes to sit down before shift change. Chaos, absolute chaos.

Semi Competent on the Drager Babylog


Mostly Competent on the Vamp Art-line System


Fully Competent  at consuming anything Tim Horton's.