September 25, 2016, 8:46 pm

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The topic is as appropriate now as it was then.

******************************

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20 Comments

  • Andrew
    Andrew

    November 28, 2006 at 10:48 pm

    when i was working in the field up in the mountains, the local ER MD’s treated the medics and EMT;s like crap. I really appreciate the way the our ER treats the medics and EMT’s because i have been in their shoes.


  • Dr. A
    Dr. A

    November 29, 2006 at 4:23 am

    Congrats on finishing! I know I couldn’t have done that. Great job!


  • Deacon Barry
    Deacon Barry

    November 29, 2006 at 4:40 am

    Way to go! 50K words in a month! Well done.


  • john cowart
    john cowart

    November 29, 2006 at 5:25 am

    Great news about your book!
    I’ll bet Stephen King is loosing sleep worried that you’ll bump him off the best seller list.


  • Susan
    Susan

    November 29, 2006 at 6:47 am

    I can’t believe you did it! Good job, buddy!


  • Mama Mia
    Mama Mia

    November 29, 2006 at 7:55 am

    Absolutely. What a terrific post. I’d like to copy and paste it in the emergs that I work in, if you are ok with that…


  • Mama Mia
    Mama Mia

    November 29, 2006 at 8:20 am

    Oh, and I can’t wait to read your novel…


  • Candy
    Candy

    November 29, 2006 at 8:29 am

    Good for you!! I’m very impressed — I started last year, but never got past 10,000… I’m anxious to read this, too.

    Now go get a latte and listen to some Trans-Siberian Orchestra!


  • PaedsRN
    PaedsRN

    November 29, 2006 at 2:30 pm

    Congratulations 🙂


  • Cathryn Domrose
    Cathryn Domrose

    November 29, 2006 at 4:48 pm

    Dear Kim,

    Congratulations on the book. Writing is hard work!

    I’m sorry to hijack your comments, but I don’t know any other way to contact you. I’m working on a story for Nursing Spectrum about nurses on the net, that includes a section on blogging. Basically the story is for nurses fairly new to the net, and the blogging section would offer tips on starting blogs, how to get the blog noticed, what common mistakes to avoid, why blog at all, etc. Since what I’ve read of your posts shows you are extremely interested in getting other nurses to blog, I thought you would be a good person to talk to for this.

    Thanks for any help you can give me.


  • Jodi
    Jodi

    November 29, 2006 at 6:39 pm

    That’s awesome Kim! Let me know when it hits the bookshelves eventually (I’m sure it will) …I’d love to buy it.


  • TuxBaby
    TuxBaby

    November 29, 2006 at 6:51 pm

    Woohoooo! Congratulations! That is quite a feat- and quite the accomplishment!

    ~TuxBaby


  • TuxBaby
    TuxBaby

    November 29, 2006 at 6:57 pm

    And in my excitement about NaNoWriMo, I forgot to add my comments about the Medics. I worked as a Medic before I became a nurse- and I absolutely LOVED the job. I actually love it more than being an ER nurse in many ways- but unfortunately, the pay doesn’t even compete with nurse’s pay. If I ever reach a point where money doesn’t have a claim on me (how do you get these bills to stop coming in?!?), I would probably love working the MICU world again.


  • mcewen
    mcewen

    November 29, 2006 at 9:41 pm

    I think it’s cheating to dig out old stuff, what a nerve! What a good idea! Congratulations on the book [or is that now block?]
    BEst wishes


  • glorified taxi
    glorified taxi

    November 29, 2006 at 10:56 pm

    I only see one big problem. And that is that there is very little peer reviewed literature that shows that what the EMS system does is beneficial or cost effective. For example, the evidence shows that intubation in the field for every demographic leads to more harm than benefit. For most things what is done in the field just doesn’t matter even in trauma or in those that are really sick. Don’t get me wrong I treat the medics with respect and admire what medics do, it is just that the importance of EMS has not been validated by science.


  • howdy
    howdy

    November 30, 2006 at 2:49 am

    Thanks for the props regarding medics, I’m an undergrad math major in medic school right now and having a friendly nurse to work with in unfamiliar ER’s during clincal shifts makes a world of difference. I was absently chatting with one of the docs on call last night and he confided in me that he laughs whenever nurses ask him to take a shot at getting a line in a patient who is a difficult stick. He remarked that if any of the experienced nurses can’t get a line in, then he knows he doesn’t stand a snowballs chance in hell at getting one started either. And when it comes down to such dire straits, they know to track down the flight medic/nurses who are stationed at our hospital, if they can’t get one in, then central line here we come.

    And regarding glorified taxi above, I merely point out that 1) emergency rooms are not cost effective either given that only 30% of patients actually pay their bill, 2) not every demographic displays more harm than benefit in regards to intubation 3) if early access to ACLS and electrical therapy (need I point out that every minute in vfib reduces the chance of a meaningful recovery by 10%, acls 2005), or proper C-spine immobilization precautions are considered unvalidated by science, I’d love to see your studies.

    That said, we transfer far too many hobos, addicts and drunks to ever get much r.e.s.p.e.c.t. anyway.


  • PixelRN
    PixelRN

    December 1, 2006 at 5:29 am

    To glorified taxi:

    So there’s not enough peer reviewed evidence to show the benefits of the EMT system… Perhaps we should get rid of it? I shudder to think.

    There is peer reviewed evidence and there is common sense. Both are valuable, but one should not replace the other.

    To Kim:

    Congrats on the novel! Again I ask myself, how on earth do you have time to do everything you do? I want to know your secret; and don’t tell me it’s starbucks. I drink that too….Anyhow sign me up to purchase a copy when it is available!


  • glorified taxi
    glorified taxi

    December 1, 2006 at 8:21 am

    Howdy,

    The profitability of ER’s depends on how the accounting is done. They may “lose” money on care provided in the ED, but considering it is the entry way for most admissions to the hospital (and therefor downstream revenue)they are absolutely vital the the financial health of the institution.

    Study after study (peds, adults, trauma) that is coming out looking at the issue show harm in prehospital intubation. Sure there are instances where it is vital, like rural long transport times. But the “multiple attempts in the field” leading to aspiration is increasing harm in most settings.

    Cardiac arrest and ACLS (which incidently, is also sorely lacking in research and hard evidence) is maybe 1-5 % of all ambulance runs. Considering less than 5% of “out of hospital” cardiac arrest leave the hospital alive, and even less neurologically intact, it is for the most part a bunch of hoopla.

    C-spine immobilization has become another farce. Yes, it is appropriate in many situations, but now it is done ALL THE TIME for mild trauma, seizures, falls, etc. If the neck didn’t hurt before being strapped to the board, it certainly will after a ride tied down. Fractres are found in less than 2% of those that recieve imaging. How many thyroid cancers are causing 3 decades later with radiation? Who knows?

    Pixie,

    What we think as common sense should also be scrutinized. As one example, common sense told us we should give HRT to postmenapausal women to lessen CV risk. Now that has been turned on its head. Common sense would say that the EMS system saves lives, but the science, data, numbers to prove it is very very piddly.


  • Kim
    Kim

    December 1, 2006 at 4:51 pm

    Interesting dialogue!

    As long as an airway can be maintained and oxygenation provided en route, intubation would not be necessary.

    In fact, I rarely see an intubation except in a cardiac arrest and the ones I do see are done appropriately (I can’t remember the last time I saw an ET in the wrong place…).

    I know in pediatrics the standard has changed to no intubation.

    Don’t even get me started on ACLS. I’ve been a nurse for close to 30 years and I’ve seen trends come and I’ve seen trends go. First it was all respiratory. Now it’s all cardiac. First it was five compressions to two breaths. Now it’s 15:2. First it was stop compressing to allow the breaths, now it is compress so damn fast you are out of breath after 2-3 cycles.

    My point is that today’s standards are tomorrows has-beens where studies and especially ACLS are concerned.

    Glorified Taxi, you might find it interesting to know that I work with an ER doctor who feels the exact same way you do re: pre hospital care! We’ve had many interesting conversations!

    I guess after three decades, you don’t take anything as gospel truth…. : )


  • […] OTHER FUN READS:Kim wants us to give it up for the paramedics! […]


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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