January, 2007 Archive

January 30, 2007, 10:35 am

Life, Liberty, the Pursuit of Grand Rounds and Other Interesting Tidbits!


God Bless Grand Rounds!

It’s hosted this week over at Envisioning 2.0 (nice job, Fard!).

Get this, the topic of the week is exactly what I have to write a paper on for my Leadership and Management class that is due February 11th.

Can you believe that? I now have access to twenty-four differing opinions from all over the blogosphere to draw from, all in one handy place.

How did I ever get through college without the internet back in the day?



Can I give you some really good advice?

Do not, under any circumstances, watch “The Sixth Sense” twice in one night and then walk through your house in the dark.

No, I didn’t see any dead people, but I swear I heard about fifty of them behind me.

I’m just sayin’.


Speaking of seeing things, Radiology Grand Rounds are up at Sumer’s Radiology Site.

I got to see a pneumomediastinum on film once. Totally cool! Not for the patient, of course but in the context of an educational experience. I can barely see air in lungs, let alone a mediastinum….


The vast majority of the ERs I have worked in did not insert arterial lines in the department. The patient would get them put in on arrival to the the Intensive Care Unit. Well, this week I assisted in the insertion of my first arterial line since the Reagan administration. The tubing still has that danged “piggy tail” thing for flushing. That seems so tenuous, like it could break off any time. One would think after all these years a more suitable device for flushing an art line would have been invented.


I have not gone deaf!

Seriously, my ability to auscultate lung sounds seemed to have dropped dramatically in the last few years I was afraid I might have lost the ability to hear some frequencies due to the decible level of the occasional (!) rock concert. I used to be able to hear a single rale from the doorway.

So, you can imagine my delight when my brand new Cardiology II stethoscope came in the mail and I used it on my first patient. Clear, concise breath sounds filled my auditory canals with joy! And it was even better when there was rhonchi and rales to hear! Got wheezes? Bring ’em on!

Totally cool. Not for the patient, of course, but in the context of being able to make an appropriate assessment.


Dr. Crippen hosts the best of the British Medical Blogs every Sunday.  Another good read with my morning coffee!

Change of Shift will be hosted at Nurse Ratched’s Place on February 8th.  Submission can go via Blog Carnival or directly to nurseratchedsplace at yahoo dot com.

Reminder: Nursing Jobs.org is offering $5000 in nursing scholarships via their essay competition.  You know why you went into nursing, right?  Well put it down on your blog, give it the title “Why I Chose Nursing” and send it in! First place is $3500 and that will cover a lot of units! The information is “below the fold” so scroll down when you get to the link!

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January 28, 2007, 1:03 am

Health Care is NOT an Entitlement


The “Fun-Tier”?

Were they serious?

Baylor actually sent out this paper “tower” of information on Texas!

They sent out a toy as a recruitment tool!

And it’s free for the asking! Just mail in the coupon!

As Will Smith said in “Independence Day”: “I gotta get me one of these!”


Notice that this particular nurse is suffering from the dreaded “occipital slip” of her cap.

Probably too busy playing with her toy to care!


Health care is not a right. Health care is a need, like water or food. And like water or food, it isn’t free.

Everybody should have health coverage, and each individual should have the opportunity to choose the health care they want from the provider they want.

Every individual needs to be responsible for purchasing their own health care and making sure their children are covered.

What follows is what I would consider a “best case scenario”. I don’t have all the answers and I may border on living in La-La land but this is what I would like to see.


What should a Health Care Insurance company be required to offer in their plans in return for premiums?

  • Full coverage for “Well Care” without deductibles
    • Yearly physical, well-baby checks and immunizations
    • Screening tests (mammograms, PSA levels)
    • Labs (liver function testing for statin use, A1C levels for diabetes)
    • Classes for patient education: smoking cessation, hypertension information, diabetes, diet and nutrition
  • Medications without a co-pay and without restrictions to a “formulary”.
  • Mental health care covered – including counseling and hospitalization as necessary.
  • Emergency and Hospital Care
    • Here is where any deductibles would come into play
      • The individual can choose the amount of their deductible for emergency care.
      • The individual can choose the amount of their deductible for hospital care.

The amount of the premium would be based on the number of people covered and the deductibles chosen. The maximum amount of the hospital deductible would be $10,000.

There should be no exclusion of pre-existing conditions and no lifetime maximum, thereby protecting people from catastrophic illness. Cosmetic surgery would not be covered unless required as the result of accident.

Each person is able to pick their own provider of health services, be it physician, nurse practitioner, chiropractor.

Health care decisions are made by the patient and their health care provider, free of outside influence.


Okay, there’s the foundation.

Now we need to pay for it.

I do not believe it is the government’s responsibility to actually purchase and provide health care, but there are things them government can do to facilitate the ability of individuals to do so.

In fact, I thought the recent proposals in the State of the Union message were a definite step in the right direction (hang in there with me, readers of the Democratic persuasion!). As I understood it:

  • Tax breaks for both individual and families to purchase health insurance offset by
  • Actually taxing employer-sponsored health benefits as income

Personally, I want the government involved as minimally as possible in my health care decisions. However, there are some situations where the government may be able to provide a “safety net” by providing a system of basic care, including mental health coverage to:

  • Those who are unable to work due to disability and therefore unable to receive the tax breaks, including children of the family affected.
  • The elderly who are unemployed or disabled.
    • Not every elderly person is poor or needs to have government health care, especially if they are receiving tax benefits that allow them to purchase private plans.
    • Not every older adult aged 65 needs Medicare, again if they are receiving tax breaks to purchase private plans.
  • Health care should be provided to all Veterans through the VA system as a benefit for having served their country in the armed forces.

I’m talking citizens of the United States, by the way. Children should never suffer, even if their parents are illegal aliens and should have access to immunization and health care. If you are an adult from another country in the US illegally, you shouldn’t be receiving one dime in benefits from this country. Access to health care, yes. But you pay for it.


This all means the health care insurance industry will now have to compete for the health care dollar.

If an individual has the ability the choose their health plan, the industry will have to become competitive. People will spend their health care dollars where the plans are competitive and the premiums reasonable.

Individuals can decide the amount of coverage they want and how much to spend on it. Younger people may choose a higher deductible as they are relatively healthier. They can add coverage as they get older and depend more on the health care system.

Individuals who (irresponsibly)choose not to have health insurance of any kind will pay the price in the form of what is popularly known as ” a bill” from the provider of the service.


In terms of how to spend the money obtained, I’ve said it before and I’ll say it again: the majority of the money should be spent at the level of primary care: Family practitioners, Internists, Pediatricians. Think prevention. Think basic care. Deal with potential health care problems BEFORE they become problems and money will be saved in the long run.

Make private practice attractive again by making it feasible to run a practice by paying what the service is worth and not a portion of what some bureaucrat thinks it is worth. Enact legislation to stop exorbant/frivolous lawsuits so malpractice premiums will drop.


As you have probably ascertained, I am not for a single-payer health plan. Frankly, I’ve never seen one that works. There’s the NHS in Great Britian, but I direct you to the NHS Blog Doctor for a good look at how THAT system works. Canada has national health care, but if I’m not mistaken there are waiting lists for procedures and surgeries.

Can’t imagine that would go over big here in the US, where people get upset if they have to wait an hour in the ER.

We have universal access. All you have to do is go into an ER and you MUST be treated whether you have insurance or not or whether you can pay or not. You cannot be turned away.

Most of the nursing organizations (and most of the readings in my Leadership and Management class) all promote the idea of a single payer system.

I don’t think it’s the government’s responsibility to care for a citizen from cradle to grave. I believe it is the government’s responsibility to help facilitate the individual citizen in obtaining needed services.

I believe that individuals citizens and their respective states need to take on at least some of the onus of paying for and maintaining a viable health care system that assists citizens with purchasing the health care of their choice.

Maybe someday it will be possible to do away with the employer-paid health care altogether. I’d rather have the money and be able to choose my own plan with my own provider.

Minimal government interference and individual responsibility.

That’s what I believe is the way to address health care in this country.

Because health care is not an entitlement.

(Let the bashing begin………)

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January 25, 2007, 5:55 pm

The Rules of “Emergency!”


“Hello, 911???”

“There’s a naked guy sleeping on a green blanket in the middle of the street!”


Obviously the medic with the blanket is initiating the “Butt Cheek Cover” maneuver.

The other guy is preparing to do an emergent cervical spine manipulation.

See what happens when you don’t wait to take your Ambien until you get home?


As I’m sure you’re all aware, working night shift is pure unadulterated hell and non-stop running from the time you run through the door until the time you drag yourself home at daybreak.


Okay, sometimes it’s not so busy.

Sometimes the CT is down and you can’t take any ambulance traffic.

Sometimes the last patient is discharged, the rooms are stocked, the drugs are ordered and the IV trays are all filled by 0100.

Sometimes you’ve read every nursing journal there is to read, have read over all pertinent policies and memos and have refreshed your memory on everything JCAHO could possibly ask should they pop in five minutes later.

(That was for the benefit of my manager……)

And once in a blue moon there is a laptop computer nearby.

A DVD-playing computer.



If you are now, or ever have been, involved in the EMS system in any capacity, you must get this DVD! Better yet, view it while you are sitting in an ER.

(Not that I would know what that’s like, of course.)

I laughed so hard, I had tears running down my cheeks.

No, it wasn’t meant to be a comedy, and was quite popular in its day. But viewed over thirty years later, it is one hilarious time capsule!

Here are the “rules” of “Emergency!” as ascertained by yours truly:

  • All firehouses must have ashtrays on every table.
  • All rescues involve a car, or a fall down into a ravine.
  • All scenes in the ER must have people in the background with gauze taped to their faces staggering around with a nurse at their elbow.
  • When confronted with a patient who you think may be drunk and collapses on you, leap over the body in your high-heeled nursing shoes and run down the hall, yelling.
  • “A defibrillator is not an aspirin.” (Per Dr. Kelly Brackett as told to Medics Gage and DeSoto)
  • When dealing with a woman who is having acute dyspnea with tachypnea,
    • do not put her in a gown,
    • do not auscultate her lungs,
    • do not take any vitals,
    • lay her supine on the gurney and have the head nurse look at her with concern while
    • two doctors stand to the side of the room and discuss the dangers of hyperventilation.
    • Have one doctor pull a paper bag out of nowhere and cure the patient with three breaths into the bag.
  • Dixie McCall, RN, has the BEST.CAP.EVER.
  • Approximately fifty percent of the nurses at Rampart Hospital went to the same nursing school as Dixie, as they are all wearing the same cap.
  • Dixie McCall, RN is forbidden to change her facial expression at any time during her shift.
  • There are only two rhythms you can have in the show: Sinus Rhythm or Ventricular Fibrillation.
  • CPR at Rampart Hospital consists of:
    • Dr. Bracket, Dixie McCall, RN and unidentified orderly. That’s it.
    • Five chest compressions, approximately 5 seconds apart
    • Placement of an ET tube that juts out from the patient’s mouth at a 90 degree angle (off camera).
      • There is no ambu bag attached
      • There is no respirator attached
      • There is no oxygen source attached
      • There is, however, an orderly with a huge afro looking on in a concerned fashion
    • Two defibrillatory shocks of 400 watt seconds each,
      • thereby frying the already dead heart and
      • everyone around the patient because Dr. Brackett does not yell “clear!”.
      • He never would have passed ACLS…
    • No response. Code called.
  • If you do survive being shocked at 400 watt seconds in the field,
    • you get 50mg of Lidocaine and two amps of Bicarb.
    • That’s after the medics get permission to start your IV,
    • which they don’t even set up for until they get the okay from Dr. Brackett,
    • who never seems to have a life outside the hospital
    • while Dixie poses at the nurse’s station waiting for the calls from the medics.
  • If you are a nurse on a ride-along with the medics, you wear a white pantsuit with white heels, your nursing pin and your name tag.
    • You do not take your cap.
    • You roll around in the mud in the ravine and you never even get a bit of dirt on your uniform.
    • You dive into a car balancing on the precipice of a hill to drag out a victim, hit your head and become unconscious.
    • After the commercial break, the bleeding laceration on your forehead is totally healed.
  • The only people sent out on any rescue call are two medics. That’s it. No engine company, no police, just Gage and Desoto in the ravine.
  • C-spine precautions must have been invented in the ’80s ‘cuz they are nowhere to be found in the repertoire of Rescue 51!
  • The only normal characters are Gage and DeSoto. Everyone else over-acts, under-acts or is a cartoon representation of real life.

I could go on and on, but you get the picture. I am now going to purchase the complete set of this series and I suggest you do the same.

You think “Scrubs” is funny?

You ain’t seen nothin’ until you’ve seen “Emergency!” from the vantage point of the 21st century.

But do yourself a favor and watch it with your co-workers.

You’ll be living off the laughter-induced endorphins for a week!

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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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