January, 2007 Archive

January 9, 2007, 10:33 am

Food For Thought At Grand Rounds!

fruit

In honor of all the chocolate I consumed during the holidays, I present this photo of healthy food for perusal.

Food, it all shapes, forms and composition (or decomposition, for that matter) is the theme for this week’s Grand Rounds, scrumptiously hosted by Dr. John LaPuma at Dr.John LaPuma dot com!

So, grab that cup of coffee along with your morning bagel, for today we can eat, drink and be entertained at the same time!

Thanks for hosting, Dr. John!

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January 7, 2007, 9:41 am

A Meditation on Regurgitation

nose

Oh, now this is attractive!

One can only hope that one would use a different applicator for the nasal application than, say, for the rectal application.

Hmmm…

According to my Mac dictionary widget, catarrh means “excessive discharge or buildup of mucous in the nose or throat”.

How would one have rectal catarrh?

Isn’t that called diarrhea?

How would you know you have stomach catarrh anyway?

Just saying catarrh makes me feel like I’m coughing up a hairball!

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

How on earth is one able to tie in a “food” theme to working in the emergency department?

Well, it is true that every single patient in the ER wants a meal (after the commode and a glass of water), but you really can’t write an entire post on that!

And….we do hold the world’s record for shoving pizza down our gullets on those nights from hell when the only person who will deliver is from “Mr. Pizza Man”.

But no…I don’t think that’s too interesting.

But the theme for this week’s Grand Rounds is food!

What’s a blogger to do?

*****

Then, inspiration! It struck last night!

Or should I say it flowed…from both ends?

You see, the San Francisco Bay Area is in the throes of a vomiting/diarrhea epidemic of, well, epidemic proportions. And what are vomiting and diarrhea but the products of, you guess it! Food!

We in the ER are privy to food in the post-production, post-consumption phase. We see food in every way, shape, form, color and smell you can imagine (and some you wouldn’t want to!)

I have just returned home from a night shift full of food in varying stages of digestion.

The fact that I am sitting here two hours after my shift

  • having shed my uniform at the door,
  • dived into a hot bath with antibacterial soap and
  • washed my hair…

… and still smell the gastrointestinal buffet presented to me last night has put me into a meditative frame of mind.

Join me as I contemplate the regurgitation and prodigious elimination of food in the ER.

*****

I think we all should buy stock (no pun intended) in Campbell’s soup, because I do believe everyone in my county of employment had the Chunky Chicken version for dinner.

I know because they all gave it back to me.

Everybody vomited the same bright yellow color, the same chunky texture, and the colorful vegetables with the same smell. Everyone except the little boy who supposedly had tuna casserole for dinner but threw up macaroni and cheese. He may have been saving his up since lunch.

They call it the “flu”. I think I would call it the “spew”.

And then there are the different styles of regurgitation of. We have:

  • The Dribbler: this person just lets the reappearance of the last meal dribble down their chin without expending a lot of effort. This is the only person an emesis basin works for.
  • The Projector: this person will saturate their socks with the remnants of their last meal without getting a bit on their sweat pants. No basin works for this person unless it’s at the foot of the bed.
  • The Puffer Fish: this person is able to hold the regurgitated food in their ever-expanding cheeks until you give them a large basin at which point they will proudly display their achievement for your assessment and evaluation. I saw productions tonight that should have gotten standing ovations.
  • The Dry Heaver: this person tries so hard to produce anything of a semi-digested nature, but they are so dry they can’t even give you a hint of bile in the basin. You almost want to give them Campbell’s Chunky Chicken soup so they can at least have a chance at competing in the World Emesis Championship.
  • The Two-Fer: this person goes for the gold by giving not only a world-class emesis, but prodigious diarrhea at the same time. This usually occurs after doses of Zofran and Phenergan and most likely just as you begin to transport the patient to their room after waiting five hours for a bed assignment. These patients are 99.9% likely to be bedridden, requiring two nurses to clean them up, resulting in another two-fer.
  • The Starbucks Throwback: these coffee ground emesis givers are troublesome in that they usually require an NG tube to assess for bleeding. Which is silly because if they just threw up coffee grounds, there’s trouble in Gastric City and you don’t have to go looking for more!
  • The Cough and Urp: these patients are pediatric in nature and are rushed in by their parents for repetitive vomiting. With a bit of careful investigation, along with observing the child vomiting on your stethoscope while assessing respirations, you realize the child is experiencing post-tussive vomiting secondary to gagging on their copious respiratory secretions. While not officially related to the intake of food, you do get to see what curdled breast milk looks like and so it is included in this overview.
  • The Non-Chewer: this producer of stomach contents does not chew their food and so you will see entire florets of broccoli floating in a sea of intact shrimp with a bit of parsley for decoration. It’s impossible for them to aspirate as the expelled food is too large to fit in the trachea.
  • The Bottomless Pit: this patient puts out more in one emesis than a normal person eats in an entire day and repeats the performance at least three times! No wonder they are sick – their stomach is like an overfilled helium balloon.

So there you have it. The various and sundry ways in which perfectly good food is turned into a gut-churning experience.

This is how we experience food in the emergency department.

Consumed, semi-digested and returned with enthusiasm.

Luckily when it comes to the “other” end, people are more private about their production.

Don’t even get me started on that!

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January 4, 2007, 11:23 am

The Sweet-and-Low Bowl

nd

Well, that was a bitter-sweet ending to the Irish football season.

I’ve never seen an offense shut down like ND was shut down last night.

That was the bitter part.

The sweet part was looking back at all the fun I’ve had rooting for Notre Dame this year and how much fun I’ll have watching Brady Quinn and Jeff Samardzija in the NFL next year.

It will be whole ‘nother team next year and I’m sure I’ll find my favorites, but I will miss this team.

Go Irish!

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I swear, Journey changes band members more than most people change their underwear.

They’ve announced Jeff Scott Soto as their new lead singer.

The man is a dynamic singer with one hell of a stage presence.

I’m excited about the announcement, but will miss Steve Augeri, who had the awesome task of taking over after Steve Perry and did it with class and elegance.

What does this have to do with nursing?

Nothing!

But….woman does not live by nursing alone!

Ya gotta have some football and rock-and-roll in your life, ya know?

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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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