December, 2008 Archive

July 23, 2016, 10:56 am

ED Trial Packs Stendra 100mg + Cialis 20mg 50 $184.00

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 What on earth is going on here?

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 First of all, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 I’m pretty sure that not a single curl on the top of her head is real hair.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 She looks like a Tribble took up residence on her head, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 and she is no Nurse Chapel.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 How were you supposed to wear a cap on top of that?

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Then again, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 it could be hidden under that hairpiece.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 What is tucked under her chin?

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 I can’t tell if it’s a deflated ambu bag or a sphygmomanometer!

*****

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 This is a real photo of an actual nurse. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 It came from Life magazine and the nurse’s name is Nancy Archie, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 circa 1970. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 The photographer was Bill Eppridge. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Just for fun, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 I looked to see if there was a nurse by that name licensed in Texas. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 No results found. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 She must have retired.

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

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Don’t forget to check out this week’s Grand Rounds, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 a very unique edition “At the Interface of Evolution and Medicine” hosted at Moneduloides.

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Oh no…

That’s what you said.

That was the last thing you said.

After you had told me a joke and

Assured me you were not in pain.

Never knowing you were thisclose to death.

But I knew.

We all knew

And there was nothing I could do to stop it.

*****

Oh no…

That’s what you said as

Everyone rushed to hit their marks on the stage of the drama that is life

And death.

“E.R.” indeed. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 “The Six-Million Dollar Man.”

“We have the technology. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 We can make him better, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 stronger.”

We have the technology.

But you needed time.

And time waits for no man.

*****

Oh no…

That’s what you said as

Your eyes flew open wide and your expression…

Surprise? Shock? Fear? Dread?

I had seen that look before on the face of my grandfather who looked me straight in the eyes

As he went into V-tach.

And died.

*****

Oh no…

That’s what you said.

Before the compressions and the defibrillations and the compressions and the intubation and the compressons and

The convergence of decades worth of medical experience surrounding you and the nurses frantically grabbing the equipment for three physicians at once for the insertion of lines into vessels that were useless

And those infernal compressions.

CPR can seem so violent.

So intrusive.

Without hope.

*****

Oh no…

That’s what you said.

Before you died.

I’ve never felt so helpless in the face of death.

I know there was nothing that could have been done even though everything possible had been done and yet

I can’t shake it off, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 even after all this time.

*****

Critical stress debriefing.

We don’t have it at my hospital.

Maybe it’s just another term for “mourning”.

Mourning a man I never knew until that night.

Mourning that began

When you said

Oh no….

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July 23, 2016, 9:09 pm

Floxin 400mg Pills $125.00

Haridra 60 tablet bottle $56.00 A day late and one respiratory virus after the fact, haridra 60 tablet bottle $56.00 I’d like to thank Mother Jones over at Nurse Ratched’s Place for hosting the Christmas edition of Change of Shift!

Haridra 60 tablet bottle $56.00 This week, haridra 60 tablet bottle $56.00 Curious George takes us on a visit to a children’s hospital, haridra 60 tablet bottle $56.00 with posts cleverly woven into the fabric of the story.

Haridra 60 tablet bottle $56.00 The first edition of Change of Shift for 2009 will be hosted by our favorite flight nurse, haridra 60 tablet bottle $56.00 Crzegrl!

Haridra 60 tablet bottle $56.00 Send your submissions to “emily at crzegrl dot net”.

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

Haridra 60 tablet bottle $56.00 Oh my!
With everything going on this week I came a wee bit late to the Grand Rounds party, haridra 60 tablet bottle $56.00 but Walter over at HighlightHEALTH has put together a gorgeous holiday edition of the best of the granddaddy of medical blog carnivals.

Haridra 60 tablet bottle $56.00 But it gets better!

Haridra 60 tablet bottle $56.00 Walter has arranged for all the major health carnivals that rotate hosting duties to be syndicated by RSS!

Haridra 60 tablet bottle $56.00 You can subscribe to one, haridra 60 tablet bottle $56.00 two or all of these carnivals with just one click.  So if you’re hosting, haridra 60 tablet bottle $56.00 your edition will hit the feeds of everyone who subscribes!

Haridra 60 tablet bottle $56.00 What a great idea, haridra 60 tablet bottle $56.00 and many, haridra 60 tablet bottle $56.00 many thanks to Walter for setting this up!

Haridra 60 tablet bottle $56.00 Me?  I subscribed to the “MashUp”, haridra 60 tablet bottle $56.00 of course!  I want them all!

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July 23, 2016, 1:53 pm

Endep 10mg Pills $163.00

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Here is another in the series of “IVs and the Nurses Who Love Them”.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 First things first: the cap is definitely a 10/10 on the Emergiblog Cap Rating Scale. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 I do notice a bit of “occipital slip”. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 The cap should be visible at the top of the head when the wearer is standing in front of a mirror.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Then again, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 this looks like a student so I shall cut her some slack.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 This looks like a classic photo of “goldfish therapy”.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Either that or that’s a water balloon hanging up there.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 It doesn’t even have a drip chamber!

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 (Check out the wall paper. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 It’s early American Twilight Zone.)

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

Many thanks to Laurie Edwards at A Chronic Dose for including Emergiblog in last Tuesday’s Grand Rounds!

It’s a best-of-2008 edition, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 so be sure to check it out if you haven’t already!

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

Nurses and doctors do not perceive the emergency department in the same way.

This is not a knock on my medical colleagues, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 merely an observation.

Actually, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 it’s more a realization that hit me after a recent shift.

My jaw still hurts from hitting the floor.

*****

In my county, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 hospitals are able to go on what is called “ambulance diversion”.

This means if the emergency department is overloaded with patients and cannot safely take another at that time, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 they are allowed to divert non-emergent ambulances to another facility.

It can help somewhat, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 but it isn’t perfect. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Any cardiopulmonary arrests or life-threatening situation still go to the nearest hospital, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 even if they are “diverting”. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 And of course, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 there are always the patients who can walk in with a major STEMI (aka: heart attack).

But…it keeps routine ambulance traffic at bay until the department can safely handle another patient.

It’s something the night shift rarely has to invoke.

*****

This particular shift was different.

The department was full, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 with patients who had been there 3-4 hours and 3-4 triages in the wings.

It was one of those situations. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Everyone who walked in had a serious medical issue. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Abdominal pain was the theme of the day.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Every patient required a substantial work up. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Tests were coming back positive for everything from appendicitis to ovarian cysts, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 bowel obstructions to pancreatitis, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 severe gastroenteritis to Crohn’s flare ups. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Patients were requiring admission, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 surgery, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 pelvics, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 ultrasounds, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 CT scans, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 lab work, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 EKGs, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 multiple doses of IV narcotics, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 IV anti-emetics, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 IV antibiotics, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 and IV anti-fungals

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Interspersed throughout this scenario were patients whose lungs decided that an oxygen saturation of 80% was a good idea, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 or who needed multiple sutures to piece them back together after head/knee/arm vs. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 cement/table/knife.

Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 It was busy.

*****

The shift started with three nurses and an ER tech who work hard and work well together.

The doctor on duty was a great guy (and I’m not just saying that because my co-workers know I blog). Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 He’s calm, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 friendly, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 unflappable and a great doc on top of it.

We do not get overwhelmed easily, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 but we were overwhelmed that night.

We approached the doc and told him we were going on divert unless he had any objections.

He didn’t and we diverted.

*****

One caveat of the diversion policy is a six hour limit in a 24 hour period.

This means we don’t divert unless we have to and we divert sparingly.

We used a considerable chunk diversion time that night.

*****

At 0330, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 our third nurse was off duty. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 Now we were down to two nurses. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 No dedicated triage nurse. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 No dedicated charge nurse. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 No nurses to call in for back up.

We were so out of ratio it was pathetic. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 We told the supervisor we were both filling out “Assignment Despite Objection” forms and we never ask for those. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 It was that busy and the patients were that sick.

*****

We maintained a full department until around 0530 that morning, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 when we went off divert.

So we had a solid six hours of non-stop running. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 No breaks, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 no meal, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 no bathroom, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 and worse, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 no coffee!

When we advised that we were going off divert, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 our doc said something that floored me.

He said, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 and I’m paraphrasing, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 that he figured we knew when we were overloaded so he let us (the nurses) decide when we needed to go on divert, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 but if anyone asked him why we were on divert for five hours he would shrug his shoulders and say he could have taken care of another patient.

Essentially, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 if there was any question, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 it had nothing to do with him.

Excuse me?

It’s a good thing I like this guy or I’d have smacked him upside the head.

*****

Let me state this diplomatically.

The nurses do the triaging of the patient and the rooming of the patients. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 We place the chart in the to-be-seen pile.

The ER doc examines the patient, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 decides what tests to order or confirms the tests we have already initiated per protocol, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 and then walks out of the room and onto the next patient.

All those orders that he writes?

They are carried out by the nurses.

The questions and requests from patients and family members? The continual assessment of the patient’s response, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 the continual reassessment of vital signs and symptoms? The placement of the IVs, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 the drawing of the labs, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 the placing of the foley catheters, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 the insertion of the NG tubes? The endless documentation of everything that goes on with the patient while they are in the ER? The running for ice chips, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 warm blankets, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 more pain medication, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 more nausea medication? The written report required before admission?

These are all done by the nurses.

*****

So while the nurses (and tech and secretary) were running our butts off trying to meet the needs of multiple sick patients for the entire shift, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 in the doctor’s eyes, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 we weren’t that busy and he could have easily done more.

While we shared the same space, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 we were definitely working in parallel universes.

And that’s when it hit me. Ed trial packs stendra 100mg + cialis 20mg 50 $184.00 It’s something I fundamentally knew, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 but had never heard it so clearly stated.

Nurses are from Mars and doctors are from…

…some other galaxy all together.

Either way, ed trial packs stendra 100mg + cialis 20mg 50 $184.00 we don’t see this world through the same eyes.

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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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