December, 2008 Archive

September 29, 2016, 10:56 am

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Amoxil 500mg pills $189.00 First of all, amoxil 500mg pills $189.00 I’m pretty sure that not a single curl on the top of her head is real hair.

Amoxil 500mg pills $189.00 She looks like a Tribble took up residence on her head, amoxil 500mg pills $189.00 and she is no Nurse Chapel.

Amoxil 500mg pills $189.00 How were you supposed to wear a cap on top of that?

Amoxil 500mg pills $189.00 Then again, amoxil 500mg pills $189.00 it could be hidden under that hairpiece.

Amoxil 500mg pills $189.00 What is tucked under her chin?

Amoxil 500mg pills $189.00 I can’t tell if it’s a deflated ambu bag or a sphygmomanometer!


Amoxil 500mg pills $189.00 This is a real photo of an actual nurse. Amoxil 500mg pills $189.00 It came from Life magazine and the nurse’s name is Nancy Archie, amoxil 500mg pills $189.00 circa 1970. Amoxil 500mg pills $189.00 The photographer was Bill Eppridge. Amoxil 500mg pills $189.00 Just for fun, amoxil 500mg pills $189.00 I looked to see if there was a nurse by that name licensed in Texas. Amoxil 500mg pills $189.00 No results found. Amoxil 500mg pills $189.00 She must have retired.


Amoxil 500mg pills $189.00 Don’t forget to check out this week’s Grand Rounds, amoxil 500mg pills $189.00 a very unique edition “At the Interface of Evolution and Medicine” hosted at Moneduloides.


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.

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“We have the technology. Amoxil 500mg pills $189.00 We can make him better, amoxil 500mg pills $189.00 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, amoxil 500mg pills $189.00 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….

Average Rating: 4.9 out of 5 based on 183 user reviews.

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September 29, 2016, 9:09 pm

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Average Rating: 4.9 out of 5 based on 168 user reviews.

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September 29, 2016, 1:53 pm

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Augmentin 250mg pills $135.00 Here is another in the series of “IVs and the Nurses Who Love Them”.

Augmentin 250mg pills $135.00 First things first: the cap is definitely a 10/10 on the Emergiblog Cap Rating Scale. Augmentin 250mg pills $135.00 I do notice a bit of “occipital slip”. Augmentin 250mg pills $135.00 The cap should be visible at the top of the head when the wearer is standing in front of a mirror.

Augmentin 250mg pills $135.00 Then again, augmentin 250mg pills $135.00 this looks like a student so I shall cut her some slack.

Augmentin 250mg pills $135.00 This looks like a classic photo of “goldfish therapy”.

Augmentin 250mg pills $135.00 Either that or that’s a water balloon hanging up there.

Augmentin 250mg pills $135.00 It doesn’t even have a drip chamber!

Augmentin 250mg pills $135.00 (Check out the wall paper. Augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 merely an observation.

Actually, augmentin 250mg pills $135.00 it’s more a realization that hit me after a recent shift.

My jaw still hurts from hitting the floor.


In my county, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 they are allowed to divert non-emergent ambulances to another facility.

It can help somewhat, augmentin 250mg pills $135.00 but it isn’t perfect. Augmentin 250mg pills $135.00 Any cardiopulmonary arrests or life-threatening situation still go to the nearest hospital, augmentin 250mg pills $135.00 even if they are “diverting”. Augmentin 250mg pills $135.00 And of course, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 with patients who had been there 3-4 hours and 3-4 triages in the wings.

It was one of those situations. Augmentin 250mg pills $135.00 Everyone who walked in had a serious medical issue. Augmentin 250mg pills $135.00 Abdominal pain was the theme of the day.

Augmentin 250mg pills $135.00 Every patient required a substantial work up. Augmentin 250mg pills $135.00 Tests were coming back positive for everything from appendicitis to ovarian cysts, augmentin 250mg pills $135.00 bowel obstructions to pancreatitis, augmentin 250mg pills $135.00 severe gastroenteritis to Crohn’s flare ups. Augmentin 250mg pills $135.00 Patients were requiring admission, augmentin 250mg pills $135.00 surgery, augmentin 250mg pills $135.00 pelvics, augmentin 250mg pills $135.00 ultrasounds, augmentin 250mg pills $135.00 CT scans, augmentin 250mg pills $135.00 lab work, augmentin 250mg pills $135.00 EKGs, augmentin 250mg pills $135.00 multiple doses of IV narcotics, augmentin 250mg pills $135.00 IV anti-emetics, augmentin 250mg pills $135.00 IV antibiotics, augmentin 250mg pills $135.00 and IV anti-fungals

Augmentin 250mg pills $135.00 Interspersed throughout this scenario were patients whose lungs decided that an oxygen saturation of 80% was a good idea, augmentin 250mg pills $135.00 or who needed multiple sutures to piece them back together after head/knee/arm vs. Augmentin 250mg pills $135.00 cement/table/knife.

Augmentin 250mg pills $135.00 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). Augmentin 250mg pills $135.00 He’s calm, augmentin 250mg pills $135.00 friendly, augmentin 250mg pills $135.00 unflappable and a great doc on top of it.

We do not get overwhelmed easily, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 our third nurse was off duty. Augmentin 250mg pills $135.00 Now we were down to two nurses. Augmentin 250mg pills $135.00 No dedicated triage nurse. Augmentin 250mg pills $135.00 No dedicated charge nurse. Augmentin 250mg pills $135.00 No nurses to call in for back up.

We were so out of ratio it was pathetic. Augmentin 250mg pills $135.00 We told the supervisor we were both filling out “Assignment Despite Objection” forms and we never ask for those. Augmentin 250mg pills $135.00 It was that busy and the patients were that sick.


We maintained a full department until around 0530 that morning, augmentin 250mg pills $135.00 when we went off divert.

So we had a solid six hours of non-stop running. Augmentin 250mg pills $135.00 No breaks, augmentin 250mg pills $135.00 no meal, augmentin 250mg pills $135.00 no bathroom, augmentin 250mg pills $135.00 and worse, augmentin 250mg pills $135.00 no coffee!

When we advised that we were going off divert, augmentin 250mg pills $135.00 our doc said something that floored me.

He said, augmentin 250mg pills $135.00 and I’m paraphrasing, augmentin 250mg pills $135.00 that he figured we knew when we were overloaded so he let us (the nurses) decide when we needed to go on divert, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 if there was any question, augmentin 250mg pills $135.00 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. Augmentin 250mg pills $135.00 We place the chart in the to-be-seen pile.

The ER doc examines the patient, augmentin 250mg pills $135.00 decides what tests to order or confirms the tests we have already initiated per protocol, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 the continual reassessment of vital signs and symptoms? The placement of the IVs, augmentin 250mg pills $135.00 the drawing of the labs, augmentin 250mg pills $135.00 the placing of the foley catheters, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 warm blankets, augmentin 250mg pills $135.00 more pain medication, augmentin 250mg pills $135.00 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, augmentin 250mg pills $135.00 in the doctor’s eyes, augmentin 250mg pills $135.00 we weren’t that busy and he could have easily done more.

While we shared the same space, augmentin 250mg pills $135.00 we were definitely working in parallel universes.

And that’s when it hit me. Augmentin 250mg pills $135.00 It’s something I fundamentally knew, augmentin 250mg pills $135.00 but had never heard it so clearly stated.

Nurses are from Mars and doctors are from…

…some other galaxy all together.

Either way, augmentin 250mg pills $135.00 we don’t see this world through the same eyes.

Average Rating: 4.8 out of 5 based on 294 user reviews.

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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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