January, 2010 Archive

January 25, 2010, 6:25 pm

Grand Rounds – the LOL Edition!

Welcome!  Grand Rounds Kitteh is IN!Welcome to the LOL edition of Grand Rounds!

I just adore the I Can Has Cheeseburger – LOL Cat site and the kittehs provide our background theme for the week.

This is a great place to announce that the finalists of the 2009 Medical Weblog Awards are now up at Medgadget!

This is also a great place to let you know that the Med/health bloggers will be meeting again at BlogWorld/New Media Expo 10 in Las Vegas, October 14 – 16, 2010! Put in those time-off requests, save up the dough because what happened in Vegas is going to happen again in Vegas (okay, maybe not the serenading at dinner…)!

And now, without further ado, our Feature Presentation!


CPR Kitteh is pretty excited there! And I’m excited to showcase the Editor’s Picks of the Week, right here!

Evybody Cleerz!This submission from Bongi at other things amanzi is devastating. Be ready for an emotional roller-coaster, from anxiety to fuming anger, in the dogs of law.

Nurse Me works in a heavy-duty trauma center. In a poignant story written during the holiday season, during a moment of repose, Nurse Me ponders Neglect.

Dr. Rob at Musings of Distractible Mind will be hosting Grand Rounds next week. This week, Inspiring makes it into the Editor’s Picks. Great story.

Kent from the ICSI Health Care Blog discusses Why Smart People Don’t Learn From Failures. Be sure to download the article by Chris Argyris. A fascinating study what keeps us from learning from our mistakes.

This post should be titled “Lauren gettin down wit her bad self!”. The actual title is Wheelchair Dance and I dare anyone to keep their fingers from tappin’ while they read! Lauren, you are truly a Novel Patient!


HIPAA kitteh neber tells

HIPAA kitteh may never tell, but I found out some new things this week!

Allergy Notes posts that you can get Food Hypersensitivity by Inhalation. (And only 8 foods cause 90% of food allergies!)

Fibro Mom at the Fibromyalgia Blog has some advice for daughter Dot, who is dealing with repercussions from an MVA three years ago: Dot! Don’t Just Lie There, You Could Die — Well, Sort of…

The Cockroach Catcher views the source of a common medication (while on a cruise!) in Chile: Salar de Atacama & Bipolar Disorder. Interesting!

Terri sends in a sober look at racial profiling in The Ghost of Nurse Aiko Hamaguchi. At Nurse Ratched’s Place.


Health reform kitteh is pooped out; a kitteh will take any excuse for a nap!

Breaking News - Healthcare reform kitteh exhausted...

David at HealthBlawg doesn’t think we need to wait for the Feds to start working on improving access, cost and quality of health care and he has the ideas to prove it in Holy Mackarel: Scott Brown, Health Reform Redux and What Can (Should) Happen Next.

Over at Health Business Blog, David Williams posts that Oncologists Care About Costs, noting “Oncologists are already taking cost into account in treatment, so we might as well encourage objective comparative effectiveness research.”

In a post near and dear to my heart, the Robert Wood Johnson Foundation’s User’s Guide to the Health Reform Galaxy Blog looks at one group whose voices and opinions should be a larger part of the health care debate: nurses! Lots of folks agree, check out Call to Action: Tapping Nurses’ Leadership and Expertise.


itz tiem for yor  consultashun

Does stroke mortality vary by what day the symptoms occur? Research studies show opposite findings, as the ACP Hospitalist discovers in Stroke: Is There a Weekend Effect or Not?

Ever heard of Gaucher’s Disease? Me, neither. But it is rare, and treatment is breathtakingly expensive. Henry from InsureBlog explains what it is, and how the Orphan Drug Act works to help its victims.

From the “This job is killing me!” department Clinical Cases and Images reports that Night Shift/Calls May Lead to Increased Risk for Cardiovascular Disease.

Will Meek, PhD, takes a complex process and renders it understandable as he breaks down therapy into the Four Questions of Counseling.


Hammy gets a  cat scanSpeaking of rodents, Dr. Charles writes about mouse sperm cooperation and segues into maximizing human male reproduction capabilities in Mouse Sperm Cooperatively Swimming Together and Other Thoughts. I may never look at Mickey the same way, again.

If you only “scan” one You Tube video this week, let it be this one, submitted by How to Cope With Pain. It’s Inspiration for Living With a Challenge. Stunning!

Laika from Laika’s MedLiblog notes you can “scan” the Cochrane Collaboration for evidence on disaster interventions in Cochrane Evidence Aid for Catastrophes Like Haiti’s Earthquake. Did you know quick debriefings are not helpful?


i haz boo boo  call amblance

Hey docs! You have to see patients ASAP, it’s the law! Sorry, having a hard time getting my mind around this one. Sounds like the ACP Internist is, too. Check out The Doctor Will See You Shortly – by Law.

Over at Nursing Student Chronicles, Laney gets the short end of the entitlement attitude stick at her PICU in What a Dirty *!?$@.

Oh, this is freaking hilarious! Precordialthump at Life in the Fast Lane offers a list of Signs of Imminent Admission. Be sure to click on the links for more LOL posting!

Doc Gurley wants to spread the wellth! No, that’s not a typo! Get the scoop at ACL Injury, Lung Cancer, Free Classes for Your Health: A Get Wellth Round-up! (P.S. If you watch TV shows on the computer, does that count towards your demise?)

Mark Surgical Site  ur doin it wrong

Alison at Shoot Up or Put Up is “pancreatically impaired” and, as she notes in Why Are Insulin Pens So Ugly?“, It’s not life saving stuff, but having an insulin pen that’s vaguely attractive really wouldn’t be hard to do and would be very nice to have.”

Speaking of surgery, NPs Save Lives at The Nurse Practitioner’s Place notes that she is already doing what a recent study recommends in Nurse Practitioner Ahead of the Game in Treatment of MRSA. Seems to me we were having pre-op patients shower with anti-bacterial soap way back in the late ’70s…


You ordered WHAT?  not in dis lifetiem, palIf you are sick enough to be in a hospital, you are sick enough to need IV access. Ah, but what kind of IV access? The Happy Hospitalist takes on Vein Light Technology and IV Access. Always provocative, never boring, Happy lists the hierarchy of IV starters ; )

I love The Muse, RN! Did you read that RWJF post on nurses a few links above? Well, so did she and here is her great response: Robert Wood Johnson Foundation Wants Me. And I concur with her conclusion!


And that’s it for this week’s Grand Rounds. Many thanks to those who submitted. Thanks to Nick at Blogborygmi for organizing (drop him an email if you would like to host!) and Dr. Val at Better Health for promoting Grand Rounds.

Next week, your host will be Dr. Rob at Musings of a Distractible Mind.

Thanks for reading!

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January 21, 2010, 1:23 pm

Change of Shift – Volume 4, No. 15

OffwhitelogoIt’s time again for Change of Shift, the bi-weekly nursing blog carnival!

It’s an eclectic selection this week: hospital to office, students and veterans, money and…well, poo-poo, disasters and preparedness.

Quick note: I have a “mailing list” that I use to mail out CoS notifications. If you are not on the list and want to be, drop me a line. If you are on the list and do not want to be, *sniff*, drop me a line!


Hmmm..it seems that NPs Save Lives has been hearing a few excuses lately! Learn How Not To Choke Your Non-Compliant Patients over at www.npplace.com.

The situation in Haiti is critical. Nurses are lining up, ready and willing to serve. But, as  the Muse, RN notes, there are  10,000 US Nurses Sign-Up for Haiti! Can’t Go. Find out why. Frustrating.

On a similar note, Shawn Kennedy writes a post giving Praise for Haiti Nurse Volunteers – and a Word of Caution. Important info, to be found at the American Journal of Nursing’s blog Off the Charts.


Laney at Nursing Student Chronicles has a new look and a great post on The Good and the Bad of nursing school. (They do uniform inspections?)

Thought your New Year’s Eve was exciting? Nurse Me can top that, easily! Check out Rave On, and see for yourself why I don’t work in a trauma center!

Dr. Dean at the MillionaireNurse.com Blog is right. I, for one, am totally clueless on my retirement info. Find out what you need to know in 401k 101: The Basics of Retirement Investing for Millionaire Nurses. Time to go look up my funds!


On her Medscape Blog, On Your Meds: Straight Talk on Medication Safety, Barbara Olsen gives a beautiful take on what patient safety actually means and how it has evolved. Check out Welcome Changes.

I have absolutely no doubt this story is true – chalk it up to two decades in an ER. Submitted by a co-worker of NYCRN, author of Pee and Sympathy: True Stories from an RN, I give you One Flew Over the Poo-Poo’s Nest. Seriously.

At Career Transitions and Other Nursing Topics, Laura at Nurse Connect discusses disaster preparedness on a personal level.  Living directly on the Hayward Fault gives me reason to agree that A Prudent Nurse is Always Prepared.


Keith from Digital Doorway takes time out from exploring the country (and dealing with aggressive Armadillos!) to submit The Demise of the Public Health Nurse. Sadly, I witnessed this first-hand during my community practicum last semester. Keith may be contemplating his “occupational navel”, but he describes it beautifully in Of Nursing and Soulful Employment.

Feeling a little restless at work? Not as happy as you used to be? Nurse Connect blogger Kathy discusses the possible reasons behind these feelings in Job Satisfaction, Have You Found Your Niche?

From the “Egg On My Face” department – in the last CoS, I told Max. E. Nurse from It Shouldn’t Happen in Health Care that if he stopped blogging I’d go down to Australia and punch him. He thanked me profusely….because he lives in the U.K! Seems Max has a new job and needs us to send him some blog love on The Flip Side…


TC at donorcyle is posting again! Still hard at work, this time from an office, she answers that all important question Mama, What Do You DO All Day? Responsible for 250 patients? I need a nap just reading the post!

At NurseZone, E’Louise’s RN Talk blog discusses Web-Based Medical Records: Dream or Nightmare? Weigh in with your opinion!

Student nurse Cassie, in her NurseZone blog Campus Corner, talks about opportunities for Volunteering for Student Nurses. She names a few, can you think of any more?


And that, my friends, concludes this edition of Change of Shift! Thank you for reading, thank you for linking and thanks to all those who submitted this week!

UPDATE: The next CoS will be over at RehabRN, so send submissions to “hotelrehab at nyms dot net”.

BTW, I’m hosting Grand Rounds on Tuesday, so post away and send ’em my way!

(Remember, Change of Shift now has subscription options; you can follow by email or RSS feed. An aggregated feed of credible, rotating health and medicine blog carnivals is also available. Many thanks to Walter Jesson at Highlight Health for setting those feeds up!)

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January 18, 2010, 12:58 pm

Anatomy of a Pain Shot

druggie:locThis has me stumped.

What on earth is she doing?

She is drawing something up from a spoon, I assume it is a medication.

But what?

I usually associate this sort of activity with heroin addicts, but obviously this is a clinical environment.

Okay, all you nursing historians out there…

What medication would need to be drawn up from a spoon instead of a vial or an ampule?



It’s carnival time at Emergiblog!

Not only is Change of Shift going to be here on Thursday, but I’ll be hosting Grand Rounds next Tuesday!

Nurses, get cracking for Change of Shift – I’ll be taking submissions until Wednesday night.

Those of you who forgot to submit last week, now is your chance for redemption!


For Grand Rounds, it’s all comers and submissions until Monday evening at 5 pm Pacific time!

There is no theme, I’m put one together out of the submissions that come in.

Click the “Contact” button to send your submission for either carnival!



Three days.

Out of pain medication and vomiting so you wouldn’t keep it down, anyway.


Emergency department.


You’re in luck – no one in triage!

A bed opens up, the nurse takes you straight to a room.

Gown, blanket.


Two minutes later you send your cousin out to ask how long it will be until you get your pain med.

Excuse me?


There is an unrealistic expectation of just how long it takes to get pain medication in an ER.

A few procedures that need to occur before that shot gets to its destination.

  • Registration – We must have the information. The admitting clerk is not trying to hassle by asking for your address and birthday and ID.? We need that information to officially identify our patients when we give medication.
  • Examination – There must be an evaluation by the physician or the nurse practitioner before medication can be given. There may be patients who arrived before you who have yet to be evaluated; there may be patients who arrived after you experiencing life-threatening issues. Either way, they will be seen first.
  • Orders – The physician/NP writes the order for your medication. Your nurse, also responsible for other patients, may be busy in another room. They will notice that medication has been ordered and take the chart to prepare the meds.
  • Medication Preparation – The nurse pulls the medications from the medication dispensing system. The medications are carefully drawn up and all syringes are labeled before they leave the med room. The nurse will bring them to your bedside.

And you get your shot.

It’s so basic, really. Organized. Logical.

But it is not instantaneous.

Nothing in the ER is instantaneous except CPR when you go into cardiopulmonary arrest.

So, understand that you will probably have to do a certain amount of waiting before you receive your pain medication. It’s okay to ask for an update if you aren’t sure of what is going on.

But at least let your cousin sit for longer than two minutes before you send him out to remind us that you are in pain.

We didn’t forget.

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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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