“Cheer up things could be worse. So I cheered up and sure enough things got worse!”
-Joseph Rudyard Kipling
From where I sit July is the perhaps one of the most dangerous months of the year to come to hospital. Regular readers will know why I say that because they are familiar with a previous post “Shiny Stethoscope Month”. But for those of you who have just joined us or are too lazy to read the offered link I refer to this particular month in such as fashion because this is the time of year when Clinical Clerks become Residents.
Now what this means to the uninitiated is that prior to July 1 the now first year residents who are now making so many big decisions about your stay in hospital not to mention your life where just a very short time ago clinical clerks who were not allowed to tie their shoes by themselves let alone make a decision. Suddenly in the best example of modern day survival of the fittest they have been tossed head first from the nest to become grownup doctors who have to start thinking for themselves. Now to be fair here I’m sure the transition is indeed a rough one for them and I do have some small sympathy for their plight.
That said however what this all means to both patients and nurses is that come the dawn of the morning of July 1 (Happy Canada Day) we all have to deal with a group of new “doctors” who for the most part lack confidence not to mention in a number of cases competence. Anyone still wondering why I suggest you stay the hell out of the hospital during the month of July if possible? From where I sit it's simple case of increasing your chances of survival. Let the latest round of kinks, bugs and numerous delays related to indecision get worked out of the system on someone else.
Here in Calgary though things go from bad to worse because unlike other places we have the privilege of a 2 for 1 deal in regards to the first weeks of July. You see in addition to the issues raised by new residents we also get to experience the fallout of the “World Famous Calgary Stampede”.
Now for those of you who are lucky enough not to know what that is; it’s a 10 day Rodeo that celebrates a number of things. Different people will tell you different things about stampede but from this humble Angy Nurse’s point of view it’s a 10 day drunken orgy where what would be normally classed as even more stupid behavior then usual is the norm. During stampede people that should be considered as fodder for the Darwin Awards are not only routinely encountered, but sadly tolerated with a shrug and the often muttered phrase of “hey it’s stampede”.
So with these two factors in mind let’s do a little math here:
New Residents + Huge numbers of Dumbass Drunks with trauma=Disaster!
Needless to say neither July nor stampede is my favorite time of year!
Even if I could get past the number of posers trying to pass themselves off as cowboys and cowgirls who quite frankly wouldn't be able to tell you what comes out of the south end of a north bound cow. I'd still have to deal with the new residents that are having a hard time dealing with normal patients lets alone the herds of even more drunk and stupid people than usual that are gracing us with their presence.
July in Calgary!
YaFU@KINGHooo
Wednesday, July 08, 2009
Thursday, July 02, 2009
Hang Time!
“The Knack of flying is learning how to throw yourself at the ground and miss!”
-Douglas Adams
Talking to a patient post car accident awhile back and of course I asked them the inevitable question “Do you remember what happened”?
Calmly the patient relates the details of the accident including the fact they were ejected from the vehicle.
Now that’s a serious accident no matter how you stack it. The fact that the patient seems orientated and talking to me rules out a serious head injury, something that given the mechanism of the accident is nothing short of amazing! Somewhat skeptical I ask the patient if they actually remember things or did someone tell them about it?
Again the patient cat calm looks at me smiles and says: “Remember it! Dude I got to a 3 one thousand count before I hit the ground…
If what the patient say is true that my friends is serious hang time not to mention a horseshoe up his ass!
In the end it seems the patient had some road rash and few other minor injuries.
Moral of this story wear a seat belt and don't play the odds of being ejected! This patient was very much the exception to the rule.
-Douglas Adams
Talking to a patient post car accident awhile back and of course I asked them the inevitable question “Do you remember what happened”?
Calmly the patient relates the details of the accident including the fact they were ejected from the vehicle.
Now that’s a serious accident no matter how you stack it. The fact that the patient seems orientated and talking to me rules out a serious head injury, something that given the mechanism of the accident is nothing short of amazing! Somewhat skeptical I ask the patient if they actually remember things or did someone tell them about it?
Again the patient cat calm looks at me smiles and says: “Remember it! Dude I got to a 3 one thousand count before I hit the ground…
If what the patient say is true that my friends is serious hang time not to mention a horseshoe up his ass!
In the end it seems the patient had some road rash and few other minor injuries.
Moral of this story wear a seat belt and don't play the odds of being ejected! This patient was very much the exception to the rule.
Wednesday, June 24, 2009
Anatomy of an accident
“Most accidents are anything but accidental”
-Author unknown
Work for more than a day or two in emergency and the evidence supporting my opening quote regarding “accidents” rapidly becomes obvious as well as numerous not to mention over whelming!
Now to be fair I will not for a moment deny that there are some “accidents” that are truly a conspiracy of improbable and coincidental events occurring simultaneously to nice people who were just minding their own business and just trying to go about their respective days. But the truth is and I’m sure most experienced Emergency nurses will agree with me is that very few “accidents” actually fall into that rarified category. The sad reality is that most” accidents” occur because one or more of the victims in said” accident” is engaged in at least one or even worse more than one of what I like to refer to as the six I’s of accidents.
Just what are the six I’s you may ask? Well they’re as follows:
1)Inebriation!
This one is the most common factor and a bit of a no brainer. You’ll often hear it used as almost a justification of sorts. Someone will try to tell you that the “accident” was caused by someone who was possibility under the influence of alcohol at the time in question. Summed up in less politically correct terminology and the manner I’m fond of is BULLSHIT! Some asshole was either three sheets to the wind, hammered or just plain shitfaced that he/she hurt either themselves or some of the aforementioned nice people who were just minding their own business and just trying to go about their respective days because jerk wad was so soused that he/she could barely speak let alone walk upright or drive a car let alone engage in whatever activity they were doing when said accident happened.
Inebriation to my mind is one of the biggest causes of “accidents” I can think of.
2)Intelligence!
Actually I’m referring specifically to a lack of intelligence here, or put simply idiocy! This factor not only includes the persistent failure by some to plan something through, but also covers delusions of competency in activities that certain people shouldn’t have been doing in the first place. Also in this factor the intelligence or lack thereof can be as previously mentioned an ongoing occurrence or in some cases a situational lapse. Either way people in this category for the most part have IQ’s at least in regards to the events leading up to said “accident” that make Forest Gump look like Albert Einstein.
One can of course argue that inebriation can contribute to a lack of intelligence (idiocy) issues which is sometimes the case. But don’t fool yourself! The lack of intelligence (idiocy) on its own causes almost as many “accidents” as inebriation.
3)Indifference!
The sad truth is that some people just don’t care about anything but themselves. Now I’ll concede that being self centered is a survival characteristic in certain circumstances. But those occasions aside they types I’m referring to here are those people who seem to think the rest of the world exists to serve them and everyone should just get out of the way because no one is as important as they are no matter what. These are the type of people who are likely to tell you that if you don’t like their driving stay of the sidewalk and actually mean it. They are also the types who barge to the head of a triage lines demanding care for their boo boo post accident not even stopping to thing the 5 people they just ran into might need our help a little more.
4)Indecision
Hesitation kills! It’s a simple fact. If you pause at the wrong time to make a decision or you’re the type who simply can’t decide anything than sooner or later something bad is going to happen to either you or the aforementioned nice people who were just minding their own business and just trying to go about their respective days. I often am staggered as to the amounts of hesitation people display even when dealing with the simplest situation. Take a look at people at an automatic cashier in a store or an ATM sometime. Far too many of them look like they’ve just been suddenly asked to calculate a rocket trajectory for the mars mission instead of punching in their friggin 4 digit pin number. Now consider what will happen when you put the same people in a really stressful situation where the decision making skills and reflexes of a fighter pilot are required like say driving a car in traffic. Poof! Instant deer in the headlights with the obvious implications.
5)Inattention
Most people walk around with their head up their butts. Cell phones, texting, mp3 players are just a few of the distractions that people routinely and voluntarily utilize to place their lives in danger. Now I’m not suggesting for a moment that people shouldn’t use these types of devices but when they do, they should be aware that there is a better then odds chance that they are now unaware of their surroundings and potential hazards. Discretion is the rule and people just don’t get that you need to be more attentive while you’re enjoying your music. It’s as simple as look! Of course for most people that’s far too much trouble and a result they will trip and fall, walk into traffic or run afoul of an obvious hazard that had if they had been paying attention in the first place wouldn’t have even been a threat to them.
6)Indestructibility
While more dominant in younger people, don’t fool yourself for an instant. It’s not just the teenagers who seem to think that they can’t be harmed no matter what they do. Foolish assumption to say the least! Trust me when I tell you if you run out in front of a fast moving car you will be hurt when it hits you. It’s simple physics. The car will not bounce off of you; you will bounce off the car. If you don’t wear a seat belt you can and will be ejected through the windshield in an accident and get to experience firsthand the joys of sudden deacceleration trauma. Despite what many seem to think people are not Superman or Hancock and should stop acting like they are. But of course try and tell them that and you get the usual we just want to have fun, or I’m entitled to do what I want. To that I say so you are, but be sure you are ready to pay the margin when it gets called.
In the end it’s easy to see that individually each of the 6 I’s can cause accidents. Worse is when the 6 I’s begin to combine and work together the odds of something going wrong also begins to increase at a geometric rate. Many people who know me would point out that I have suffered from some; if not all of the 6 I’s both individually and in combination at one point or another in my life. They’re right when they say it. But in response to that very correct accusation I will tell you what I used to tell the junior high students we’d tour through our ER in the PARTY program (Prevent alcohol risk related trauma in youth):
“I’m not standing here because I’m good looking, intelligent, well educated and well trained. I’m standing here because I got lucky. Anything you’re thinking about doing to be cool, I’ve been there; done it; got the tee shirt, the scars not to mention photo’s as well as a dead friend or two to prove it. I’m standing here because I got lucky! No other reason”
Take my word for it lady luck is fickle! Don’t play those odds and avoid the 6 I’s as much as you can. Forewarned is forearmed and the last thing you want to do is to wake up with me as your nurse.
-Author unknown
Work for more than a day or two in emergency and the evidence supporting my opening quote regarding “accidents” rapidly becomes obvious as well as numerous not to mention over whelming!
Now to be fair I will not for a moment deny that there are some “accidents” that are truly a conspiracy of improbable and coincidental events occurring simultaneously to nice people who were just minding their own business and just trying to go about their respective days. But the truth is and I’m sure most experienced Emergency nurses will agree with me is that very few “accidents” actually fall into that rarified category. The sad reality is that most” accidents” occur because one or more of the victims in said” accident” is engaged in at least one or even worse more than one of what I like to refer to as the six I’s of accidents.
Just what are the six I’s you may ask? Well they’re as follows:
1)Inebriation!
This one is the most common factor and a bit of a no brainer. You’ll often hear it used as almost a justification of sorts. Someone will try to tell you that the “accident” was caused by someone who was possibility under the influence of alcohol at the time in question. Summed up in less politically correct terminology and the manner I’m fond of is BULLSHIT! Some asshole was either three sheets to the wind, hammered or just plain shitfaced that he/she hurt either themselves or some of the aforementioned nice people who were just minding their own business and just trying to go about their respective days because jerk wad was so soused that he/she could barely speak let alone walk upright or drive a car let alone engage in whatever activity they were doing when said accident happened.
Inebriation to my mind is one of the biggest causes of “accidents” I can think of.
2)Intelligence!
Actually I’m referring specifically to a lack of intelligence here, or put simply idiocy! This factor not only includes the persistent failure by some to plan something through, but also covers delusions of competency in activities that certain people shouldn’t have been doing in the first place. Also in this factor the intelligence or lack thereof can be as previously mentioned an ongoing occurrence or in some cases a situational lapse. Either way people in this category for the most part have IQ’s at least in regards to the events leading up to said “accident” that make Forest Gump look like Albert Einstein.
One can of course argue that inebriation can contribute to a lack of intelligence (idiocy) issues which is sometimes the case. But don’t fool yourself! The lack of intelligence (idiocy) on its own causes almost as many “accidents” as inebriation.
3)Indifference!
The sad truth is that some people just don’t care about anything but themselves. Now I’ll concede that being self centered is a survival characteristic in certain circumstances. But those occasions aside they types I’m referring to here are those people who seem to think the rest of the world exists to serve them and everyone should just get out of the way because no one is as important as they are no matter what. These are the type of people who are likely to tell you that if you don’t like their driving stay of the sidewalk and actually mean it. They are also the types who barge to the head of a triage lines demanding care for their boo boo post accident not even stopping to thing the 5 people they just ran into might need our help a little more.
4)Indecision
Hesitation kills! It’s a simple fact. If you pause at the wrong time to make a decision or you’re the type who simply can’t decide anything than sooner or later something bad is going to happen to either you or the aforementioned nice people who were just minding their own business and just trying to go about their respective days. I often am staggered as to the amounts of hesitation people display even when dealing with the simplest situation. Take a look at people at an automatic cashier in a store or an ATM sometime. Far too many of them look like they’ve just been suddenly asked to calculate a rocket trajectory for the mars mission instead of punching in their friggin 4 digit pin number. Now consider what will happen when you put the same people in a really stressful situation where the decision making skills and reflexes of a fighter pilot are required like say driving a car in traffic. Poof! Instant deer in the headlights with the obvious implications.
5)Inattention
Most people walk around with their head up their butts. Cell phones, texting, mp3 players are just a few of the distractions that people routinely and voluntarily utilize to place their lives in danger. Now I’m not suggesting for a moment that people shouldn’t use these types of devices but when they do, they should be aware that there is a better then odds chance that they are now unaware of their surroundings and potential hazards. Discretion is the rule and people just don’t get that you need to be more attentive while you’re enjoying your music. It’s as simple as look! Of course for most people that’s far too much trouble and a result they will trip and fall, walk into traffic or run afoul of an obvious hazard that had if they had been paying attention in the first place wouldn’t have even been a threat to them.
6)Indestructibility
While more dominant in younger people, don’t fool yourself for an instant. It’s not just the teenagers who seem to think that they can’t be harmed no matter what they do. Foolish assumption to say the least! Trust me when I tell you if you run out in front of a fast moving car you will be hurt when it hits you. It’s simple physics. The car will not bounce off of you; you will bounce off the car. If you don’t wear a seat belt you can and will be ejected through the windshield in an accident and get to experience firsthand the joys of sudden deacceleration trauma. Despite what many seem to think people are not Superman or Hancock and should stop acting like they are. But of course try and tell them that and you get the usual we just want to have fun, or I’m entitled to do what I want. To that I say so you are, but be sure you are ready to pay the margin when it gets called.
In the end it’s easy to see that individually each of the 6 I’s can cause accidents. Worse is when the 6 I’s begin to combine and work together the odds of something going wrong also begins to increase at a geometric rate. Many people who know me would point out that I have suffered from some; if not all of the 6 I’s both individually and in combination at one point or another in my life. They’re right when they say it. But in response to that very correct accusation I will tell you what I used to tell the junior high students we’d tour through our ER in the PARTY program (Prevent alcohol risk related trauma in youth):
“I’m not standing here because I’m good looking, intelligent, well educated and well trained. I’m standing here because I got lucky. Anything you’re thinking about doing to be cool, I’ve been there; done it; got the tee shirt, the scars not to mention photo’s as well as a dead friend or two to prove it. I’m standing here because I got lucky! No other reason”
Take my word for it lady luck is fickle! Don’t play those odds and avoid the 6 I’s as much as you can. Forewarned is forearmed and the last thing you want to do is to wake up with me as your nurse.
Wednesday, June 17, 2009
Grace under fire
“Humour is mankind’s greatest blessing”
-Mark Twain
It’s a fact that when people are under stress they will sometimes use humour as a coping mechanism. I’ve seen it more times than I can count in emergency patients. It’s an understandable response to things to say the least.
I do have to admit that I sometimes think the jokes are not only a little strained, but totally inappropriate; but truthfully there are also times when some people manage to be dam funny despite what is happening to them.
Two of my favourites are as follows:
1)An elderly man with renal failure and chest pain at 0300 in the morning. When I asked if he was allergic to anything quietly responded “Not to worry she’s at home asleep right now”.
2)Another Elderly man who despite obvious abdominal pain in response to the under the circumstances asinine possibility of family violence question politely assured me that no one was trying to hurt him. But when I followed up with the equally asinine second question of “Do you feel safe right now” he sat up, looked quickly around and smiling said in response “I’m not sure, does my wife have my wallet”? Oblivious to what he was actually saying I assured him his wallet was safe with his clothing he again smiled and said “Well I guess as long as she hasn’t got it, I’m fine”.
One can only hope that when it’s their time to be a patient on a stretcher they can manage a decent joke or two not to mention still find the strength and patience to gently explain it to the dumb ass nurse (i.e. me) who didn't get it the first time.
-Mark Twain
It’s a fact that when people are under stress they will sometimes use humour as a coping mechanism. I’ve seen it more times than I can count in emergency patients. It’s an understandable response to things to say the least.
I do have to admit that I sometimes think the jokes are not only a little strained, but totally inappropriate; but truthfully there are also times when some people manage to be dam funny despite what is happening to them.
Two of my favourites are as follows:
1)An elderly man with renal failure and chest pain at 0300 in the morning. When I asked if he was allergic to anything quietly responded “Not to worry she’s at home asleep right now”.
2)Another Elderly man who despite obvious abdominal pain in response to the under the circumstances asinine possibility of family violence question politely assured me that no one was trying to hurt him. But when I followed up with the equally asinine second question of “Do you feel safe right now” he sat up, looked quickly around and smiling said in response “I’m not sure, does my wife have my wallet”? Oblivious to what he was actually saying I assured him his wallet was safe with his clothing he again smiled and said “Well I guess as long as she hasn’t got it, I’m fine”.
One can only hope that when it’s their time to be a patient on a stretcher they can manage a decent joke or two not to mention still find the strength and patience to gently explain it to the dumb ass nurse (i.e. me) who didn't get it the first time.
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