SoSanguineRN

A 2nd year RN who just started work in the ED. This blog is nursing info, humor, healthcare, and medical science related. Some images and stories may be graphic and/or hilarious.

[deathandmysticism]

[deathandmysticism]

Women’s Medical College of Pennsylvania, Philadelphia, 1892

[lamentations44]

A Moment

There’s nothing more to say Moving on is a simple thing What it leaves behind is hard You know the sleeping feel no more pain And the living are scarred

- Megadeth

She was 34, I am 33. I tried not to think about it but it whispered through my brain.

She was dying when I met her.

At 0910- Her nurses eyes met mine down the hall and even before she said the words, “I need your help”, I was already heading that way.

There is an unwritten rule or look among nurses in high acuity areas.  An expression that lets you know that things are taking a turn for the worst.   Most of us have a phrase that we say that alerts our coworkers without screaming for help.  It’s our scream, it’s our cry for help. And coworkers respond just as fast to that as they would a true yell for help.

“I need your help.”  

The code began moments after I walked into the room.  It last 2 hours.

I was tripled at the other end of the hall so I didn’t know anything about her when I walked into the room except one thing.

She had just given birth the day before.

As the violence of the code commenced, I learned other things.  She was 34.  She was in fulminant DIC.   For the first 30 minutes we gave epi, did 2 minutes of cpr and she would have ROSC for about 2 minutes and then code again. At 0930 the cardiac surgery team descended on the room.  They cannulated for ecmo and we continued to brutally code her.

Probably because of her age.

Probably because she had just had a baby.

Probably because she had 5 other kids.

Probably because none of us wanted to say we lost her.

That’s probably why we continued for another hour.

The ecmo clotted after 5 minutes.  She had no circulating volume despite the blood we were pouring into her.  

At 1042, covered in blood, sweat and literally tears- the code was called.

The doctors left and we tried to clean up before her family arrived.

It took another 45 minutes to clean up the horrendous mess we had created.  A 5 minute code leaves a room trashed, a 2 hour code leaves the room decimated.  

When the violence was covered and the blood wiped up, the chaplain intervened and gathered us all back in the room.  

Shoulder to shoulder we stood in the room with our patient.  The PA that helped run the code, the doctors who cannulated for ecmo, the respiratory staff that bagged her for 2 hours, the nurses who broke her ribs and squeezed blood into her, and even the cleaning staff who mopped her blood from the floor.   We had a moment of silence.  A settling moment that let us acknowledge what we had done, and worse… what we couldn’t do.   

Because, we couldn’t save her.  

And that fact broke us all.

[cranquis]

deep inhale…

deep exhale…

[theglowstickchronicles]

When ICU refused an admission after 3 consults, and an hour later they code

[biomedicool]

The Effects of Space on the Human Body

Weightlessness/low gravity

While travelling through space, the body is weightless. Planets smaller than Earth will have lower gravity (Mars = one-third of Earth’s gravity).

Short-term exposure to microgravity causes space adaptation syndrome, a self-limiting nausea caused by derangement of the vestibular system (balance and coordination).

Muscle and bone wastage

Without gravity bones lose minerals, with density dropping at over 1% per month.   may not be corrected by rehabilitation –> risk of osteoporosis-related fractures later in life

Muscle strength and endurance decreases, and cardiovascular deconditioning is experienced since it does not take effort to float through space.  

Kidney stones may develop due to dehydration and increased excretion of calcium from bones.  

Fluids are no longer pulled down

Fluids shift upwards towards the head - ‘puffy face’

puts pressure on your eyes causing vision problems.  

Can also cause balance disorders and a loss of taste and smell

Get taller - fluid-filled discs between each of the bony vertebrae are no longer compressed, stretching your height by about 3%. Returning to Earth-like gravity reverses that effect.

Immune system disrupted

Things like radiation, microbes, stress, microgravity, altered sleep cycles and isolation could all have an effect on immune systems, 

bacteria have been found to be more resistant to antibiotics and to thrive in the near-weightlessness of space.

Readapting to Earth’s gravity 

Transitioning from one gravity field to another affects spatial orientation, head-eye and hand-eye coordination, balance, locomotion, and usually produces motion sickness. 

High gravity

During takeoff and reentry gravity is increased, An untrained person can usually withstand about 3g, but can blackout at 4 to 6g.

temporary loss of vision and then at higher g-forces loses consciousness. 

Space Radiation

Earth’s magnetic field and atmosphere protect us from harsh cosmic radiation.

increase cancer risk

can damage central nervous system –> altered cognitive function, reduced motor function, and behavioral changes.  

radiation sickness –> nausea, vomiting, anorexia, and fatigue. 

degenerative tissue diseases such as cataracts, cardiac, and circulatory diseases.  

Difference between male and female adaptation to space flight

Sources:

NASA  BI Stanford

[jdubbwya]

After century of removing appendixes, docs find antibiotics can be enough

In a five-year follow-up, nearly two-thirds of patients never needed surgery.

[nursingtheheart]

So true it hurts lol.

[npr]

There are a lot of misconceptions out there about the flu shot.

But following a winter in which more than 80,000 people died from flu-related illnesses in the U.S. — the highest death toll in more than 40 years — infectious disease experts are ramping up efforts to get the word out.

“Flu vaccinations save lives,” Surgeon General Jerome Adams told the crowd at an event to kick off flu vaccine awareness last week at the National Press Club in Washington, D.C. “That’s why it’s so important for everyone 6 months and older to get a flu vaccine every year.”

But many Americans ignore this advice. The U.S. vaccination rate hovers at about 47 percent a year. This is far below the 70 percent target. And college students are among the least vaccinated.

Think You Don’t Need A Flu Shot? Here Are 5 Reasons To Change Your Mind

Photo: Mary Mathis/NPR

[medresearch]

Researchers Discover Novel Subtype of Multiple Sclerosis

Researchers at the Cleveland Clinic’s Lerner Research Institute have identified a new subtype of multiple sclerosis (MS) that features neuronal loss but no demyelination of the brain’s white matter. The process of demyelination was believed to be responsible for neuron death that leads to irreversible disability for patients. The researchers believe that this finding could lead to more personalized therapies.  

“This study opens up a new arena in MS research. It is the first to provide pathological evidence that neuronal degeneration can occur without white matter myelin loss in the brains of patients with the disease,” says Bruce Trapp, PhD, chair of Cleveland Clinic’s Lerner Research Institute Department of Neurosciences. “This information highlights the need for combination therapies to stop disability progression in MS.”

Read More

Funding: National Institute of Neurological Disorders and Stroke and the National Multiple Sclerosis Society

Raise your voice in support of expanding federal funding for life-saving medical research by joining the AAMC’s advocacy community.

[bpod-bpod]

Twisted Sense

Our sense of hearing begins with minute deflections of sensory hairs on the inner hair cells of the cochlea, a coiled structure in the inner ear, ultimately causing electrical signals to reach the brain. Cells known as type I spiral ganglion neurons (SGNs) are responsible for signal transmission: pictured in a section of mouse cochlea, SGN cell bodies (in green, bottom right-hand corner) extend long projections, or peripheral processes (in red and yellow) to contact hair cells (top left, also in green), then send signals downstream to the brain through the auditory nerve. Recent research shows that type I SGNs fall into three distinct subtypes, which express different sets of proteins, supporting earlier evidence of variation in SGN sensitivity to sound. As work in mice suggests one specific SGN subtype may be linked to age-related hearing loss, appreciating SGN diversity could be critical to tackling different types of hearing defects.

Written by Emmanuelle Briolat

Image by Chester Chia, Harvard Medical School

Department of Neurobiology, Harvard Medical School, Boston, MA, USA

Image copyright held by the original authors

Research published in Cell, August 2018

You can also follow BPoD on Instagram, Twitter and Facebook

[nprfreshair]

“Most people think on this anniversary that two buildings came down that day and 2,753 innocent lives were lost [in New York City]. … But since then, about 2,000 [more] people have died because of their illnesses. They, too, are heroes. And in many ways — I talk to a lot of them — they wish they would have died that day, because what they have had to go through and fight, not only their illnesses but the bureaucracy and the poor leadership, and to see their other friends pass away from Sept. 11-related illnesses. These men and women have been through the ringer, through the mill. … We call ourselves the greatest nation in the world. But yet we have a strange way of repeating history, and letting veterans come home from war, or 9/11 responders, or just responders now across the nation, how they sacrifice themselves and then we don’t take care of them. That’s sad.”

— John Feal, 9/11 first responder and activist, with Terry Gross 

[bpod-bpod]

Neuron and Off

Our brains thrive on communication. Connections between neurons fine-tune signals zipping between brain areas, ultimately guiding everything we do. Tree-like Purkinje cells are the master communicators of the cerebellum, where their many connected branches help to coordinate precise body movements. These virtual Purkinjes, from a new computer model, predict how real cells react when nearby brain structures called climbing fibres (not shown here) turn them ‘on’. The model predicts this isn’t a simple on/off switch, though, but a sort of volume dial. Ramping up the electrical input (from left to right here) fires up an increasing number of the Purkinjes branches. These predictions fit with real experiments from all over the world. The idea of controlling brain signals sensitively, rather than just ‘on’ or 'off’, already has researchers racing to explore the implications for development and disease.

Written by John Ankers

Image from work by Yunliang Zang, Stéphane Dieudonné and Erik De Schutter

Computational Neuroscience Unit, Okinawa Institute of Science and Technology Graduate University, Okinawa, Japan

Image published with a Creative Commons 2.0 licence

Published in Cell Reports, August 2018

You can also follow BPoD on Instagram, Twitter and Facebook

[well-this-is-my-legacy]

[meanwhileonwednesday]

As a medical professional and a medically complicated human this is very important to me

[licensetomurse-deactivated20200]

That’s not wrong.

[captainmdphd-blog]

The tone of both comments is what causes poor doctor-patient relationships. Don’t underestimate how much education a doctor has. This doesn’t simply stop with medical school. It continues during residency and fellowship. For good doctors, this continues during practice. Good doctors stay up to date with medical guidelines and the changes that occur over time. Good doctors will research any condition their patient has with which they’re unfamiliar. Good doctors will listen to their patients and gently correct errors and misconceptions. Unfortunately, not all doctors are good doctors.

On the other hand, I’ve learned tons from my patients. Things that no book will ever teach me. As a patient, you deserve to be treated respectfully. Most doctors do their best to listen to their patients. No one puts in the time and effort required to be a physician with the goal of being a shit doctor. Of course, it happens. Doctors are humans and are just as flawed as everyone else. That’s the exception rather than the rule. Please respect the fact that we have a better filter for information than you do, regardless of how long you’ve had an illness. When patients request a specific test that I know is not indicated, I ask WHY. When a patient thinks they have an illness that that subjective and objective data do not support, I ask WHY. What are they concerned about? What is their fear? This is the question that needs to be addressed. That information generally allows me to either come up with a different, more appropriate test or list the reasons why their fear isn’t likely to be a reality. It’s all a two-way street that requires respect from all parties involved. Don’t go to a doctor who doesn’t respect you. Don’t go to a doctor who makes you uncomfortable. Don’t go to a doctor who is overly dismissive of your concerns. These are all red flags that you’re dealing with an asshole who just happens to be a doctor.

[cranquis]

There is much learning in this post.

For #medblr readers, @captainmdphd nails the key point: 

I ask WHY. What are they concerned about? What is their fear? This is the question that needs to be addressed.

[md-admissions]

Accurate. Patient-physician relationships should not be antagonistic or one-sided. They are mutual and we learn from each other. When either party takes on a snarky or dismissive tone, we all lose out. A doctor is useless and even damaging to the patient when they don’t listen. A patient may not be able to get the exam, tests, or referrals they need to get better if they walk in with the presumption that all doctors are unreliable assholes.

[webofgoodnews]

How a shampoo bottle is saving young lives

ON HIS first night as a trainee paediatrician in Sylhet, Bangladesh, Mohamad Chisti (pictured above) watched three children die of pneumonia. Oxygen was being delivered to them, through a face mask or via tubes placed near their nostrils, using what is called a basic “low-flow” technique which followed World Health Organisation (WHO) guidelines for low-income countries. But it was clearly failing. He decided to find a better way.

Read more

[wayfaringmd]

We need more innovators like this man.

[politishaun-deactivated20230409]

Man Creates Edible Water “Jelly Drops” to Help Dementia Patients Stay Hydrated

London-based student Lewis Hornby is a grandson on a mission. When he noticed that his dementia-afflicted grandmother was having trouble staying hydrated, he came up with Jelly Drops—bite-sized pods of edible water that look just like tasty treats.

Each of these colorful “candies” is made up of mostly water, with gelling agents and electrolytes making up just 10% of their composition. Available in a rainbow of colors and presented in packaging reminiscent of a box of chocolates, Jelly Drops are an easy and engaging way to avoid dehydration—a common problem for those suffering from degenerative neurological diseases.

“It is very easy for people with dementia to become dehydrated,” he explains. “Many no longer feel thirst, don’t know how to quench thirst, or don’t have the dexterity to drink.” With this in mind, Hornby set out to find a solution. In addition to seeking advice from psychologists and doctors, he opted to “experience” life with dementia himself through the use of virtual reality tools and a week in a care home.

Once he was familiar with what dementia patients need, he brainstormed what they want. “From my observations, people with dementia find eating much easier than drinking. Even still, it can be difficult to engage and encourage them to eat. I found the best way to overcome this is to offer them a treat! This format excites people with dementia, they instantly recognize it and know how to interact with it.”

Case in point? Hornby’s own grandmother’s reaction: “When first offered, grandma ate seven Jelly Drops in 10 minutes, the equivalent to a cup full of water—something that would usually take hours and require much more assistance.”

[actualaster]

@thebibliosphere

[thebibliosphere]

What a fantastic helper.

[bpod-bpod]

Vital Vaccination

Typhoid fever is an infection caused by Salmonella typhi bacteria, spread by eating or drinking contaminated food and water. Nowadays typhoid can be mostly prevented by the use of vaccines thanks to pioneering immunologist Almroth Wright - born on this day. A professor at the Army Medical School, Wright was the first scientist to produce a typhoid vaccine, which was later used to inoculate soldiers during the Boer War. He also invented his own technique for testing bodily fluids for bacterial infections, known as the ‘teat and capillary glass tube’. Wright held controversial views against women’s suffrage, vigorously expressed in his book, ‘The Unexpurgated Case Against Woman Suffrage’, and his opposition to both women’s suffrage and their involvement in science was due to a wilful belief of women having ‘intellectual defects’. Nevertheless, Wright’s scientific achievements are undeniably profound, and he is celebrated today as the UK’s first academic immunologist.

Almroth Wright: Icon of Immunology was recently featured in the MRC LMS Heroes of Health article series

Written by Ellie McLaughlin

Photograph from the Wellcome Collection

Illustration created for the MRC LMS Heroes of Health comic book by Lindsay McBirnie

Portrait originally published under a Creative Commons Licence (BY 4.0); Illustration copyright held by the artist

You can also follow BPoD on Instagram, Twitter and Facebook

[rohie-deactivated20191102]

[allthecanadianpolitics]

Halifax PhD student tackles ‘groundbreaking’ work on Black nurses

Keisha Jefferies of Dalhousie University hopes to gather more data around Black nurses in health care and look at how that underrepresentation impacts overall health in the Black community.

As a young girl growing up in New Glasgow, Keisha Jefferies always knew she wanted to do something to help her Black Nova Scotian community.

After two years working as a nurse in the neonatal intensive care unit at the IWK Health Centre, Jefferies decided to go back to school to pursue graduate studies.

The Dalhousie University PhD student is now conducting research described by one of her thesis supervisors as “groundbreaking.” She’s gathering data to show how the under-representation of Black nurses in health-care settings and leadership roles impacts those nurses and the Black community at large.

“Having an absence of Black nurses in a position where they’re able to influence policy has a negative effect on the Black community itself, and we know this because we see the Black communities with more (people having) poor health compared to the general Canadian population,” Jefferies said in an interview.

Continue Reading.