[dxmedstudent]

Psych attending: Any parting words for our future doctors here?

Patient: Yeah...don't fuck up.

[nursingschooltrauma]

My first shift in my grueling stretch over Christmas week and we've already had 2 deaths. What a merry Christmas so far :/

[docinlimbo]

If I come in tomorrow and that patient is intubated I will be intubating one of you! And you will not like where I shove the ET tube!!!

My ICU attending  (via docinlimbo)

[sarcasticbabywhispererjess]

The crit care doc wants to prone the patient that won’t stop coding...

[floweringscrubs]

I’m a bit lost here… for what purpose would the doctor want the patient prone?

[sarcasticbabywhispererjess]

So there’s this thing called ARDS (acute respiratory distress syndrome) that really sick (usually vented) patients can get… if they aren’t intubated, they will be ASAP. Their lungs become full of fluid and the patient cannot get good gas exchange. These are the patients we prone. This is similar to the pulmonary edema that occurs with CHF exacerbation when they get fluid overloaded, but it is much worse and the mortality rate is high. 

The reason for that is that there is much more lung surface area at the back, so we use gravity to help pool all the fluid to the front of the lungs, leaving the larger area free for oxygenation. Also, let’s be honest, most of the adult patient population is overweight, therefore their body habitus is working against them as well. Taking all the pressure of the excess weight their body is storing on their chest off of their lungs also allows them to expand more freely. In addition to being proned they’ll be on pretty high vent settings (PEEP - positive end expiratory pressure) in an attempt to push the fluid back into circulation and keep those alveoli open for gas exchange. 

Hopefully that was helpful. If you want more info, check out the link I added above… it’s to the Mayo clinic’s website, so the information should be legit (full transparency, I didn’t read through everything… because I am lazy).

[nursingschooltrauma]

I remember proning my first patient as a student in the ICU, and the attending and primary nurse preplanning how they'd run the inevitable code during the process. Thankfully we made it through without the patient trying to die too hard 🖒

[whatshouldwecallpgy1]

CT finding of the day

“… note is also made of an enormous rectal stool ball”

[dxmedstudent]

I remember one kid we had on paeds. Really bad abdominal pain. Can’t have been older than 5 or 6. Investigations just pointed to really bad constipation. Now, nobody likes a doagnosis of constipation. It doesn’t matter that it’s beter than most of the other diagnoses you could get when you’re suffering wihth similar symptoms. 9/10 times, there’s a real risk people will feel that you’re fobbing them off. Anyow, this child’s parents were livid. Like, walking around the ward shouting at staff, mad. Because they felt that by treating for constipation, we weren’t taking their child’s pain seriously. Because constipation can’t be that bad, right? It’s just constipation. Right? Everyone knows  that only really serious things cause that much pain, right? We managed to calm them down, but you can see where they were coming from. Anyhow, we got them to bear with our treatment. Later that afternoon, I was rounding the ward, and the patient’s dad  excitedly bounds up to me, saying “YOU’LL NEVER GUESS WHAT, DOCTOR!  HE PASSED A GIANT POO THE SIZE OF A GRAPEFRUIT! AND HE’S STILL GOING!”. This was no news to us; we’d seen the X-rays. But somehow it only became truly real to the parents when they saw physical proof. No wonder that kid was in pain. So if you rembember one thing about constipation, remember that it can be excruciatingly painful, and that you can have no idea how much poo the human body can hold.

[modernathenamd]

A summary of my mental to-do list during my 30 hour call:

-get kid A to poop. Pain Management requires this but is also giving kid massive amounts of opioids. Titrate up miralax dose until goal achieved.

-get kid B to poop. He’s been NPO for three weeks and on pain meds the entire time and bedridden for most of it. Have now started NJ tube feeds so add liquid stool softeners via NJ and teasingly threaten him with suppository.

-Figure out why New Admit 1 is not pooping. Determine it’s because Mom isn’t feeding the baby enough. Also explains rapid weight loss since birth.

-Be asked repeatedly why New Admit 2 is pooping so often. Explain repeatedly that he’s pooping like all healthy babies poop

-hear that kid B is passing gas. Go do celebration dance with the parents.

-repeatedly pop in to ask kid A if he’s pooped yet. “Embarrass the hell out of” your 16 year old patient and when he complains tell him you’re trying to “embarrass the crap out of you, the hell can stay.”

[pleasedotheneedful]

@doctor-dumplings I think this happened to you on peds lol

[docinlimbo]

In all seriousness, has anyone ever successfully used vagal maneuvers or carotid massage to get a person from SVT back to normal sinus rhythm???

I’ve been doing it all year and everytime I try that first the nurses laugh. I try it anyway, but it never works! Just once I want to see magic happen!

I’m challenging the next patient to the ice bucket challenge…  

[drdessertfox]

I’ve used the modified valsalva. It has a 50% success rate.

[nursingschooltrauma]

I had a patient convert out of AFlutter to NSR on our first attempt of modified valsalva with a 10cc syringe. She had been cardioverted in the past for SVTs.

[nurse-x-ramblings]

The next time someone asks you why you didn’t become a doctor instead of a nurse, tell them you will give them $5 if they can actually list 10 things a nurse really does. Then tell them you will give them $100 if they can list a singular valid reason why one job is considered more important than the other. Then tell them you only barter in Monopoly money, since you don’t gamble with life or stupid questions.

Health Care Life Hacks 💵💰 (via nurse-x-ramblings)

[blackshuckofficial-deactivated2]

I may not have the best body but it sure does hold all my organs in place

[nursingschooltrauma]

hernias

[nursingschooltrauma]

I need help!!!

So the other day, I heard from my dream unit (the ICU I did my final preceptorship at as a student) that they want to interview me, after trying to get one for 6 months! I’m beyond excited that I got an interview, but also shitting my pants a bit because the last 5 years of my life have been working towards this interview and I really, really don’t want to screw it up.

That being said, does anyone have tips for ICU interviews? Keeping in mind that I’m pretty green out of school? Any insight or words of encouragement are super duper appreciated!!

[thegraymethod]

Nothing grinds my gears more than patients who think they can do my job better than I can

[homotology]

What my face says when they’re like this.

[specialtynurse]

I don’t care if you were a nurse 40 years ago, Mildred, drinking 6 Diet Cokes in an 8 hr shift isn’t good for your CHF. 

[laboranddeliverymemes]

[theonion]

SHREVEPORT, LA—Unable to contain his enthusiasm as he burst through the front door, emergency room doctor Barry Henke excitedly told his wife Monday that he got to use those shock paddle things today. “You’ll never believe it, honey—I finally did that thing with those electric paddles at work!” said an ecstatic Henke, adding that he couldn’t have been more thrilled to order everyone to get out of the way as he rushed over to the patient while rubbing the shock doohickies together. “I’ve been wanting to play with those thingies since my first day, and I finally got to! I put them on the guy’s chest, yelled ‘Clear!’ and they went bzzzzzzzz just like they do on TV! Boy, I hope I can do it again soon!” Henke went on to say that it was the most fun he’s ever had on the job, even though the guy died.

[pnwnurse]

What my days off frequently consist of when I work a long streak of 12s

[mursejesse]

[boluscoffeestat-deactivated2020]

When I don’t have one of the caps covered while pushing PO meds through a feeding tube

[nursingschooltrauma]

patient vomiting/vagal after mobilizing, EMS waiting for my other pt for stat CT before we could get a 18G in, and my fresh post op comes back

shit storm is an understatement

[nursingschooltrauma]

we had a walkie talkie in our ER tonight with an unreadable high glucose, pH in the 6’s, bicarb of 6, and K of 7. the human body never fails to amaze me.

[sarcasticbabywhispererjess]

“His BP is 88/50. Isn’t that incredibly low?”

The reply they’re looking for…

What I actually say…

[cardizembolusrn]

Yeah bro, I’m not worried till we see a SBP in the 70′s. 88 rounds up to 90, which is basically 100. We’re cool.