#abg syringe

[spmmedicare]

ABG Syringe | SPM Medicare

In-line arterial blood sampling set designed for precise arterial blood collection. It features an ABG syringe specifically tailored for accurate arterial blood gas analysis. This arterial syringe ensures reliable collection of blood samples for critical measurements, such as oxygen and carbon dioxide levels, essential in patient monitoring.

[mrfr-blogs]

Breaking Down Growth Patterns: Trends in the Arterial Blood Collection Devices Market

Market Overview –

According to forecasts, the arterial blood collection market would grow at a 10.2% annual rate from 2022 to 2030, or USD 1924.34 million.

The arterial blood collection market focuses on products and devices used to obtain blood samples from arteries for diagnostic testing, particularly for arterial blood gas (ABG) analysis. These tests measure the levels of oxygen, carbon dioxide, and other gases in the blood, providing critical information about a patient's respiratory and metabolic status.

Market growth is driven by the increasing prevalence of respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS), and the growing demand for point-of-care testing in emergency departments, intensive care units, and operating rooms. Arterial blood collection devices enable healthcare providers to quickly and accurately obtain blood samples for ABG analysis, facilitating timely diagnosis and treatment of respiratory and metabolic disorders.

Technological advancements and innovations in arterial blood collection devices are shaping the market, offering improved safety, ease of use, and sample quality. From prepackaged arterial blood gas syringes and safety lancets to integrated blood gas analyzers and wireless monitoring systems, these advancements enhance workflow efficiency and patient care in healthcare settings.

The Arterial Blood Collection Devices Market is witnessing substantial growth, primarily fueled by the rising demand for arterial blood collection syringes in healthcare settings. These devices are crucial for accurate blood gas analysis and are extensively used in critical care units and laboratories. Technological advancements and the increasing prevalence of chronic diseases are further driving market expansion.

Moreover, the COVID-19 pandemic has highlighted the importance of arterial blood gas analysis in managing respiratory complications and optimizing mechanical ventilation strategies in critically ill patients. Arterial blood collection devices play a crucial role in monitoring patients' oxygenation status, acid-base balance, and ventilation parameters, contributing to better patient outcomes and reduced mortality rates.

However, challenges such as blood sample variability, operator proficiency, and infection control concerns pose obstacles to market growth. Addressing these challenges requires collaboration between device manufacturers, healthcare providers, and regulatory agencies to develop standardized protocols, training programs, and quality assurance measures for arterial blood collection and analysis.

Overall, the arterial blood collection market presents significant opportunities for innovation and collaboration to improve patient care and outcomes in respiratory and critical care medicine. By investing in research, education, and technology, stakeholders can drive continued growth and advancement in the market and contribute to the development of more effective diagnostic and monitoring tools for patients worldwide.

Segmentation –

A wide range of blood collection devices are available for both venous and arterial blood collection purposes. Arterial blood collection involves obtaining blood samples from arteries to analyze arterial blood gases. The blood collection devices market is categorized into various types, including blood collection tubes, lancets, needles, vacuum blood collection systems, microfluidic systems, and other devices such as arterial cannulae and blood bags.

Arterial blood collection devices play a crucial role in diagnosing and treating diseases. They enable healthcare providers to conduct blood tests, aiding in disease diagnosis and treatment planning. These devices are utilized for arterial blood gas sampling and intraoperative blood salvage. The arterial blood collection market is further segmented based on application into arterial blood gas sampling, which includes disease diagnosis and acid-base status monitoring.

In terms of end users, the blood collection devices market includes hospitals and clinics, laboratories, blood banks, and other facilities like ambulatory surgery centers.

Regional Analysis –

Regional analysis of the Arterial Blood Collection Market provides crucial insights into the distribution and trends of blood collection methods for arterial sampling across diverse geographic regions. Understanding regional dynamics is essential for stakeholders to tailor their strategies effectively, considering factors such as the prevalence of cardiovascular diseases, healthcare infrastructure, and regulatory frameworks.

For instance, regions with a high prevalence of critical care admissions or cardiac surgeries may witness a heightened demand for arterial blood gas testing, thereby driving the adoption of arterial blood collection methods. Developed regions with advanced healthcare systems often have well-established protocols for arterial blood gas analysis, making arterial sampling a routine procedure in intensive care units and operating rooms. Conversely, developing regions may encounter challenges like limited access to arterial blood gas testing facilities, shortages of trained healthcare personnel, and financial constraints.

Factors such as government healthcare expenditure, reimbursement policies, and technological advancements significantly influence regional dynamics in the arterial blood collection market. Conducting a comprehensive regional analysis enables stakeholders to identify growth opportunities, assess competitive landscapes, and tailor strategies to address the specific needs of each region. Furthermore, understanding regional disparities in healthcare delivery and patient demographics facilitates the development of targeted interventions to improve access to arterial blood collection methods and enhance patient care outcomes. Overall, regional analysis serves as a vital tool for optimizing resource allocation, promoting innovation, and advancing healthcare quality in the arterial blood collection market.

Key Players –

The Arterial blood collection devices leading players include Becton, Dickinson and Company, Bio-Rad Laboratories, Inc., NIPRO Medical Corporation, QIAGEN, F. Hoffmann-La Roche Ltd, Terumo Medical Corporation, and Thermo Fisher Scientific, Inc.

Related Reports –

Medical Tourniquets

Forensic Swab

Ascites

Intraoperative Neurophysiological Monitoring

For more information visit at MarketResearchFuture

[dont-eat-my-buns]

Lack of essentials in JJ Hospital

I worked as an intern in JJ Hospital and despite the name and legacy that JJ Hospital has, I was in shock at the lack of basic medical essentials at the biggest Government Hospital in Mumbai! This is a hospital with a 175+ years of legacy behind it, with probably the most funding of any government hospital in maharashtra and one of the top institutions of the country.

My first posting was in Medicine and during my emergency shifts (we handled any medical emergencies that came during the day for 24 hours, and then the next unit took over). This is where I was taught the basic steps in Medical treatment as I had no exposure before - attending clinics during my 4.5 years of MBBS just provided basic knowledge in understanding patient care and also I was afraid of needles (a whole another story) so I didn't want to go to patient wards. The first steps after history taking and examination, were collection of blood and iv line insertion. For collection of blood, there were hardly any syringes present in the emerg ward (you need atleast a 10 ml syringe for the amount of tests), and the needles that were present were green needles (the widest ones and hurt like crazy). On top of that, there weren't any blood collection bulbs!!!!!!! Not just that, nor were there any iv cannulas, there weren't any bivalves or iv lines. (all of this is required for fluid and antibiotics to be given urgently to patients)

Thus I was told to give a list to every patient is to be admitted for them to go and buy which included needles, syringes (Rs 10 each), bulbs (Rs 10 each), bivalves(Rs 75 each), iv lines, iv cannulas (Rs 150 - Rs 250 each). These might look like small amounts and compared to US or other countries, they are cheaper in India, but these people are the poorest of the poor who come to JJ for treatment. And in a govt hospital, treatment is supposed to be free for people who can't afford it, but that doesn't include these purchases that they have to make from an outside medical shop!!!!!!!!!!!! And no one comes to the emergency with loads of cash, its a freaking emergency!!!!

This isn't the end of it, after getting all the supplies and then when we collect the blood of tests, I have to give the patients another paper with a list of number for medical labs that run tests coz the Biochem / patho lab in JJ isn't running certain tests. And you might wonder if these are some hi-fi tests and that's probably why it isn't being run, but no. It's the most basic tests - CBC (the most basic test that you need to know), ABG (to know if a patient has acidosis / alkalosis / good O2 saturation) and many more aren't run in JJ. And thus they have to give it outside, which again isn't reimbursed. And these tests do add up to the costs of the patient's!!

The same is the case of wards, the medicine wards lacked the same stuff again. I learnt of a barter system that if I could get the medical lab to give me bulbs to use for the patients then I'd give their number of the tests. It provided some (mind you, a very minute) relief for the patient.

After this was casualty posting. This is where we attend to patients first! If anyone comes with any emergency, casualty is the one that gives a preliminary diagnosis and then sends them to the respective department, for eg fracture is sent to orthopaedics, heart attack is sent to medicine and so on. In casualty, I found out that there is no nitroglycerin tablets! This is first line therapy for anyone with a heart attack! Supposed to given immediately if you suspect a heart attack or atleast seen on ecg, but nope. If a patient comes with chest pain and the ecg shows signs of Myocardial Ischemia (heart attack), all we can do is give pain relief and ask the patient's relatives to buy nitroglycerin and come.

Rant over for sometime! Will come back with a part 2, I got too worked up just thinking about this.

[keeptheotherone]

A Brief Summary of My Week or How I Lost My Status as Second-Floor Gin Rummy Champion

I work four 10-hour shifts in the PACU at a 80-ish bed community hospital. 

Tuesday: Pt comes out from the OR on a T-piece. Pt remains intubated for approx 45 minutes (this is a REALLY. LONG. TIME). CRNA chats with anesthesiologist while I assess, intervene, and chart so the (inexperienced) anesthesiologist doesn’t Narcan a post-op--(I remember the bay the patient was in. I remember the anesthesiologist’s and CRNA’s first and last names. I remember what time we extubated the patient (1814), his pH, pCO2, end-tidal CO2 at the end of the case, and when the MD drew the ABG. I cannot for the life of me remember whether the patient was male or female or what surgery s/he had)--so he doesn’t Narcan an immediately postop patient and reverse all his pain control. 

(This was after surgery yelled at me for doing a urogyn’s voiding trial too early and made me cry. I haven’t cried because a doc yelled at me in ... over a decade? He refused to discharge her, ordered her foley replaced, and said repeat the voiding trial in two hours. She failed that time, too.)

Wednesday: Mr. I Don’t Want a Catheter for My Five-Hour Surgery’s first words upon waking from anesthesia? “I have to pee.” Scanned for 1007 within 10 minutes of PACU arrival, I&O’d for 1100.

Later on Wednesday: Young, healthy, DOC (read: freakishly strong) patient arrives in PACU accompanied by a corrections officer and an apologetic CRNA. Pt has received an enormous dose of ketamine and is batshit crazy experiencing emergence delirium. He’s verbally and physically aggressive, despite arriving restrained at wrist and ankle, which he protests vociferously and loudly with abundant use of both profanity and vulgarity. After 40 of Precedex and 2 of Ativan, 50 of fentanyl finally does the trick. Roughly forty-five minutes after his arrival, three nurses remain at his bedside to do everything necessary in as short a time as possible before he wakes up and starts swinging again. Dude wakes up less aggressive but still belligerent and irritable. I have the “here’s a urinal, it’s okay to pee--no, you’re not getting out of bed, you just had surgery” conversation every 90 seconds for the second time in six hours.

Thursday: CRNA and anesthesiologist (very bad sign) wheel my last patient around the corner and the CRNA’s first words are “we’re concerned about her breathing.” I take one look at the patient and know she’s approaching respiratory failure. MD says he wants a CXR. I open my mouth to ask about an ABG (I know her CO2 is high, it’s obvious she’s not blowing it off) but am distracted by the CRNA starting report, which gets worse the longer she talks. Patient is responsive, oriented, but lethargic and c/o 10/10 pain. Anesthesia asks if it’s ok to give pain meds. Having been burned before, I look up from my assessment and warily ask, “how much Dilaudid?” She hems and haws a bit, worrying out loud about giving narcs with her breathing, until I offer, “we usually give .2, but if you want to give .4, that’s okay.” She does. Pt seems to tolerate it ok, but just does not look good. She’s clearly struggling to breathe. I ask if the CRNA wants an ABG. “Yes!” I’m reaching to call the MD when she asks if I want her to order it. My yes is just as immediate, so off I go to hunt for an ABG syringe. But the ones with needles have mysteriously disappeared since I fetched them for Tuesday’s T-piece patient, so I call CCU and ask them to tube a couple over. (They send me six.)

I’m monitoring heart rate, breathing, blood pressure, oxygen status, respiratory effort, and mental status nearly constantly, drawing labs, doing wound checks and neurovascular assessments, giving IVF and non-narcotic pain meds, trying to get at least something charted, working around x-ray and keeping my patient informed and calm when my coworker passes me the charge phone.

Lab has just tried to call critical results to the teenage volunteer in the waiting room: pH 7.18 and pCO2 78.1. This patient just bought herself an ICU bed. I notify the anesthesiologist, he asks for BiPAP, I tell him to call respiratory, we page the hospitalist for admit and postop orders. I recognize the RT who arrives and chat pleasantly with her as we work on separate tasks for the same patient. Pt continues to c/o pain from her brand-new hip replacement; I’m discussing non-narcotic interventions with the MD and trying to explain to her that it’s more important to keep her safe than it is to keep her comfortable. Things settle enough for me to bring family back, ortho comes out with their last patient, and I snag the resident to chat about NSAIDs. Anesthesia repeats the ABG and I’m just starting to think about calling report when I look up and realize--it’s shift change. This patient is mine for at least another 33 minutes.

tldr; A series of crises forced me to prioritize patient care over playing cards ... or eating, or drinking, or urinating, or even charting. 

In other words, I am a nurse.

[microcosmfortwo]

Side by side; through and through

Learning from that day’s internal jugular central venous catheter (CVC) insertion

1) Recognising the indication for insertion of CVC

- is it urgent?

- if it is urgent, why was the femoral vein not the first choice? was the anatomy unfavourable?

- if it is not urgent, can i hold it off till I have optimised the patient further with fluids?

2) Choice of site

- if IJ is chosen as the site, is there anything that makes it more challenging/more risky?

> carotid artery below the IJ, small IJ

> dynamically collapsing IJ with inspiration/expiration (pt is heavily ventilated, fast respiratory rate

- can I choose a safer site then? 

> contralateral IJ, femoral vein

3) If the IJ site is more risky than usual and I don’t have other available sites, can I optimise the site?

- fluid resuscitation to maximise venous distension

- Trendelenburg positionin

4) If backflow in the syringes once IJ puncture is attempted suggests arterial blood, (bright red and/or pulsatile), how do I confirm it?

- do not put in the guidewire yet; send an undiluted ABG sample first, and then place the guidewire in partially to maintain access

- things to take note on the ABG is the SpO2 (expected <75% for venous blood) and lower Pao2. you may get a mixed reading (higher than venous but lower than arterial if aspiration took place while going through both artery and vein.

- confirm placement on ultrasound

- if in doubt, remove the needle and re-attempt cannulation. ITS NOT TOO LATE TILL YOU DILATE the cannulation tract.

[dxmedstudent]

Have you ever been the 1st doctor there to respond to a crash call? How was it?

I’ve never been the first (or only person) to be present at a proper cardiac arrest, though I’ve been the one to pull the emergency buzzer a few times for things like seizures. Colleagues come to help, and you continue with treatment as per protocol. Sometimes you just need another pair of hands. There was even one memorable moment when I was visiting family in hospital, and came across someone who’d collapsed in the lobby; which was deserted at the time. Fortunately they were breathing and started to come around before the crash team came, so it didn’t end up escalating to a full crash situation. Nevertheless, putting out the call is the only way to get urgent medical help so it was the right thing to do. If in doubt, you always pull the emergency buzzer or put out a crash call; it doesn’t HAVE to just be for arrests. There’s no ‘this situation is too silly to ask for help’, if you need a hand, you need other people. That’s not to say I haven’t attended arrests; I’ve dealt with more than one paediatric situation and at least several adult ones ( I find it hard to remember how many, oddly). And as for resus calls into A&E, there have been so many that I’ve lost count. But I’ve never been the only person there. Since nurses tend to spend more time with patients, they are almost always the ones to put out the call, and first to the scene. So by the time I arrive, bleeps jangling and thoughts racing, there are already people there. Although there’s an algorithm for everything, exactly how crash calls or blue calls (when someone comes in as a resus call straight to A&E resus) depends on who is there. If it’s a small team, or if you are first on the scene, you may need to lead, even as a very junior doctor. However the ‘team leader’ is usually either a senior doctor or senior nurse, because it takes time to gain that confidence. If you are alone, then you do your best with what you have, until your team comes to support you. This usually means having one person to provide oxygen/hold the mask, and one to do chest compressions. When more people come, then things kick in properly.We work with the standard ABCDE framework, assessing someone’s airways, then breathing, then circulation, then mental state/disability then exposing the patient to see if there’s anything we missed. It means you don’t worry about a cut on their leg when you haven’t realised they aren’t breathing! As you go along, you are doing detective work; what could be causing their current state? Is it something you can fix? What can you try?  Whenever you start a treatment, you have to go back and check to see if it’s working.And when you’ve assessed things, you go back and assess it all again.It works; even in a panicked situation, it gives you a structure which eventually becomes second nature. Which is important because these situations can be very stressful, particularly if you can’t find what’s causing it. But because it’s scary, it’s something we are prepared to do; we receive simulation training. We have exams in resuscitation we are expected to pass every few years, with a refresher to make sure we still feel competent at it. Many teams also organise informal or formal sesisons for practicing resus scenarios. At first it feels incredibly awkward because everyone is watching you struggle to lead a scenario. But you get better and more confident, and it’s a safe environment for you to struggle and learn; much better struggle on a doll than on a real person! So if you’re a budding student thinking ‘this all sounds impossible to do’, you get training, and it gets less scary. In a well-run scenario, everyone knows their role. If you are praciticing training up, your seniors may let you assess the situation by doing the primary survey. Or they may task you as the person to obtain venous access and ABG/VBG so that we can get a better picture of what is going on, and have a line to give treatments like adrenaline which are essential for cardiac arrests. Or you may be one of the people tasked with switching into the chest compression cycle. Someone has to manage the airway/bag and mask until the anaesthetists turn up, as well.  I’ve always been good with and liked the needly aspects, so I’m usually happy to let the burly blokes or buff girls take the lead in CPR whilst I stab away; but of course you play whatever role the team needs, and that depends a lot on how many people you have to help you.  In some cases, there are a huge number of people. Your consultant is there, A&E staff are there. Multiple registrars, other juniors above you. Lots of nurses. Then your role changes. There may already be people with more experience doing everything you can do; anaesthetists will take over the airways, your seniors will take over leading and making decisions. There’s often more people than you strictly need. What they sometimes need then is the ‘odd jobs person’. Sometimes that means running around ensuring that there’s enough equipment available; cannulas, saline, adrenaline. That any meds that need to be given are calculated properly or prescribed if possible. You need the one who keeps track of how many needles there are so nobody gets stabbed, and ensures that rubbish doesn’t build up and people don’t get needlestick injuries whilst trying to save someone.  This doesn’t look as exciting as being the one giving the meds, or doing the compressions, and it isn’t as hard as leading the arrest. But it’s an oddly important little job; I still remember after one resus call where I wished I’d done more than just run around doing little things, that my seniors took me aside and told me they were impressed with how I’d worked during the really stressful situation. “whenever we needed something, we turned around and BAM! there you were with it” was basically how they’d described it. The worst thing during a stressful and time sensitive situation is when your staff are panicking because they can’t find the drug you need, you’re all out of syringes, the cannulas in the size you need ran out and you can’t run over to grab more; the little things can waste time that you can’t afford to waste. This task sometimes falls to nurses, or even students, but it’s absolutely not beneath a doctor. Then there’s the record keeper; the one who notes down exactly when everyhing happened; when each medicine went in, when each cycle happened, when you got the patient back or when you called the arrest and pronounced time of death. This often falls to a med sutdent or student nurse, but it’s actually an immensely important task, because every detail matters.  When done properly, this person is the one letting people know that a cycle is completed, and it’s time for the next adrenaline, or reminding the leader of what’s happened so far and how much time the arrest has taken up so far.  It’s a very important role, and actually a really good one for observing emergency situations and learning from them. You aren’t required to dive in and do anything else (and believe me, diving in to do stuff automatically makes you less focused on the other bits), so apart from the leader, you probably have the clearest picture of what’s going on. This too can be a really important task if it falls to you. There will also be the person who runs off to send VBG/ABG samples or grab supplies, and that usually won’t be you, but again it depends on who you have on the ground. There is no role that you can’t or shouldn’t do as a doctor, though there may be roles that can be more easily left to others if you have enough people. Usually, there might be a porter or someone else who can do the less medical roles so you can focus on getting a line or putting in an IO or leading the scenario and reassessing what may be causing it. Often, your senior or leader will know where you will be of most use, but it’s also up to you to observe the dynamic situation and see what is needed as well, given the leader will have a  lot on their plate. Regardless of whatever roles you end up taking on, it’s a situation unlike any other, and when you’ve seen a well-coordinated arrest or resus situation, you appreciate what real teamwork is. I’ve never felt a more integral part of a team, never felt more attuned to my colleagues than when I’ve been in such scenarios.

[itscarlawthac]

#CarlaTheClerkie: First Week - Internal Medicine

I haven't blogged about the uncertainties I have with clerkship. I haven't even blogged how I passed third year and how I maintained my scholarship and all those mushy year enders. Sorry for making this tiny space not updated but I promise this time, I'll do it weekly per rotation *proud happy dance* Hingang malalim, here it goes. INTERNAL MEDICINE. The moment I saw that our first rotation was IM, I really didn't know what to feel. Relieved since come comprehensive exam time, we will being having time to review or extra scared since it is the most toxic and tedious rotation among all departments. When people ask me what kind of doctor I'd like to be, I will easily say "Di ko pa alam eh, basta sure ako hindi Pedia at naka cross out na ang IM" IM is my waterloo subject and it is practically composed of all specializations imaginable - cardiology, neurology, endocrinology, nephrology, oncology, hematology). It is the meat of medicine! Imagine how I struggled last two years because of IM and now IM pa talaga ang first rotation ko, edi gulatan kung gulatan! It's a sunday and thankfully, I didn't have to give up sleep and food. I messaged my mother to bring me to somewhere happy. Kahit saan basta sa masaya kami kakain ng lunch. I feel so drained and tired and every duty night when my feet hurt from going down to the laboratories from 4th floor (the elevator is so slow and everything needs to be fast!!!) I ask myself, "bakit ganito kataas ng pangarap ko? Hindi ba pwedeng simpleng trabaho na lang yung pangarapin ko?" then I would encourage myself with "kaya mo yan doctora, kaya mo yan carla" or "4 hours na lang uuwi ka na" or "nakakahiya kung magq-quit ka, sayang three years" because those are my real thoughts for this week. I feel so lost because kahit anong endorsement ng higher years sa amin, kahit anong tips experience is really the best teacher. So don't be on the sidelines, stay where there is action because from that, you will learn. Ilang beses ko nalunok yung pride ko at kung ano pa. Sabi ko nga, feeling ko tupa lang ako na imbis na baa, baa ang sinasabi ko, "opo mam, opo sir", "yes po doc, sorry po doc", "patulong mam nurse, salamat mam nurse" pero at least may mga tao kang kasama sa laban na ito. Mga taong hindi ka papabayaan. Ayan naiiyak na ako, ilang beses kasi ako napagsabihan dahil sa kashungaan ko. I am the kind of person who hates being lost, yung not in control in anything, OC ako eh. And yung first week ko, ramdam na ramdam ko na disorganized ako as a person. Sobrang inefficient. Magulo yung quarters namin, madaming papeles na hindi ko pa kabisado, may mga taong hindi kilala, may mga procedures na hindi kayang gawin, naliligaw pa rin sa ospital - I want to control how things work but that was not applicable bilang I am a mere dirt sa hierarchy sa ospital. Nasisigawan, nasasabihan. Nakakapagod pero kapag bumisita ka naman sa mga pasyente mo para kunan ng vital signs, mawawala yung pagod mo sa simpleng "kain na tayo, doctora" o "ayos ka pa ba?" Yung mga kwentuhan din nila na ayaw mo man putulin ay dapat magcarryout ka na. Tapos yung mga mam nurse at sir nurse na pwedeng pwede mo lapitan kapag kailangan mong ipa-paracetamol yung isang pasyente, wala ka ng 5ml syringe, o kailangang kailangan mo ng tulong sa reseta. My co-rotation interns na super amazing sa skills, isang tusok lang pasok na kahit edematous pa salamat kahit ang kulit kulit ko na andaming tanong! To my co-service residents who try their best to be understanding of our kashungaan, I promised you a new and improved Carla so antay lang po. Super dami ko na agad natutunan from them kasi ang galing nila magturo. Pasensya na po kung di ako makasagot agad agad sa tanong. Siyempre nagrant talaga ako sa post na ito. Dami kong cases na nakita, stroke, coronary artery disease, UTI, sepsis from CAUTI, rheumatic fever!!!, hypokalemia, dengue, CHF, super laking sacral decubitus ulcer, supraventricular tachycardia na ako nag ECG, alcoholic liver disease na andaming complications, MI, etc... I practiced skills - IV insertion, venipuncture, ABG, ECG, walang kamatayang vital signs... still no foley cath and NGT insertion pero nagawa ko na naman yun sa Pahinungod. One week and I LEARNED SO MUCH. Medical cases, skills or papers, my favorite learning is HUMAN INTERACTION. I dealt with a lot of different personalities, work ethics, attitudes, and values. From how my co-clerks handled every duty, how my interns are already tired and feared for their boards yet still willing to help, our residents trying to be understanding and patient with us, the nurses and the difficulty of their job, the bantay of patients who are so eager to tend to their loved one even though there are lots of things to do, and the patients. The patients who try their best to cheer you up after hours of no sleep, no food, and no bathroom break by encouraging you to try another vein, ask you how you are, pretend it does not hurt so you would calm down and relax. So when asked what my favorite learning is, it would outright be HOW TO BE HUMAN ENOUGH FOR OTHERS.

[tails89]

Land Below the Waves Ch.12

I’ve been sitting on this for a while because… well… I’m not a doctor…I have no idea what I’m doing and this. was. hard. I apologise for what I’m sure are many, many medical inaccuracies.

Chapter One

Also posted here

 “Twenty-two year old male, unresponsive but breathing.” The paramedics kept pace with the gurney being pushed through the stark white hallway. “Open fracture to left tibia and third degree burns to the shin and foot.”

The gurney was brought to a stop next to one of the emergency room’s beds. Hands reached out from all around.

“On the count of three-“

In one smooth movement the man was transferred across to the larger bed and the buzz of activity started again.

“He’s on 100% oxygen for smoke inhalation and possible carbon monoxide poisoning.” The paramedic continued. “He was trapped for an unknown amount of time beneath a burning wall.”

The doctor on duty nodded as he listened to the paramedic’s assessment and began directing the others around him.

“I want a CBC, ABG, x-rays of his chest and of that leg.” Noting the dark bruise beginning to bloom beneath the floppy, brown fringe, the doctor took out his penlight. He raised one of the man’s eyelids and flickedg the light to watch the reaction of his pupils. “Possible concussion.”

There was a commotion from behind the curtains. The sound of marching feet echoed up the hallway.

“Sir, you can’t go back there just yet.”

“That’s my son in there!”

“And right now the doctor is working on him. You’ll only be in the way.”

“I need to see my son!” Stoick wrenched the curtains aside. “Oh Thor.” It was a broken whisper.

He watched on in horror as one of the nurses began cutting through Hiccup’s singed and sooty clothing. Another was drawing blood, checking blood pressure, attaching leads. This one tiny area of the emergency room was crammed with people, all moving about. Hiccup in contrast was completely still as the doctors tried to elicit some response from him.

Stoick had never seen his son so still. Even in sleep, as a child Hiccup had been a jumble of limbs, twisting and tangling in his sheets. This… this was not Hiccup. It couldn’t be.

Stoick’s gaze drifted upwards. His son’s body was covered in small cuts, grazes, burns. None as bad as the burn on his leg. His face was almost completely obscured by the mask blowing oxygen into his nose and mouth.

“Sir, you need to wait out here,” a small hand was placed over Stoick’s much larger arm and the man was guided outside to a seat. “You need to let them do their jobs.”

The doctor poked his head out of the cubicle to yell to another staff member. “Where’s my x-ray? And Madeleine, get on the phone to Westmead Hospital and the retrieval team.” He pulled the curtain closed behind him.

“Westmead? Retrieval team?” Stoick looked in askance to the nurse who had pulled him aside.

“Let me go see what’s going on,” she offered. “I’ll update you on his condition as soon as I know.”

She ducked into the cubicle and Stoick was left to sit in the cold, uncomfortable, plastic waiting room chair. . All he could do in that moment was watch.

Watch as more machinery was wheeled into the room. As X-rays were taken and discussed, though not with him. Watch as people darted in and out of the tiny cubicle that held his only child.

“I can’t lose him too Val.”

And he couldn’t just sit there and wait.

The large man stood, pacing his small corner of the hospital. Round and round. The little nurse who had promised to keep him updated had not returned. It had been over an hour! When was someone going to tell him what was happening to his son?

“Mr Haddock?”

Stoick paused in his pacing to look towards Hiccup’s cubicle.

“You’re Henry’s father?”

“Yes,” Stoick strode over to the shorter man. The doctor reached to shake his hand.

“I’m Dr West, one of the emergency doctors here.” He was holding a clipboard in his free hand. “Can we talk?”

“Yes, I need to know,” Stoick released the doctors hand. “How is he? Can I see him?”

Dr West nodded. “We’ll get you in to see him in a moment,” he promised. “First let me update you on the situation.”

The doctor was not a small man, but still he was dwarfed by Stoick’s towering build. He directed Stoick back to the chairs and gestured for the older man to take a seat.

“Right now we’re getting him ready to transfer to Westmead Hospital,” he explained. “We’re only a small regional hospital, we can’t properly deal with his injuries here.”

“And what are his injuries?” Stoick pressed the doctor for more information.

“Right now there are a number of things we’re concerned about.” Dr West lay his chart across his knees. “The most concerning are the third degree burns Henry has to his left shin, coupled with an open fracture – the bone has broken through the skin – the risk of infection is incredibly high. We’ve already started him on antibiotics, but he’ll need surgery as soon as he reaches the city.”

Stoick shifted in his seat. “Okay, so he’s got a broken leg, why hasn’t he woken up?”

“I’m afraid it’s more serious than a broken leg. A broken leg we can fix here, it’s the burn. We can’t do a thorough assessment here, but the tissue damage is severe. This means issues with circulation – blood isn’t getting to his foot, issues with sepsis if it’s not properly cleaned. Henry is going to need skin grafts at the very least.” The doctor took a breath. “As to his level of consciousness… it could be a combination of things. Smoke inhalation, concussion, shock all play a part.”

“Can I see him now?” Stoick was already rising from his seat, anxious to see his boy.

“Of course,” Dr West rose as well, leading the way to the closed curtains. He pulled them aside slowly, revealing Hiccup lying motionless on the bed. His clothes had been thrown away and a blanket had been placed over him, covering the unconscious boy to his chest.

There were numerous wires attached to his chest. On his left arm there was a blood pressure cuff and a little grey clip on his finger. The wires led up to a machine that displayed his heartrate, blood pressure and oxygen saturation.

Beside the machine was a tall silver pole with several bags hanging from it. Tubes connected to the IV bags and twisted down towards the bed where they disappeared underneath the skin of Hiccup’s right hand.

“I don’t understand, he was breathing when he came in.” Stoick rushed to Hiccup’s side. He took his son’s hand gingerly, wary of the cannulas taped to the skin, and took in the sight before him. There was a large bruise on Hiccup’s temple – the source of the concussion? It was hard to notice anything around the tube jutting from his mouth.

“It’s a precautionary measure.” Dr West was studying the numbers displayed on the monitor. He pressed a few buttons and turned back to the bed. “The results of his blood tests indicate he’s inhaled quite a bit of smoke. Treatment needs to be aggressive, in case his condition deteriorates, it could be hard to intubate later. Until he wakes, it’s important we maintain his airway.”

Stoick reached a hand to smooth back Hiccup’s hair. It felt greasy and gritty with dust from the collapsed wall he’d been pulled from.

“Okay, and what’s the next step?”

“The retrieval team should be here any minute.” Dr West scribbled some notes onto his clipboard and lay it on the bed. “Henry is stable enough to be moved, it’s about a forty-five minute flight to the city. Barring any complications, he should be in surgery in an hour.”

()

The next twelve-hours hours were rough.

Within minutes of landing on the helipad at Westmead Hospital Hiccup was in surgery. His leg was set and the burns to his leg was cleaned, dead skin and muscle was removed.

Afterwards, he had been moved to the Burns Unit to be monitored until he woke up.

It hadn’t happened yet. He’d shifted slightly at one point, letting out a breathy groan, but hadn’t surfaced completely.

Stoick’s back was aching from sitting in the too small, too hard chair. His body just wasn’t designed to contort like that. He was a big man.

Despite his discomfort, he hadn’t left Hiccup’s side since he had been wheeled from recovery and settled into his current room. There had been more testing, more X-rays and Stoick made sure he was present for it all. He wasn’t going anywhere.

It was late now.

The events of the morning seemed so long ago.

There was a soft knock on the door. Lucy, one of the senior nurses looking after Hiccup walked into the room.

“Evening Mr Haddock,” She walked around to the far side of the bed.

“I told you earlier lass, you can call me Stoick.” He sat up straighter in his chair and stretching out his weary muscles.

Lucy smiled and pulled on a pair of gloves.

“Well, Stoick,” she checked a couple of things and then injected something into Hiccup’s IV. “I’m about to head home and the night shift will be taking over.” Lucy deposited the syringe in the sharps container and reached for the thermometer on the bench by the bed. “You should think about getting some rest.” The thermometer beeped and she checked the number, recording it with a little frown.

“I’ll get some rest when I know my boy is going to be okay.” Stoick lay his hand where Hiccup’s leg was resting under the blankets.

Lucy packed up her things and removed her gloves.

“I figured you’d say that,” she told him. She paused by the door. “If you need anything, just let one of the nurses at the desk know.” She left the room.

Stoick settled back in his chair, trying to find something that resembled a comfortable position. The steady beeping of the heartrate monitor was reassuring, as was the sight of Hiccup breathing on his own. The ventilator had been replaced once more by a simple oxygen mask.

()

Stoick woke with a start. He didn’t remember falling asleep.

There was someone shuffling around the room. Working by the small light above the bed. They flinched when Stoick shifted in his seat.

“I’m sorry, I didn’t mean to wake you.”

Stoick realised it was another nurse.

“Night time rounds,” she explained her presence as she checked Hiccup over. She reached for the thermometer. “Lucy noticed his temperature was up a little.” She placed the tip in Hiccup’s ear. “It’s not uncommon given everything he’s been through,” she continued her explanation. “And burns are susceptible to infection, I’m sure the doctor would have explained that.” The thermometer beeped.

“Ah, it is a little higher than we would like,” she made a note of it in the chart. “I need to take a look at his leg. He’s due to have the bandages changed soon, we’ll just do it a little early, make sure everything looks okay.”

The young nurse gathered up her supplies to rebandage the burn.

“You probably won’t want to watch this.” She lifted the blanket to uncover Hiccup’s legs. “It’s not a pretty sight.”

“I can handle it,” Stoick told her. “I’m not going anywhere.”

The nurse pulled on her gloves and removed the bandages covering the wound. Stoick almost gagged at the sight. He looked away as the nurse redressed the burn.

Hiccup stirred. The process of removing the bandages looked painful. Stoick took his son’s hand and found himself hoping the boy would stay asleep through it.

“All done,” the nurse announced, pulling the blankets back over Hiccup’s feet.

“And it all looks… okay?” The mess of Hiccup’s leg did not look ‘okay’ to him, but he was a fisherman, not a medical professional.

“There are a few things I’d like to check over with the doctor. I’ll be back in a minute.” She disposed of the rubbish and bustled out of the room. She returned ten minutes later, with a doctor in tow.

“Mr Haddock, can you give us a minute here?” The doctor was not one Stoick had met yet, and he had met many in the last few hours. She was already pulling on her gloves as she addressed Hiccup’s father.

“I’d rather stay.” Stoick stood up from the chair to stand by the bed.

“It’ll only be a few minutes; you can wait outside. Give him a little privacy for this one.”

Stoick reluctantly agreed. As much as he hated to admit it, his kid was an adult and would probably prefer if there were some things his dad didn’t see.

“I’ll be right outside. Come and get me the minute you’re done.”

“We will,” the nurse promised as she lifted Hiccup’s blankets once more.

True to their words, a few minutes later the door to Hiccup’s room opened. Stoick was up and waiting just outside as the doctor emerged with the nurse.

“We might need to switch up his antibiotics. With the redness around the burn, the swollen lymph nodes, the fever, his leg is not looking good.”

They looked up and saw Stoick waiting expectantly.

“Let’s take a walk,” the doctor motioned for Stoick to follow her and the nurse peeled off to visit her other patients.

“What’s wrong?”

Stoick had to slow his pace to match the woman’s.

“His leg has become infected,” the doctor explained as they walked down the hall. “The damage is already significant and he has poor blood flow to his foot. If he doesn’t respond to the antibiotics more tissue could die. He’s going to need more surgery to save his leg.”

“Save his leg?” Stoick stopped in the middle of the hallway.

“It’s a lot to process right now,” the doctor acknowledged. “We’ll check on him through the night and reassess in the morning.”

With all this to think about Stoick returned to Hiccup’s room. The nurse from earlier bustled back into the room making the doctor’s requested changes and bustled out again.

Alone with his son, he resumed his position by the bed.

By morning Hiccup’s fever was spiking. He was sweaty and shaking and moaning in his sleep. His doctor had been by and he’d been scheduled for more surgery.

Stoick knew he was in for a long wait when his son was wheeled away again.

Hours passed with no news. He was forced to sit and wait and wonder if Hiccup was going to be alright. At some point Lucy had appeared again and pressed a sandwich into Stoick’s hands. She’d waited, coaxing him, until he took a bite. She’d reappeared later with a cup of tea.

Each time she appeared, just as Stoick thought he would lose his patience, and sat with him until she had to dart back off to work.

Finally, she was able to bring him some news.

“He’s out of surgery,” the matronly woman resumed her seat beside the worried father. “He’ll be in recovery for a bit before we get him settled back in his room.” She saw Stoick open his mouth and answered the question before it was asked. “I don’t know yet how it went. Henry’s doctor should be out here soon.”

The was the swish of sneakers against linoleum.

“And speak of the devil,” Lucy stood as the doctor entered. “I can stay if you want.”

Stoick shook his head. “No, I’m sure you’ve got a lot of work to do. Thank you.” He stood and turned to man dressed in scrubs and a lab coat. “Dr Greyson, tell me. How is Henry?”

“It was as we thought.” Dr Greyson gave a sympathetic sigh. “There was too much damage. Circulation was compromised. With the added complication of infection there wasn’t much we could do. I’m sorry. We couldn’t save his foot.”

[pusware]

Goldberg

I did my Internal Medicine residency in a county hospital were we often did the blood draws, started IV's, did the abg's etc. Old school. Stupid school. I do not think patients benefited from an endless series of newbies trying to access a vein or an artery, although it did instill in me a deep appreciation of arm veins. To this day the first thing notice in another human is the veins of their arms: are they an easy stick or not? Medical training instills all sorts of curious quirks.

I remember when of my fellow interns (it was NOT me) couldn't get a blood draw late one night on an IVDA who had used all her arm and leg veins. Finally in disgust she grabbed the syringe from him and stuck her own femoral vein, which she was quite adept at, and filled the syringe. He made in the mistake of mentioning it and was reprimanded, but I thought it was a great idea.

Femoral vein users have been relatively rare in my practice, and

The main reason given for starting to inject in the groin was that 'no other sites were left'. However further discussion identified this meant no other convenient sites were accessible.

 Continue reading at http://boards.medscape.com/forums/?128@@.2a82f4a9!comment=1

[nursetina2118-blog]

I surrender

Its only been two shifts in and I’m already convinced there is no experience in the world quite like being a new grad nurse.

One minute I’m on top of the world for hanging an IV bag correctly or finally getting an axillary temp then five minutes later my patient is dead. 

Okay maybe its not always that dramatic. But seriously, it’s emotional whiplash. 

There is just SO much going on. I’m trying to learn everyone’s names, remember the code to the supply closet, decipher the “lingo” of the unit in the conversations going on around me, all while trying to not look like a fool. When I finally muster up enough courage to ask my preceptor to explain the exchange that just occurred I am delighted to find I DO know what they were talking about after all. For a moment I feel light as a feather, maybe I’m not an impostor after all. 

Then I’m attempting to draw an ABG off my patient’s arterial line after his oxygen saturation dropped to 85% on 60% bipap and I’m fumbling with the 3cc syringe and trying to remember which way to turn the valve and my preceptor has to step in and I’m buried again. 

I surrender. I wave the white flag. I can’t bypass this storm. There’s no avoiding it, no other way around it, I have to go through it. I just pray I survive.