Fournier's Gangrene!
I remember hearing about a case of this on the unit, but I didn't get to see it. Well, last night I got well acquainted with it. I think it is, to date, the most fascinating, gruesome, eye popping, awesome disease process I have seen. I got lucky, really! I just happened to walk to another unit to see if I could be of any assistance. One nurse, Chad, was preparing to give a bath, but needed to do a dressing change first. When I saw the site of the dressing change, I knew I had struck gold! What lay behind the mass of ABD pads and saline-soaked gauze was a bout of gangrene that left the poor patients left testicle totally exposed.
The doctors had debrided the wound yesterday, and removed so much necrotizing flesh that today I was able to observe the left spermatic cords' descent through the internal oblique! I was so shocked to see real live anatomy that I began to call everything out by name as I saw it. It was a remarkable specimen to see, but unfortunately this poor patient is not doing well, and will probably have to go back in for more debridement.
That pretty much sums up my night! We did loose a patient sometime after I got off work last night, and we are sure to lose a few more when their families come to grips with their loved ones' demise. It's a sad, sad thing...death. C'est la vie.
Wednesday, February 25, 2009
Tuesday, February 24, 2009
Goodbye, February!
Wow...is it me, or does it seem like the months are flying by. March is just a few days away!
Great night last night on the unit. Lots of interesting cases: 18 y0 overdose, acute MI, syncope with PVC's, multisystem organ failure, and DKA. I'm learning lots!
I mustered up the energy to go to the gym after work. Today was leg day. Ugh! But it was one of the most intense workouts I've had in a while. I needed it badly! Threw in bi's and tri's since I skipped out on in last week. I'm feeling pretty good now. Let's see how I feel at work tonight!
Great night last night on the unit. Lots of interesting cases: 18 y0 overdose, acute MI, syncope with PVC's, multisystem organ failure, and DKA. I'm learning lots!
I mustered up the energy to go to the gym after work. Today was leg day. Ugh! But it was one of the most intense workouts I've had in a while. I needed it badly! Threw in bi's and tri's since I skipped out on in last week. I'm feeling pretty good now. Let's see how I feel at work tonight!
Monday, February 23, 2009
Change of Heart
LOL...no not about that. Are you kidding me!
Part of the reason why I took this new job is that it's located in one of the most beautiful areas in my state. I love southern living! I love rolling hills, cows and horses, and homes with land! All of this is a plenty in the town where I work. I can easily see myself working hard in the hospital, rounding on my patients, running the local clinic, and playing just as hard at home with the cop and Linc. But my dream is crumbling before my eyes.
It's becoming obvious to me that my hospital is run by the nurses. And PAs are at the bottom of the totem pole. I work at night, so I don't get a chance to see them rounding in the mornings. The NP's there greatly outnumber the PAs, and they are more office assistants than practitioners. I refuse to work in that capacity, and I don't know if I have the energy or the time for being the first PA to really be utilized properly. That's an uphill battle that I'm not willing to fight, and my first few years as a PA should be about getting my skills up to snuff. Once I pass the PANCE I may have a different outlook. But it sure would be nice to hit the ground running in a practice that knows what a PA is and how they are used. The cop says if the right opportunity comes along, he is willing to move anywhere after I graduate! Sweet!
Part of the reason why I took this new job is that it's located in one of the most beautiful areas in my state. I love southern living! I love rolling hills, cows and horses, and homes with land! All of this is a plenty in the town where I work. I can easily see myself working hard in the hospital, rounding on my patients, running the local clinic, and playing just as hard at home with the cop and Linc. But my dream is crumbling before my eyes.
It's becoming obvious to me that my hospital is run by the nurses. And PAs are at the bottom of the totem pole. I work at night, so I don't get a chance to see them rounding in the mornings. The NP's there greatly outnumber the PAs, and they are more office assistants than practitioners. I refuse to work in that capacity, and I don't know if I have the energy or the time for being the first PA to really be utilized properly. That's an uphill battle that I'm not willing to fight, and my first few years as a PA should be about getting my skills up to snuff. Once I pass the PANCE I may have a different outlook. But it sure would be nice to hit the ground running in a practice that knows what a PA is and how they are used. The cop says if the right opportunity comes along, he is willing to move anywhere after I graduate! Sweet!
Saturday, February 21, 2009
Patients And Their Families
Back to work tonight! I'm looking forward to it. Last week was CRAZY! Lots of admissions, not too many sad stories, but lots of drama to make up for it!
I'm beginning to realize just how much families can interfere with the care of a loved one. We had several instances like this last week, but one stands out above all others. We had a patient come in with respiratory failure. He was ventilated and subsequently trached. His family was outrageous. Two by two, they would switch "shifts" with one another to make sure the patient has someone in the room with him at ALL times. They kept a detailed notebook of drugs given, for what purpose they were given, the name of the nurse or repiratory therapist that administered those drugs, and names of all techs (including me). They refused to let us turn the patient because it would cause him pain, even after being told that this would surely cause skin breakdown. They would run out to the nurses station anytime they felt a vital sign was too low, or when the monitor alarms went off. They demanded the patient be given his pain meds well before it was time. And they hovered over anyone who was rendering care to the patient, even to the point of becoming a hazard. They were unbearable. Furthermore, they somehow got the doctor to order the presence of a family member in the patients room at all times. There was nothing we could do to get rid of them. What makes all this so bad is the patient was one of the sweetest I've had since I started working there. He was in horrible pain, but always managed to smile and crack jokes. I loved him, but hated his family.
I wish families would understand why their loved one is in ICU to begin with. When one walks into the ICU, 1) they are usually very sick, and 2) require special care that requires lots of knowledge and expertise. If this patients family felt they had the expertise to take care of him, why didn't they discharge him and take him home???
I think what made me more upset is the lack of authority on the part of the nurses. Not once did they sit down and talk to the family about their behavior. Not once did they draw the line. I can only recall two people who made it clear in one way or another that the family needed back off: me, and only one nurse! I know this is risky business. I know the family thought they knew what was best. But clear lines must be drawn when it comes to rendering care. And if anyone gets in the way of that, we have a problem. The night techs rotate units every week, so fortunately, I will not have to deal with this family anymore. But as the saying goes, the grass is NEVER greener on the other side!!!
I'm beginning to realize just how much families can interfere with the care of a loved one. We had several instances like this last week, but one stands out above all others. We had a patient come in with respiratory failure. He was ventilated and subsequently trached. His family was outrageous. Two by two, they would switch "shifts" with one another to make sure the patient has someone in the room with him at ALL times. They kept a detailed notebook of drugs given, for what purpose they were given, the name of the nurse or repiratory therapist that administered those drugs, and names of all techs (including me). They refused to let us turn the patient because it would cause him pain, even after being told that this would surely cause skin breakdown. They would run out to the nurses station anytime they felt a vital sign was too low, or when the monitor alarms went off. They demanded the patient be given his pain meds well before it was time. And they hovered over anyone who was rendering care to the patient, even to the point of becoming a hazard. They were unbearable. Furthermore, they somehow got the doctor to order the presence of a family member in the patients room at all times. There was nothing we could do to get rid of them. What makes all this so bad is the patient was one of the sweetest I've had since I started working there. He was in horrible pain, but always managed to smile and crack jokes. I loved him, but hated his family.
I wish families would understand why their loved one is in ICU to begin with. When one walks into the ICU, 1) they are usually very sick, and 2) require special care that requires lots of knowledge and expertise. If this patients family felt they had the expertise to take care of him, why didn't they discharge him and take him home???
I think what made me more upset is the lack of authority on the part of the nurses. Not once did they sit down and talk to the family about their behavior. Not once did they draw the line. I can only recall two people who made it clear in one way or another that the family needed back off: me, and only one nurse! I know this is risky business. I know the family thought they knew what was best. But clear lines must be drawn when it comes to rendering care. And if anyone gets in the way of that, we have a problem. The night techs rotate units every week, so fortunately, I will not have to deal with this family anymore. But as the saying goes, the grass is NEVER greener on the other side!!!
Saturday, February 14, 2009
Happy V-Day
It's a bit gloomy in my part of the world, but it's still been such a lovely day.
The cop and I went out for breakfast this morning, then went horseback riding. The sun came out for a bit, and we were able to get some great pictures! Tonight we are going out for dinner! And dare I sa the cop managed to plan all of this on his own. There is a God!
I go back to work tomorrow night to work a 12 hour shift. After today, we could use the overtime pay, and hopefully there will be some interesting cases to read up on. Time flies, so enough about work for now. I'm off to continue celebrating this day of love and happiness. Cheers to you all!
The cop and I went out for breakfast this morning, then went horseback riding. The sun came out for a bit, and we were able to get some great pictures! Tonight we are going out for dinner! And dare I sa the cop managed to plan all of this on his own. There is a God!
I go back to work tomorrow night to work a 12 hour shift. After today, we could use the overtime pay, and hopefully there will be some interesting cases to read up on. Time flies, so enough about work for now. I'm off to continue celebrating this day of love and happiness. Cheers to you all!
Tuesday, February 10, 2009
First Day of School
Yes, I'm a student once again! But this time, the material isn't nearly as interesting.
I began taking my Music History course for my degree yesterday. I can't say I'm excited about taking it; I just want to do well and get my degree at the end of the summer. I had another great weekend! I surprised the cop with salsa lessons, dinner at a restaurant downtown, and salsa dancing afterwards. It was great! My feet still hurt. I can honestly say I have found another love! As soon as I got home, I ordered some ballroom shoes. The cop got us some DVD's so we can improve our dancing skills, and we are planning on going to our next salsa social in a few weeks. I can't wait!
Work is still going well. I think my secret may be out, though. I'll write more about that later. There have been lots of interesting cases lately: the DKA guy who made a complete turnaround, the ruptered pancreatic pseudocyst that led to sepsis, and the brain dead paraplegic that is having her organs procured as I write. Lots of learning opportunities for me, that's for sure.
Well, there's not much else to write today. I'm exhausted, so I'll call it a day.
I began taking my Music History course for my degree yesterday. I can't say I'm excited about taking it; I just want to do well and get my degree at the end of the summer. I had another great weekend! I surprised the cop with salsa lessons, dinner at a restaurant downtown, and salsa dancing afterwards. It was great! My feet still hurt. I can honestly say I have found another love! As soon as I got home, I ordered some ballroom shoes. The cop got us some DVD's so we can improve our dancing skills, and we are planning on going to our next salsa social in a few weeks. I can't wait!
Work is still going well. I think my secret may be out, though. I'll write more about that later. There have been lots of interesting cases lately: the DKA guy who made a complete turnaround, the ruptered pancreatic pseudocyst that led to sepsis, and the brain dead paraplegic that is having her organs procured as I write. Lots of learning opportunities for me, that's for sure.
Well, there's not much else to write today. I'm exhausted, so I'll call it a day.
Monday, February 2, 2009
Back to Work
I had a blast this weekend! Spent time with my sister, went to the doggy park with Linc and the cop, and got some much needed rest. Tonight, I return to work. I'm looking forward to it.
I've been really successful with keeping this PA school thing under wraps. I don't know how much longer I will be able to do so, though. I've been searching for a list of PAs that work at my hospital, and it had been an uphill climb until late last week, when I make a contact in the Medical Services office who has a complete list of PAs that she is willing to share! Furthermore, she made it sound like they would be more than willing to let me shadow.
SUCCESS!!!!!!
So, tomorrow morning before I head home, I'll be stopping by to get that list, and then I hope to begin shadowing soon. I really miss it.
Also, I begin school on the 9th! Music History...what fun. NOT! The only thing that excites me about thsi course is that it brings me one step closer to completing my degree. I can't wait to get it over with.
I've been really successful with keeping this PA school thing under wraps. I don't know how much longer I will be able to do so, though. I've been searching for a list of PAs that work at my hospital, and it had been an uphill climb until late last week, when I make a contact in the Medical Services office who has a complete list of PAs that she is willing to share! Furthermore, she made it sound like they would be more than willing to let me shadow.
SUCCESS!!!!!!
So, tomorrow morning before I head home, I'll be stopping by to get that list, and then I hope to begin shadowing soon. I really miss it.
Also, I begin school on the 9th! Music History...what fun. NOT! The only thing that excites me about thsi course is that it brings me one step closer to completing my degree. I can't wait to get it over with.
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