Nursie999

hello

2008-10-23T23:18:00.001+01:00

im still alive im just thinking

working

2007-07-24T00:25:00.000+01:00

Well i managed to get a full time job at my work, which was a big hooooo haaaaaaa but i loved it, iv seen a few interesting things lately, a fat kid that had stood on a bit of wood with a nail in it and the nurse practitioner told me just to w$nk it off, i think she must have meant yank, iv managed to find 3 positive pregnancy tests and pass on the good news to now expectant mothers, Im really begining to like burns, i like checking for sooty airways and bathing burnt skin. Iv had no arrests for ages (touch wood). I laugh a lot and have a great time at work, im sad because the drs are leaving soon, they have taught me a lot and i will miss them ...well some of them.

The Wee ones

2007-06-06T12:49:00.000+01:00

i just found this post, i dont know when i wrote it but i thought i would post it anyway

Im scared of babies...well really im scared of ill babies more.

The paramedic and technician come in you can see the panic on there face , they are older men , i bet they have children of there own or have seen enough well babies to know there is something wrong with this wee mite. Mum is carrying him and closely followed by the crew. The tiny baby is put on our massivley big trolley making it look like a pea in a mountain, It is making slow and uncoordinated movements and making a noise like a kitten miawing. It is a gray and mottled colour, its skin feels like a frozen peach.

We get a handover from the paramedic it is precise and to the point and he stands at the door and watches his face is concerned and he bits his bottom lip. The technician books the baby in at reception i think he was glad to get away from pressure of the mums eyes boring into his head.

I stand and stare not knowing what to do , its so tiny, i attach our little monitors. It told us that the wee one was saturationg at 80% and even i know thats not good. The kids tray is set up and the peadiatric Doctors set about gaining access to take bloods and taking capillary bloods. Babies seem to cope for a long time and then become really ill really quickly. There didnt seem to be enough room for all the people each trying to get into a little bit of skin to do there test or procedure. In a bay we have a Peads SHO, JHO, Reg, A and E consultant, FY2, 2 A and E nurses, 2 Kids Nurses , paramedic,technician, mum and dad. Trying to move was hard but i had to try and calculate the dose of ceftriasone for an 18 week old baby, it was complicated something i had never done before and the consequences are massive.

Baby was getting quieter and quieter and grayer, 100% O2 was not picking up the saturations and baby was not improving, i was speaking with the other nurse and we were monitoring the baby while the drs waiting on the results of tests and a CXR, he went blue arched his back and rolled his eyes back . it was the scariest thing i have seen. It seemed like a life time . Thankfully a swift sternal rub brought him back. I have never been so glad to hear a miaw from a baby.

2007-06-06T00:07:00.000+01:00

iv been found out at work.......sssssssssssshhhhhhhhhhhhhh

Im ducking down so no one sees me

Super whizz technology

2007-05-21T01:32:00.000+01:00

Look i can blog from my mobile. I am getting good at this tech stuff . This is my first post from my new flat dont ask for photos as i cant do it.

im famous

2007-05-13T17:11:00.000+01:00

haha im famous, i made the papers

http://society.guardian.co.uk/futureforpublicservices/story/0,,2061220,00.html

sorry i cant link properly, is my cute wee NHS apple i book G4

Things Have Changed

2007-05-09T19:16:00.000+01:00

Iv been away for a wee while. I have now moved into the lovely flat that has taken me a wee while to get up and moving but im there now, but unfortunatly with the increasing cost of internet conections i have been unable to fit it into my monthly budget. Work has been really good lately with loads of interesting cases, like trying to get a man having constant VF arrests and trying to get him into resus, a boy who fell in a fire, a few arterial bleeds and loads of DKA, i quite like DKAs they are fun. A few cardiac arrests and plenty of GCS3. speak again soon.

Fucking radging

2007-03-20T19:09:00.000Z

some fucker nicked my mobile out of my bag while i was working. All i want to to is a days work and thats the thanks you get for it. I am so so annoyed, it was in an area only accecable by staff , so really we are looking at a tealeaf that works in my department. Im working my bollocks off and some fucker is chilling out with my mobile. I will find out if its the last thing i do. Im away to shout load and hit somethings.

regards

a very very very pissed off nursie999

oh and the nurse in charge almost said tough and done nothing to assist me, thats the last time he gets my help or cooperation in any matter and he has gone even further down in my estimations. Arse hole!

bye

What not to do in A and E resus

2007-03-15T23:55:00.000Z

Note to everyone dont call a lead paramedic an "ambulance driver" they get quite kranky about the whole thing as our dr found out today .

oh guess what i saw!

2007-03-10T06:56:00.000Z

Oh i saw an arterial bleed in a boys head and the biggest heamatoma i have ever seen, it was interesting as he wanted dto go home and couldnt really understand the enormity of the situation. So im going to put that one down as Hypovolemia as well so im not much further with the quest. 2 nightshift to go and today is my birthday......line up so i can recieve my kisses. I already have had one from a lovely paramedic so my day is complete. Night night

to further my quest

2007-02-27T17:18:00.000Z

All we have had is rubbish in the department so no further on in my quest, i dont even think i have been in resus since i last mentioned, i am going to have a rant about tradesmen i can feel it building for eruption. Watch this space!

4H and 4T

2007-02-07T03:00:00.000Z

I am on a quest to see the 4Hs and 4Ts.

It Started on Sat and i saw Hypovolemia quite rare in my neck of the woods. I got to push O neg...it all felt very casulty like, i expect charlie to come in.

1 down 7 to go........game on

Iv got a bleeder

2007-02-05T12:30:00.000Z

Oh i saw the most amazing laceration last night. It was 6" right over the knee cap and the leg it was on was extreamly odeamotus so it burst like a sausage. It gaped wide open and kept pushing out blood, when you thought it stopped bleeding you put a crepe bandage on the blood pushed thru the tiny holes in the bandage and kept beading down the leg. It was a cracker and really help by me going "Oh thats a sair yin". Right iv glossed my hair and need to sleep and my doors are away to "Dip and Strip" NIght night.

Arseholes

2007-02-03T07:28:00.000Z

i am just home from work and tonight some arseholes decided it would be a good idea to go around smashing the windscreens, windows and snapping off mirrors and also stealing what they can from the Drs and Nurses cars in the car park. These people know we are all staff working in the hospital, what moronic arseholes would really stoop as low as to do that to people who are working hard and trying to make a living. I am livid and am just left asking why why why.

My Flat

2007-01-26T23:18:00.000Z

Well i got the keys and i have one neon pink room, an ok kitchen, a sunshine yellow bedroom and a terracotta living room and a fully tiled bathroom with purple pearly tiles. the doors look like they have been thru the wars and the front door looks like its had a good kick in. Pics to follow once i can unpack my data cable.

House Moving

2007-01-23T07:44:00.000Z

Just a wee update , i should all being well move into my flat on friday but that is a post on its own. I will keep you updated.

Classsic

2007-01-22T16:32:00.000Z

A man comes into my triage room in the ACCIDENT AND EMERGENCY department (this is an important point to be remembered). He says he has had painful and watery eyes since early evening. when i ask what he was doing when these symptoms came on he replied.........."Peeling an Onion".

Is there any hope for mankind.

The Wee Ones

2007-01-12T21:47:00.000Z

Im scared of babies...well really im scared of ill babies more.

The paramedic and technician come in you can see the panic on there face , they are older men , i bet they have children of there own or have seen enough well babies to know there is something wrong with this wee mite. Mum is carrying him and closely followed by the crew. The tiny baby is put on our massivley big trolley making it look like a pea in a mountain, It is making slow and uncoordinated movements and making a noise like a kitten miawing. It is a gray and mottled colour, its skin feels like a frozen peach.

We get a handover from the paramedic it is precise and to the point and he stands at the door and watches his face is concerned and he bits his bottom lip. The technician books the baby in at reception i think he was glad to get away from pressure of the mums eyes boring into his head.

I stand and stare not knowing what to do , its so tiny, i attach our little monitors. It told us that the wee one was saturationg at 80% and even i know thats not good. The kids tray is set up and the peadiatric Doctors set about gaining access to take bloods and taking capillary bloods. Babies seem to cope for a long time and then become really ill really quickly. There didnt seem to be enough room for all the people each trying to get into a little bit of skin to do there test or procedure. In a bay we have a Peads SHO, JHO, Reg, A and E consultant, FY2, 2 A and E nurses, 2 Kids Nurses , paramedic,technician, mum and dad. Trying to move was hard but i had to try and calculate the dose of ceftriasone for an 18 week old baby, it was complicated something i had never done before and the consequences are massive.

Baby was getting quieter and quieter and grayer, 100% O2 was not picking up the saturations and baby was not improving, i was speaking with the other nurse and we were monitoring the baby while the drs waiting on the results of tests and a CXR, he went blue arched his back and rolled his eyes back . it was the scariest thing i have seen. It seemed like a life time . Thankfully a swift sternal rub brought him back. I have never been so glad to hear a miaw from a baby.

My changing life again

2006-12-17T07:57:00.000Z

Right i have had a busy time the last month or two, i have managed to buy a flat on my measly NHS wage. So now i am a going to be a home owner (end of jan to be more precise).

I am pretty scared about being on my own as i have always lived in the house i live in now and i have lived with my mum and dad and 2 brothers and sister when she was at home and we all get on really well and have so many laughs and talk about things all the time and now i am going to be coming home to a cold house (there is no heating and no mum to turn it on) with no one to talk to. To have my dinner on my own and go to bed without saying night to anyone. I actually have tears in my eyes thinking about it and i get a lump in my throat when anyone asks me about it.

But im sure there will be plus's i can have my friends round for dinner and to stay over. To be able to do things when i want and im sure i will enjoy my own space.

So i am going to be sad and lonley and skint with a nice flat. Can life get any better...you tell me.

some stories

2006-12-13T03:14:00.000Z

Well a few months in the ER and i have a few stories under my belt, not to much info as it might be you

I saw a man with a venamous snake bite, a quick call to a man in brazil and he was free to go it was only a wee bit venemous.

I got to do chest compressions on a real person

I have diagnosed spinal cord compression

i have perfected cannulation and bleeding people, and even i have done some in emergency situations, i just need to perfect grays and get in an brown or orange.

i know where most things are in resus

I have cut clothes off people and it feels good

I have seen an off ended distal femur fracture.....ouch

I have decided i definatly cannot join the ambulance service as i feel a real need to vomit travelling backwards in an ambulance. I had to do a transfer and rush hour to the certer of town, i was nearly reaching for the sick bowl. I dont know how those folk do it, i really like my feet on dry land or land anyway.

I get to see those kind folk in green and they cheer up your day with a wee bit banter

I refused to get a man a sandwich so he self discharged and got home and called 999 again as he was hungry. I found out he had done that 3 times already that day.

i have experienced the worlds worst body odour from the patients not staff

There are lots of things that are stuck places where they shouldnt

Lots of time is spent on the phone

People think you have xray eyes and ask you at triage "do you think its broken" and you get to say what you like.

There are lots of people that turn up that have not had a accident and there condition is certainly not an emergency and some nurses take great pleasue in telling them this.

I love A/E its brill

A few facts about nursing

2006-11-28T01:09:00.000Z

Why did l choose nursing for a career?

Did you hear about the nurse who died and went straight to
hell?? It took her two weeks to realize she wasn't at work!

You may be a nurse if..... You believe that every patient needs
TLC...Temazepam, Lorazepam and Chlorpromazine.

You would like to meet the inventor of the nurse buzzer system
some night in a dark alley.

You believe not all patients are annoying, some are unconscious.
Your sense of humor gets more warped each year.

Your kids get their presents in TED stockings and hospital
pillowcases. And their presents are wrapped with Micropore tape.

You know the phone number of every late night food delivery
place by heart.

Almost everything can seem funny ... eventually.

When asked by the doctor what color that patient's diarrhoea
was, you show them your shoes. If they missed your shoes, you use the well-known "poo curry colour scale" ranging from chicken korma to spinach vindaloo.

You can identify different causes of diarrhoea by the smell of it.

Every time you walk you make a jingling noise because of all the keys, scissors and clamps in your pocket.

You can tell the pharmacist more about the medication they are
dispensing than they know.

You use bladder lavage bags to drip water onto your plants when you're on holiday.

You refuse to watch Casualty because its too much like the real
thing and it triggers flashbacks or... Your family refuse to let you watch Casualty because you spend the whole time correcting everyone and pointing out upside down X-rays.

You avoid answering the phone on your day off in case anyone
from the hospital is trying to call and beg you to work.

You've been telling stories in a restaurant and made someone at
another table throws up.

You notice that you are using even more 4 letter words than you
Did before you started nursing.

You've seriously considered catheterising your children before a
long car journey.

Every time someone asks you for a pen you can find at least 4 of
them on you. Most of them have the names of laxatives on them.

You don't get excited about blood; unless it's your own.

You live by the motto "to be right is only half the battle, to convince the doctor is more difficult"

You've basted your Christmas turkey with a 50ml syringe.

You've told a confused patient that your name was that of your
co-worker and to shout if they need help.

Eating crisps out of a clean sick-bowl is perfectly normal.

Your bladder can expand to the size of a Winnebago's water tank.

When checking the level of a patient's orientation you aren't sure
of the day yourself. Or if nightshift, the month.

You find yourself checking out other customers' veins in the supermarket queues.

You can sleep soundly at the hospital cafeteria table on your dinner break and are not embarrassed when you wake up

You avoid unhealthy looking people in the shopping centre for fear
that they will drop dead near you and you'll have to do CPR on your day off.

You throw a farewell buffet for a co-worker and use a bed sheet
for a tablecloth and bedpans to hold the nachos.

You often stay awake for 24+ hrs at a time when you work nights
and realise you don't need alcohol or drugs to hallucinate just lack of sleep...

You pull over in a layby after working nights because you are too
tired to drive home and wake up to someone knocking on your window thinking you've had a stroke because you're passed out in your car drooling.

Your finger has gone into places you never thought possible.

You've seen more penises than any prostitute.

You've sworn to have "Do Not Resuscitate" tattooed on your chest Soon.

This was from a email I got from one of my collegues, it is so so true.

skills

2006-11-23T17:36:00.000Z

i got a green cannula in the hand that the SpReg couldnt..........im doing goooooooood. I have some interesting stories to tell i will hopefully get round to publishing some soon.

2006-11-07T23:12:00.000Z

Right i have worked in A and E for a month now so i think i can call myself a Accident and emergency nurse. It is so very strange of an environment. You go in in the morning there are no patients no beds to be made, no one to be bed bathed, you take this time to study, do the cleaning rota or have teaching sessions for new people or the students.

You are told what side your working on either Majors or minors. I really like minors as you get to do loads of wee bits of first aid, slings, dressings, steri stripping but you also have to coordinate the folk away at xray and during the day you only have 2 rooms to do it in.

In majors you see everything thats not catagrised as a minor. Lots of abdo pain, chest pain, RTC, trauma (we are not meant to but we do see a wee bit that walks in off the street). Lots of it is basic observations, history taking and triage but also nursing care for the people not so capable and also lots of psychitric support.

If you work major side you get to work in resus which is where the very illest patients come into like cardiac arrest, uncontrolled cardiac problems and any unstable patients. These patients are usually transferred to the CCU or ITU or to other hospitals for specialised treatment.

This is where we get to do blue light transfers my first one i had to was with scotsmedicman and on my last one i saw trumaqueen driving past waving but i was going into resus and was trying to managing a dropping blood pressure so was flying by the seat of my pants and quite hysterical so didnt hang around to chat. Resus scares me as 1/3 of the patients we see are children or babies and they look so little in a massive resus and a massive trolly bed.

I still have to get my triage signed off, you need to do 20 supervised before you can do it yourself so that will be my plan soon.

Life is good, im on holiday this week and really not doing much any offers give me a shout.

Iv Survived

2006-10-08T07:27:00.000+01:00

Well here i am its sunday morning and im still alive. I have just finished two nightshift a friday and a saturday night in A and E. Well my eyes were widened and the acride smell of irony blood and vodka is stuck to the inside of my nose and nothing i do will shift it. I am amazed at the different things people get hit with and why the person hitting them always goes for the head and it splits like a sausage wheather it be a baseball bat or a battle it still "a sair yin". i saw a bloke with his nose flopping off and helped relocate someones toes, i done a million neuro obs and met a lot of nice policemen and ambulance people. So it was a good set of nights all in all.

My changing life

2006-09-20T13:11:00.000+01:00

Right a bit of time has passed since i last wrote and i apologies for that but really my head has been up my arse. I started my new post in Acccident and Emergency on monday and my head is still up my arse. I wander round the department following people who look like they know what they are doing. It is really strange going from somewhere that you knew where everying thing was and if someone asked you to do something you knew exactly how to do it or able to get the peorson that can do it. I have had to learn everything from scratch, where the wards are and what they do. How to page someone and learn all the computery stuff and all the noises and smells. I have seen a few interesting things so far but everyone is so busy its hard to get them to tell you what they are doing so i can do it next time. I have master ECGs, im not allowed to do IV additives, cannulation, venopuncture, access VAD or anything i did in my old job so it feels like i have nothing to give them but i am taking all the time. All the staff have been very nice and the Drs are very helpful so far. I do feel very much out of my depth but i love it....

Right im away to buy a book on Emergency nursing....that will help me im sure.

Things are looking up

2006-08-20T23:53:00.000+01:00

I have managed to get a new post.......oh yeh its in A and E baby.........im living the dream.

new job

2006-08-07T23:14:00.000+01:00

Iv seen a job as a litter warden. I need it.......

If anyone sees anything they think i would like give me a shout.

nightmare

2006-07-31T22:46:00.001+01:00

i didnt get my job
My house fell thru
im ill

can it get any worse

the rest of my life

2006-07-18T23:29:00.000+01:00

i have an interview on Friday.....im shitting it!

sunny smiles

2006-07-16T20:03:00.000+01:00

All this sunshine makes me smile, you cant help but feeling good when your outside. I dont think i will be in such a good mood tomorrow when i am stuck in the boiling ward with no air.

Congratulations

2006-07-12T23:09:00.001+01:00

Well done to my brother and all the other Heriot Watt graduates that picked up there degrees ect today, my brother has worked really hard to get his Masters degree in a computery thingy and hopefully he will get a job soon and stop living that lovely student dream.

I like graduations with all those gowns and bright coloured hoods. Also champagne and strawberry reception wasnt bad either.

Riccarton is a lovely campus and in a great setting. Nice for a wander round . It would be even nicer if it wasnt filled with students.

Well done bro

Im in a bad mood

2006-07-09T18:08:00.001+01:00

right i have just worked 3 longs days at work

Things that annoy me:

Relitives phoning me contantly asking how there mum is and when i ask who there mum is they get really pissed off like im there only there to look after one person

Lying Doctors

The phone ringing at all for pointless stupid things

Unannounced ward rounds

A ward thats hotter than the burns unit and a burst sewage pipe outside our treatment room window

Sheets from laundry with pubes on them

Imed pumps bleeping and patients buzzing to tell me like i cant hear it and im obviously busy thats why i didnt get it

patient selling out MS24s on ebay

Meeting that go on to long

relitives lying on beds and tuuting when you ask then to get off, stay on it if you like but dont blame me when you get something nasty.

bed managers opening bed but not getting more staff

Students nurses who obviously cant be bothered and constantly ask to go to the library, if you want to stay in the library become a fucking librarian.

Baulshy district nurses

A4C only because i dont understand it and everyone constantly talks about it

talking about babies

Good staff leaving

No pyjamas

Patients shouting as we dont have a wireless hotspot in the ward, they are lucky they even have a TV

the recruitment department as they are crap

The traffic light system.....really we dont have the time or willing to do it

i think thats it for now i will remember more

I have been busy honest

2006-07-03T09:34:00.000+01:00

Well iv have not blogged for a while as i have been busy working among other things

I have now completed my ILS course and can now manually defibrillate patients (only when they are in cardiac arrest thou). Im loving it "stand clear..........charging....shocking now". Im just waiting for the opportunity to make use my new found skills.

I also have now done may VAD course so i can access central lines, hickmans and Piccs. Not to exciting but very helpful.

We have been using larve on the ward and the SSN made the new student nurse hold the foot with them munching and crawling about in it and she has not been back on the ward since. Larve are amazing thou, if you can ever see them working its well worth it.

I have been on duty at the RHS and seen a few interesting casuties and met some new folk and the usual pensioners were there with their "Oxygen and Egg white" Theories and pre war first aid but also loads of interesting top upto date trained people. It was great to see things working well. It make me laugh how crazy people go for free things, you could get your arm ripped off for a copy of farmers gaurdian just because its free. I also cover the edinburgh moon walk which went well lots of hypothermia (well if you will walk during the night in only your bra) and blisters strains and sprains We lest before the ful moon came in so we let the ambulance service deal with them. (phew).

i need to sleep but i will post more when i wake up....

Appraisals

2006-05-29T15:54:00.000+01:00

i got my appraisal at work and they only bad thing that was said is you cant read my writing when im stressed and i laugh to much.....not to bad i think and i was told to go for an E grade when one came up........mmm we will see!

extended roles

2006-05-25T18:33:00.000+01:00

I have now booked my ILS course and i have my VAD course booked for the same week. I have also taken on a wee teaching/facilitation role for the new CPR guideline with the RO, which are really good but very tiring. Im loving it... i have also been OSCE in venopuncture so watchout i can cannulate.

"Iv seen you naked"

2006-05-19T17:05:00.000+01:00

Who has ever had that feeling? You are just minding your own business and then you see someone and that flashes into your head.

Well it sometimes happens when i have seen patients in the street but this time is was worse much much worse.

I have to set the scene. I have been working hard our ward is short of nurses and i am working in a team that should have two nurses but there is only me and a auxilluary nurse so the stress and pressure is on. Also my ward is like a sauna and a green house mixed together so it is very very warm. So im not looking my refreshed best also it was 0830 in the morning so i havent managed to put make up on as that usually happens after i have woken up so that is usually after breakfast.

I had to go in and give handover to the dayshift doctors about what happened overnight. I stoated in and dropped my pen , so then as i bent over to pick up my pen i heard behind me "i recognise that" as i turned around the horror dawned on me who it was i couldnt forget the sexy voice.

OH MY GOD....... i felt sick and what the feck was he doing at my work. Then he introduced himself as Dr ........ the locum Dr for the team today and told everyone that we knew each other .I never knew he was a Dr! but equally he didnt know i was a nurse. I wanted the ground to eat me up there is not very often i am speechless but i was. I could get out quick enough and to make it even better he was the Dr looking after the team which all but one of my patients were in! ahhh

After report had finished he came to find me and done the old i didnt know you were a nurse and i done the cheesy old i didnt know you were a Dr , its a small world, it nice to see you, you look well, its been a long time, are you married, whats new with you and then we arranged to meet for lunch. Its not really my style i am a pretty private person and dont tell people much about me and felt a bit uncomfortable with people knowing at work buts its not like anything was going to happen. He was lovely as i can remember with dark eyes and wide shoulders. He would make lovely intelligent children (well you have to think of these things time is marching on, tick tick tick).

It not a situation i have been in before and i felt my face was constantly beetroot and i felt i was sneaking about which i wasnt i just was doing everything i would normally do but it was quite an exciting feeling. We had a nice lunch and chatted about the past and what we were doing now. Well as mch as you can in 30 minutes. Believe me you can fit quite quite a bit into 30 minutes. He was only working on our ward for 1 day i dont think i could have coped with more.

It was a different day , not something i expected to happen but it was nice but embarresing but i think i managed to keep it hush hush. I will keep you update.

Nasogastric Tubes

2006-04-16T17:15:00.000+01:00

I was so excited I passed my first NG tube. It is something I never really wanted to do. You get a 5 minute talk on it in uni and that's when you are let loose on patients. I didn't have many good experience in passing them. I have forced myself to do it a few times. Usually they come poking out of there mouth like a little snake which is pretty distressing for the patient and even more for me when the student I was with is shouts "its coming out of her mouth, Oh my god I can see it".

The next attempt was in the middle of the night for a lady who was having persistent nausea and the night SHO decided an Anderson tube for sooking out the contents of her stomach would be a good idea. So I tried to pass a tube , remembering an Anderson tube is about twice the girth of a NG tube and managed to put her heart rate off the scale into SVT and needed to get external carotid vein massage to bring it down...whoops.

Another time I had to pick a bogey that was like a stone out of a mans nose before the tube could even go into his nostril. I kept the bogey in a universal container for ages as a training tool for the students but someone stole it. I don't know what they thought it was....Yuk.

Another time I was passing a tube with sister and she managed to get it into the patients lung and she was going blue and coughing a lot and I had to say I think u might be in the lung and when we got it check xrayed, wala it was in her lung but scarily enough when we aspirated it, it showed us pH results that it was in the stomach.

Also lots of people when you start to put it in they freak out and don't let it get even to the top of their nose and they have had enough.

But last time I was at work (which was a while ago as I am on holiday) I managed to do a textbook insertion, it was amazing. The other nurses were discussing who was going to do it , I got the stuff walked in there and wham bam a few swallows and it was there. On my own no one to see my lovely slick work as usual. 50mls of air gurgling lovely in his belly and he is ready to feed. Job done I was very proud of myself , one of my fears conquered.

Medi-alert

2006-03-14T18:20:00.000Z

i have to wear medi alert now.

It is a bit of a drag, have u ever seen those minging NHS/ elizabeth duke medialert bracelets.....ewww

So i took it upon myself to get my own alert.

They are lovely, i could have picked any of them but i picked 2 cute ones. One is blue with red fire engines on it (its for kids really but it is great from work as i can get vomit on it and it just washes off).

The other one is silver with a lovely little medialert sign like a charm. They are both engraved with my name and DOB and what im allergic to and i think they are great but there is only one thing . No one knows they are medialert as they are so funky so really they do not serve the purpose they are designed.

I look cool thou. lets hope i never need them.

weary

2006-03-07T21:46:00.000Z

im tired.... very very tired

birthdays

2006-03-02T00:21:00.000Z

its nearly my birthday. I share my birthday with a really close friend so its always a good day, we are having lunch and wine and i cant wait! bring it on.

RIP

2006-02-20T10:49:00.000Z

Im afraid Maud has passed away.

She was a good friend, i have know her since she was born, she went everywhere with me. I fed her, took her to the toilet, gave her medicine when she was ill and played with her when she was bored. I unfortunatly was intrumental in her death. I only left her alone for a few hours. I thought it would be ok. When i came home there she was, she had passed away..... it was a sad sad time.

But anyway i have pressed the reset button and now i have a new friend call Jim.

I am getting really good at this caring lark, i get on well with Tamagotchis they are cheap and not as annoying as people and i dont need personal indemnity insurance or three million pounds legal cover when looking after one.

Mistooks

2006-02-14T03:21:00.000Z

All nurses are rubbish

We obviously mean to give patients the wrong drugs and burn their head with too much radiation.

The papers make out like we do it on purpose. Well I am afraid to say nurses are human too its just a shame when they make a mistake it can be life threatening.

I didn’t see it on the news when the bank lost my new switch card or when McDonalds got my order wrong.

People make mistakes, especially nurses who have just worked their 4th 12 hour shift that week and are looking after 9 patients all ill and needed her full attention and there is no staff to cover her break and the Doctor wont come and review her ill patients.

I think we need to look at the bigger picture!

pneuomothorax

2006-02-03T00:21:00.000Z

Well i spotted one of these on sunday night and felt very proud of myself.

Pain on inhalation and SOB and dropping SpO2 and history of having 400ml tapped off her chest earlier that day. It was late in manafesting and she had , had CXR but NAD.

A call to the HAN team, 10lts of O2 and a repeat CXR showed us a lovely wee pneumothorax

The patient was well on the mend.

Within a few days the patient went home as the air pocket had dispersed of its own accord.

note to Kal: i tried this time to put them on their injured side and the Doctor laugh as she had never heard of that in the treatment but i done it and the patient had great relief. So she thanked me for my imput and said she was going to read the first aid book as it seems to have some handy hints that arnt taught at medical school. I was very proud i had learnt that on the training weekend and put it into practice.

I also had an arrest last weekend but it far to traumatic to go into. xxx

I am a local hero

2006-01-28T21:18:00.000Z

I this is funny. I am being awarded the LBP Chief Meritorious Action Award for my actions see "Just Another Sat NIght" . I have to attend a ceremony and collect it later in the year. Its very funny, just little old me doing what anyone would have done getting an award.

I wonder if i will get off with parking tickets and speeding fines with my new found celeb status.

PS i would put links in but my wee link thingy as disappeared, any help would be appreciated.

The phone call

2006-01-25T14:09:00.000Z

I overheard a SpReg on the phone and all i heard him saying (in a count dracula type accent) was :

"Ve man has platelets ov two and ve are dreelling into his vrain,i seed geeve hem the feeckin platelets"

I laughed and laughed.

Nursie 999's treatment of SABO

2006-01-25T10:59:00.000Z

I love when people ask you what you do you can proudly say "im a STAFF NURSE", and then they go "oh i couldnt do that , all that sick and poo". Well people this might be contraversial but i dont see that much of the nasty stuff. Well normal nurses dont but if a patient is going to have explosive C-Diff diarrhoea it will be on my shift. But i love the challenge of extracating them from the loo without getting any on you lovely white uniform or without them slipping over because the place you want them is on the floor as the increses the percentage chance of u getting "eww" on your togs.

As for the sick/vomiting thing i pride myself on my administration of S/c anti emetics. everytime i pass them "are you feeling a wee bit queasy, ropey, sicky,dodgy" and the next question is "do you want some anti-sickness". This works well for patients that we kind of know have the chance of feeling sick but also for the patients that have medical reasons for being sick.

Im really interested in SABO (oh i love using abbreviations that nobody knows so i look smart). come on ...Sub Acute Bowel Obstruction.

If there is an obstruction, it cant go down so it comes up, its a funny kind of vomit, very green and water with little digested floaty bits, like onion soup but green. It is great as we put down and Nasogastric tube and sook out the contents of the patients stomach with a 50ml syringe, it is very rewarding when you see the lovely green stuff in your syringe and the patient doesnt feel sick anymore.

Oh i forgot to say there is quite a bit of it, some patients refuse a NG tube, its not the nicest thing to have done, so those patients just vomit because its really difficuly to know when they are going to vomit we try and pre empty it but i doesnt always work Everytime the feel sick we do it again and this rests the bowel enough to hopefully kick it into working again and resolve the obstruction.

Punters who have an obstruction have terrible bad breath, it is almost faecal so we also attack it from the other end with high phosphate enaemas, that is 14-16" foley cathater attached to the end of the enaema and inserted as far as it can go into the bowel. It has to be high, hot and helluva lot. and we usually tilt the bed as much as we can to keep it in and it seems to have the desired effect. this can be as often as 4 times a day. Constipation is a terrible thing and very painful and if it is really high it takes a lot of work to get it moving . Its hard to give systemic lavitives because we just would sook them out when aspirated their stomach contents. So we have to take a very active line of treatment.

We have to be careful giving these punters Anti emetic as you dont want to give them anything that will make their bowels more motile like Metoclopramide as this can cause pain and thats not good but the thing is it is the best anti emetic for job apart from Octriotride which is £100 a vial, it is the dogs but we dont use it very often as it is usually need in large volumes. So really we have to give people metoclopramide and a pain killer , we usually use buscopan in a 24 hour subcutaneous infusion which works really well for the abdominal cramping and bloating. You can buy it off the shelf in supermarkets and it is a wonder drug, for period pain or abdominal pain as experienced by call due to diarrhoea. The only thing is buscopan is also used to dry up secreations in palliative care patients so remember to drink a lot of water but i bet it wont quency your thirst, so no pain but very thirsty. you cant have everything.

After all this we hope the obstruction is resolved, this can be seen by a plain abdominal xray, it can take days or weeks and usually the punters slip in and out of obstruction and are never totally free from it. but it all really depends on the cause.

This is by no way exahustive just my feelings and i thought i would share them.

Nurses don't make good First Aiders

2006-01-22T19:51:00.000Z

During the 3 long years you spend at university training to be the fully qualified Staff Nurse you learn a lot of new things but there are some things that the course severely lacks and I would like to outline them to you.

In my3 years at University I had1.5 hours worth of lectures on CPR in first year, yes I said 1.5 hours and then we were given a wee book and told to read it and you would have an OSCE (a practical assessment) in 3rd year.

Then we were told of the dire consequences that would be if we didn't stop at the scene of an accident to help a member of the public as we now had a "Duty of care". I was shitting it!

I was a wee bit scared as when I started my nursing training I had never nursed a patient before in my life, honestly and really took nursing as I couldn't really get into anything else and I wanted a degree but I was really a wanabee paramedic (but don't tell SMM). So I thought with a nursing degree and a first aid certificates (haha) and some good acute experience the SAS would be begging me to come and work for them.

But... Recently I have found out I cannot travel backwards in an ambulance without anti-emetic and get a migraine when I drive fast, so I think I will leave the blue lights and sirens to SMM and Kal and I will meet them in dark blue scrubs in A and E with a friendly face, my ALS certificate and a cup of Tea.

Well im not really sure 1.5 hours worth of CPR allows me to be fully confident and even know how to do it right. So I took it upon myself to take a first aid course, the full thing 12 lovely weeks of different subjects taught by people who know there stuff (!). So I enrolled and in the December I passed my first aid course and was asked if I would like to join the section and cover duties a a First aider.

Great, I love first aid and I love helping people and making a differance (it has nothing to do with the power of the hivis and seeing things for free) but I have a problem. Now im a nurse I have a responsibilty, if I see someone doing something that may harm someone...even a dr I have to say "oi mate, you shouldnt be inserting that there" or "move over I need to precordial thump as im a nurse and you are a lay member of the public with a basic first aid certificate". Its a fine line and im not really sure myself what the boundary are.

Equally thou, nurses are crap at first aid, and I will go back to the 1.5 hours CPR/first aid we had. A nurse know that a patient with platelets of 5 has a risk of bleeding and can administer the platelet transfusion/ check co-ags and FBC that the patient needs but do they know when a nose starts to bleed to pinch the bridge of the nose and lean the patient forward for 10 minutes..I would say NO.

Ask a nurse to put on an elevation sling and they cant or ask them to give you the treatment for a cardiac arrest and I bet the first thing they say is "phone the crash team aaaahhhhhhhh" not DRABC. This is why the crash team was on ward 99 to attend a fainted patient, we know the advanced but no idea of the basics.

Dont think I am not discribing myself here as I am, I would put myself top of the list.

Recently I was at a training weekend and I had to treat a chest wound, no blood just blunt trauma. I had no idea..... I made them comfortable and talked to them and done the nursey stuff but I really wanted to phone the Doctor. I suspect pneumothorax by the symptoms but out in the big bad world I had no idea how to treat it. I knew I needed help and I needed a chest drain and I could assist someone putting it in with a lovely display of aseptic techqnique. I done basic observations and the only other thing I needed to do was put him on his injured side but I didnt.....why didnt I ...because I am a nurse!

Nurse training it very holistic covering subjects like "homeopathy in modern nursing" and "Reserch and evidence based practice"and taught by airy fairly nurse lecturers who trained with Florence and have no acute nursing skills. They havent been on the ward for years. I think nurse training is where we need to look for our failing health service, MRSA deaths and drug errors.

Move over Patricia Hewitt and Andy Kerr......Im taking over.

Brokeback Mountain

2006-01-19T11:43:00.000Z

What a film. Go and see it i saw last week and im still thinking about it.
Just Go!

Vanity

2006-01-17T02:38:00.000Z

I have decided i am geting vain in my old age. I have recently purchased GHD hair straightners and i love them and i love my lovely straight hair.
I have to admit they were ridiculously expensive but really i dont think anyone else really noticed.
I said to SMM "do you like my hair" and he said mmm its nice (in a doesnt look any differant type of voice but to be fair he had a runny nose).
I asked Doad and he said "its looks as nice as it always does" (sook!).
So all that money and no one noticed but i knew i had straight hair and made me feel better..

oh not only did i have straight hair but i was having a GHD.

2006-01-02T00:17:00.000Z

Oh Happy New Year by the way........

Dam nightshift

2006-01-02T00:07:00.000Z

well just the first and second of Jan to work and that is my crimbo and new year off duty finsihed. Thank feck!

I am knackered, i lasted to 0100 on hogmany/ new years day before i had to retire to bed. I am getting old or Nightshift is making me ill.

I have done 3 nights on , 2 off , 3 on and 2 off and then back on for 2 days. (12.5 hr shifts)

I think i am suffering from SAD i was in bed for 28 hours from friday at 1400 to 1800 on sat, fair enough it was post nightshift and 8mg of chlophenamine (see previous allergy post) but still.......come on!

I have bad skin and feel sick. When i am not on AL in Jan i am on nights.....Bring it on

Famous Faces

2005-12-21T16:27:00.000Z

Try this and see what famous people you look like

http://www.myheritage.com/FP/Company/tryFaceRecognition.php?s=1&u=g0&lang=EN

you need to upload a photo of yourself to the site (better if its just your face).

fecking excellent news

2005-12-20T17:04:00.000Z

No secondment for me!
I have just been told i do not have to go to the winter wards after all as one of our E grades have been injured in a freak paragliding accident in Oz and i am needed to keep the ward afloat.....christmas has come early.

YIIIIIPPPPPPPPPEEEEEEEEEEEEEEEEEEE!!!!!!

Festive Time as seen on scotsmedicman

2005-12-20T01:21:00.000Z

I thought i would also give you all an update on the Christmas and new year offduty. I am working nights like the young scotsmedicman but i have managed to beat the system by careful planning. I am working nightshift (thats 1930 till 0800) on the 22nd,23rd and 24th and back on for 27th,28th and 29th. Also not having any little blighters of my own i dont mind working xmas to give the girls with them to have time off.
That means i have most of christmas and new year off (sshhh dont tell sister) but for my sterling work over the last few months i am being seconded to medicine of the elderly so plenty of winter vomiting virus patients and "dumps" (thats what bed managers call patients who are dumped by their family,GPs or nursing homes in acute hospital beds when the want to go on holiday or have a peaceful interuption free festive period) . So im expecting my acute nursing skills to be pushed to the edge and to learn a hell of a lot about general medicine.

Happy crimbo readers and a drunken new year

LDxxx

update on "Just another saturday night"

2005-12-16T13:46:00.000Z

Drink driver banned for seven years after mayhem

A DRUNK motorist who crashed a van through garden fences into a greenhouse has been disqualified from driving for seven years.
A male, 26, escaped jail when Sheriff Isobel Poole heard he had no previous convictions, but she ordered him to do 240 hours of community service.

Edinburgh Sheriff Court heard he was nearly three times over the legal drink limit when he damaged the fences 6.40pm on August 6.
Prosecutor Angie Main said the vehicle he was driving "demolished" one fence and "significantly damaged a greenhouse". He then drove off, hitting a parked car, reversed on to the pavement, hit another fence, some bushes and a wall, and narrowly missed a pedestrian.
At one point residents told him to stop where he was, but instead he apologised and continued driving. However, his car tyre eventually punctured and he was restrained by neighbours (that was me)until police arrived and arrested him shortly afterwards.
Defence agent Murray Robertson said: "This was a horrendous piece of driving.
"He himself describes it as the stupidest thing he has ever done. He could have been facing more serious charges if he had hit anyone."
Sheriff Poole also ordered him, to sit a driving test following his seven-year disqualification.
He had pleaded guilty to dangerous and drink driving, failing to stop, driving with a provisional licence only and without insurance

Festive ailment

2005-12-16T13:44:00.000Z

hay i have the cold and it is excellent, i feel like my world is caving in and im getting high on lemsip.....but its great i cant nurse neutrapenic patients.....no work for me amazing!

Crimbo Night out

2005-12-09T16:04:00.000Z

Oh it was the annual ward piss up yesterday night. We done it in style. With jam doughnuts and champagne.
I feel i only ever write my worst work experiences here and never tell u about all the lovely patients i meet and how kind they are to us.
Even familys of people who have had the worst news , lost a close family member and want to forget about us and get on with their lives. They still have time to give us a box of chocs or donate money to the ward funds or to our xmas nightout funds.
People are so kind. In their days of despare and grieving they think of us.
We are just doing our job, you dont give your bank manager a box of celebrations if he approves your loan or send the man who sold you your car £100 to take his staff for a drink. So why do people think we are any differant.Although im not complaining.
One of our patients found out it was nightout last night and phoned ahead of us and put 12 bottles of top class champagne on our table. I worked it out at about £400 all this for us.

People are amazingly thoughtful

Mr Nobody

2005-12-07T23:40:00.000Z

1015 Meet patient arriving thru the door with PTS ACA
1016 Show patient to toilet (missed that sign)
1020 Meet PTS ACA coming out of the room and hands me the paper work
1021 Go to see patient who is now in his chair and tell him his bed will be available soon
1021 Patient becomes unresposive no pain response ,shout for help, GCS 3 , emergancy buzzer pulled , airway open, no breathing,2 rescue breaths, no carotid pulse, Patient lower to floor (using the clothing grabbing mode of manual handling).
1022 Precordial thump by Spreg
1022 222 call put out
1022 Crash trolley is outside room , insert size 4 guedel, start bagging, spreg on compressions, SHOs get access , adrenaline given, no output , Leads attached,PEA.
1023 Another Spreg trys to find medical note to get a wee idea about who he is and why he is on the ward
1024 Sister goes to get the consultant
1025 Team arrives , more adrenaline and atropine
1025 3 minutes of CPR and still no output
1027 2 more minutes of CPR, no output, consultant arrives, review notes
1028 Consultant allows DNR status to be put in place due to prognosis
1029 Patient passes away
1030 Team leaves and i prepare patient for chapel of rest
1031 Consultant calls Patient GP to ask him inform his wife of what has happened

All in 16 minutes RIP

Exams

2005-12-05T22:56:00.000Z

I managed to pass my first aid exam last thursday by the skin of my teeth. Everytime i go into that exam i panic my mind goes blank and i stutter thru my questions but every question the other person is asked i could reel off no problem.

Thank goodness its only every 3 year i dont think i could handle the stress.

On a plus point i was great at the practical CPR no problem, bandaging a piece of piss and the recovery position was a dream.

I have decided, i am a do'er not a rememberer if there are such people.

out of the blue

2005-11-21T22:31:00.000Z

out of the blue last night one of my patients ask me "Am i going to die tonight". I said "Of course not." She said "Promise me" so i did.

30 minutes later she arrested and died.

She knew!

Facts about nursing

2005-11-17T12:27:00.000Z

I dont wear a white dress
I dont own Suspenders or a "cute" wee hat
I dont call people i work with by their second name and prefixed with their title
I have never had sex in the linen cupbord with a Dr
My ward sister isnt a spinster old battleaxewho trained with Flo
Iv never met Hattie Jacques
Male nurses are not all gay
Please do not base our workload on the amount of work Martin Platt does
Charlie from casulty does not work in NRIE
I do have a degree and earn less than a McDonalds manager
I have never had a party in the Nurses Accomadation
We dont eat dead patients meals
We dont fancy the porters but they think we do
Iv never had a wheelchair race
We do enjoy eating takeaway in front of fasting patients
Chocolates are like golddust and appreciated at all times
We dont sleep all night on nightshift there is work to be done when patients are sleeping
There are always emergancys as you are going off shift or on meal breaks, never in the middle.
I dont have hospital corners on my bed at home (ask the drs!)
I probably have MRSA and so do you so stop going on about it.

Operative terminology

2005-10-24T12:41:00.000+01:00

I love learning new terminology and trying to impress people with it, it very rarely happens!
Here are some of my favs, more to follow

TERM.....................EXPLANATION
Pan......................Whole
Hemi.....................Half
Supra....................Above
Infra....................Below
Retro....................Forward
Ventro...................Forward
Para.....................Beside
Endo.....................Inside
Peri.....................Outside
Circum...................Outside
Trans....................Through
Inter....................In-between
EC.......................Out of
Epi......................On
An.......................Without
Ventral..................front
Dorsal...................Back
Lateral..................To the outside
Medial...................Towards the middle
Distal...................Furthest away
Proximal.................Closest or nearer
Suppimation..............Palm up
Promation................Palm down
Flexion..................Pulling in or bending
Graphy...................Recording
Rotation.................Turning
Abdult...................Away from the body
Addult...................Towards the body
Efferent.................Going away
Afferent.................Going into
Ectomy...................removal of
Otomy....................Opening into
Ostomy...................Permanent opening
Oscopy...................Looking into
Orrhaphy.................Repair of
Plasty...................Reconstruction of
Desis....................Fusion
Pexy.....................Fixing down
Tripsy...................Crushing of stones
Lapaxy...................Crushing of stones
Plication................Making tighter
Arthro...................Fusion of a joint
Desis....................Fusion of a joint

Sleep

2005-10-24T00:25:00.000+01:00

I love sleeping!

I dont really know why, it is really doing nothing. I like the feeling of being in my own bed and i love even more the feeling of not having to set your alarm clock. I always make my appointments to meet people in the afternoon as i like sleeping in. People know not to call me when they think i might be sleeping as there is not a hope in hell of waking me up.

I have some problems sleeping when:

1)I have finished my last night shift , i always get up at 1500 (or try to) and then go to bed after that night but i always sleep for about 17 hours on that sleep and get up at t time on sat and then cant get to sleep on sat night and end up sitting up till 0900 (as it was last night...well this morning actually) and have to get up early again so i can get to sleep on sunday night to go back to work on monday morning. Wasted weekend i have done nothing all weekend but sleep and eat. Well at least i dont spend money when i am sleeping.

2)When someone else is there, they invade my sleeping space and try and cuddle me. It gets to warm and they steal the covers. Even the purchasing of a new bed has not rectified this problem. I will admit i am grumpy and moany in the morning, really dont try and communicate with me, i need weetabix and my mail before i can talk to anyone.

I think in my CV i would put sleeping as one of my main interests/hobbies.

Can anyone beat 17.5 hours in one go with not one wake up or pee. Being ill or taking sleeping tablets doesnt count neither does being in a coma or drug induced sedation.

Nightshit

2005-10-19T08:53:00.000+01:00

yes i made that spelling error on purpose, nightshift this week is shit. Im on with pool staff who barely speak english and i think have bought there qualification off the internet, 2 shifts down, 2 people i have failed to save......still my save ratio is still better that SMM! 9 days till the wedding, its going to be interesting. I really need to sleep now zzz zzzz zzzz zzzz

Sorry

2005-10-17T06:25:00.000+01:00

I didnt relise that was so long or boring. LD xxx

The Information Required for the Primary Management of Wounds

2005-10-17T06:18:00.000+01:00

This is a presentation i prepared and thought some folk may like to read it.

WOUND MANAGEMENT

A large part of the first aider’s workload entails the management of acute traumatic wounds.
Wound care involves good knowledge of skin anatomy, the physiology of wound healing, the impact of infection on healing, and the provision of self-care advice to patients who can manage their own wounds (Holt 2000).

Wounds for approximately 25-30 per cent of the total workload of an A&E department (Wardrope and Smith 1992). The commonest wounds presenting to the A&E department are lacerations caused by blunt trauma (Wardrope and Smith1992), cuts, abrasions and burns, all of which usually respond rapidly to treatment and heal without complication (Dealey 1999). With this statistic we can estimate that 25-30% of the first aiders work is similar but there has been no statistical evidence to tell us if this is a fact.

What is a wound?
A wound signifies a break in the continuity of tissues covering the body and is usually associated with a loss of substance (Lippert 1999). In traumatic and intentional injury, there is a rupture of the blood vessels, resulting in bleeding, followed by clot formation (Dealey 1999). The type of trauma and extent of damage serve to further classify wounds for prognosis and treatment options.

Different types of wounds
• Cut (incised wound, incisional wound) – a breach in the skin caused by a sharp edge, such as a kitchen knife or glass. The wound edges are well defined and are often straight, with little soft tissue bruising
• Laceration (Latin lacerare – to tear) – a breach in the skin caused by a blunt instrument/force. The wound is irregular, with tearing of the tissues. It often occurs as a result of a fall, a blow from a blunt object, or a crushing force
• Contused wound – a breach in the skin, with surrounding bruising
• Contusion – an area of bruising due to a blunt force, without a break in the skin
• Haematoma – a subcutaneous collection of blood giving rise to a fluctuant swelling
• Penetrating wound – a wound with a fine path made by a pointed object, for example, railing spike, knife, rusty nail (After Critchley 1978)
Triage
At triage, the first aider will assess the patient and document the examination and findings on the injuries log. This examination and subsequent description of the wound is vital for the correct management of patients with acute injury, no matter how small.
There are three key elements to consider at triage:
• Accurate description of the wound.

• Documentation of mechanism of injury, tetanus immunisation status, current medication and known allergies.

• First aid measures for haemostasis (stopping of blood flow), proper cleansing and adequate temporary closure of open wounds, which will lengthen the time available for definitive management by First Aid post, the A and E department or the ambulance service.

Wound Assessment

The ability to make an accurate assessment of a wound is an important first aid skill (Dealey 1999). It should be carried out as part of the holistic approach to patient care in every first aid setting.

Assessment a Wound
• Anatomical site
• Size of wound (width, length)
• Depth of wound (gently probe)
• Configuration (flap, jagged)
• Tissue loss
• Deformity
• Loss of function/actual motor or sensory loss
• Pain
• Hand dominance(where relevant)
• Haemorrhage(actual and estimated)

Wound/ Patient History
In the first aid environment, the first aider will be the only person to get a detailed history from the patient while assessing and cleaning an acute wound.

Adequate history taking should include:
• Time since wounding.
• Circumstances of injury/mechanism of injury.
• Tetanus immunisation status (DoH 1996).
• Allergy – hypersensitivity to adhesive tapes, dressing materials and medications.
• Current/recent medication – corticosteroid therapy, aspirin and other anti-coagulant therapy.
• Social history – to ascertain whether the patient is able to manage to get themselves home, or has family who can assist in the management of the wound following the injury.
• Psychological problems – those associated with wounding should never be underestimated; a patient with a facial laceration or cut might well be traumatised as a result of altered body image.

Good wound management requires an accurate assessment along with a detailed history. Following careful assessment and evaluation of the patient, all findings should be documented on the patient’s documentation and forwarded with them to the ambulance service , so they can forward it to the A and E department
.
Diagrams, measurement tools, such as grid paper, clinical rulers, or even photographs maybe used to record the findings. Once this is complete, the wound can be actively managed.

Suggested History information that could be taken:

• Hours since wounding
• Mechanism of injury
• First aid treatment, if any
• Tetanus immunisation status(DoH Guidelines 1996)
• Allergy history, including medications
• Current/recent medication; remember steroid therapy
• Social history (Family, Next of Kin)
• Lifestyle/risks (Alcohol consumption, smoking)
• Psychological assessment
• Age and occupation

Wound Cleansing

Wound cleansing is essential for the prevention of infection, tattoo scarring and to exclude foreign body contaminants, such as grit (Holt 2000). Wound infection is the most common serious complication of a simple laceration (Moscati et al 1998). During wounding there is a breakdown in the protective functions of the skin and microorganisms can enter the deeper tissues and cause infection (Courtenay and Butler 1999).

Expensive surgical dressings, tissue adhesive, strip closures, staples or sutures will not assist healing if wounds are not properly and thoroughly cleansed initially. However, Hollander et al (1998), in a study exploring infection rates for face and scalp wounds, found that there was no difference in the outcome for patients who had wound irrigation prior to skin closure and those who did not. The patients included in the study had non-bite, non-contaminated facial or scalp lacerations that were less than six hours old. This finding can only be generalised to facial and scalp wounds, which are closed within a short time of initial wounding. While Moscati et al (1998) and Holt (2000) would suggest that all traumatic wounds should be considered contaminated, it is not possible to clinically differentiate on examination which wounds are at risk because some will appear clean, while others will be obviously contaminated.
Historical data collected by the first aider about the wound will alert the medical team to the possibility of potential contaminants, bacterial load, foreign body and healthiness of wound margins, but an assumption should be made that all traumatic wounds contain significant amounts of bacteria and must be decontaminated (Chisholm 1992, Moscati et al 1998). Wounds that have ingrained dirt such as deep abrasions (road rash), especially to the face, might need scrubbing and debridement under anaesthetic.
These wounds, although seemingly minor in nature, have the potential to cause long-term tattooing and scarring and, therefore, might require the skills of the plastic/reconstructive team to be managed optimally.

Management options
What to use to clean a wound?

Irrigation of the wound is essential to remove contaminants and reduce infection rates. Topical antiseptic solutions have been discredited recently, with normal saline coming to the fore as the optimum cleanser (Holt 2000, Moscati et al 1998, Walsh 1999).
However, some recent studies have shown that ordinary tap water of drinking quality has proved as effective at irrigating and cleansing wounds as normal saline solution (Angeras et al 1992, Moscati et al 1998, Riyat and Quinton 1997). Antiseptic solutions such as cetrimide and chlorhexidine claim to destroy bacteria and have a detergent effect on wounds. Holt (2000) reports that most of these solutions require 20 minutes contact time with bacteria to have an effect. There is little evidence to support the continued use of iodine solution as a first-line method of wound cleaning; it is not recommended for routine cleansing or prophylaxis due to its cytotoxic side effects on acute and healing wounds (Holt 2000). Other solutions, such as hydrogen peroxide, were previously thought to have decontaminating and desloughing properties, but these properties are greatly reduced once the solution is in contact with blood and pus (Holt 2000).
Also, the thermal effect of the solution adversely affects healthy tissue. Most of the recent literature on wound cleansing and choice of solution seems to suggest that irrigating wounds with normal saline solution or tap water offers financial and therapeutic benefits and has become the treatment of choice for cleansing many types of wounds (Dealey 1999).

How does a wound heal?

The healing of every wound takes place in phases that overlap in time and cannot be separated from one another (Lippert 1999). The usual division into three or four wound-healing phases is described in detail in most wound management texts (Courtenay and Butler 1999, Dealey 1999, Flanagan 1997, Holt 2000, Lippert 1999). It is important that first aiders are aware that many wounds might show evidence of more than one wound-healing phase concurrently.

Healing by primary and secondary intention

Wound healing has long been classified into healing by primary intention and by secondary intention. The word intention refers to the physician’s intention to achieve primary wound healing with wound edges close together and with few gaping wound margins (Lippert 1999).
Healing by primary intention includes delayed primary healing, which occurs when an infection is anticipated; in this case the wound would not be closed definitively with sutures or closure strips. The wound is dressed and observed for evidence of infection, until at approximately four to seven days, if no infection is apparent, the wound can be sutured or closed with strips and allowed to heal by primary intention.
If an infection occurs, the wound is classified as healing secondarily and receives treatment as for an open wound. Secondary wound healing always occurs when tissue gaps have to be filled or when a purulent infection prevents direct union of the wound edges (Lippert 1999). The less damage caused to the tissue, the more favorable the conditions for wound healing.
Many simple, superficial cuts (incision wounds) seen and treated in the A&E department are suitable for healing by primary intention due to ease of wound apposition and negligible loss of substance. Wounds that result from blunt trauma are often suitable for primary closure after surgical debridement.
However, there are some wounds resulting from tearing or blunt injury that are more suited to delayed primary closure or healing by secondary intention, for example, crush injury to the pulp of the fingertip or wounds heavily contaminated and more than 12 hours old (Wardrope and Smith 1992). Patients with blunt injuries sustain larger amounts of kinetic energy, resulting in micro vascular disruption, oedema and devitalized tissues (Chisholm 1992).

Other factors that might influence healing are:
• Anatomical site: areas such as the pretibial (shin) are often slow to heal due to poor blood supply and friable nature of the tissue.
• Vascular supply: the rich vascular supply to the face and scalp ensures speedy healing. If patients have underlying peripheral vascular disease, wounds might heal more slowly.
• Movement: a wound over a joint, especially over extensor surfaces, will take longer to heal.
• Method of closure: good technique with careful tissue handling is essential to a successful outcome; vigorous scrubbing of wound edges to remove grit can cause further tissue damage.
• Wound configuration: jagged wounds with large areas of skin loss or devitalised tissue will heal at slower rates than simple uncomplicated wounds.
• Mechanism of injury: incised wounds heal quicker than lacerations from blunt trauma, as there is less destruction and tissue oedema.
• Delay in management: delays in decontamination and definitive management will cause wound contamination, infection and delayed healing.
• General health and nutrition: vitamin C and zinc deficiencies can lead to poor wound healing. Older patients might have underlying disorders of vascular and endocrine systems that influence healing. Medication such as corticosteroids might bring about changes in the structure of the skin and influence wound healing rates (Thomas1997).

Tetanus immunisation status

All patients with wounds must have their tetanus immunization status established (Wardrope and Smith 1992). Clostridium tetani is an anaerobic organism and thrives in conditions where there is devitalized tissue and haematoma formation.

Two questions are essential when assessing the further need for tetanus immunisation:

• Has the patient been immunised according to Department of Health recommended guidelines (DoH 1996)?

• Is the wound clean or tetanus-prone?

Minor wounds that commonly present to a first aider department generally heal rapidly and patients return to normal activity quite quickly. However, there are always exceptions to this rule and it is the first aider can influence the outcome of this group of people. Adequate knowledge about wounding, wound assessment and management strategies will improve the outcome for a significant number of people who just have ‘a simple cut’.

REFERENCES

Angeras MH et al (1992) Comparison between sterile saline and tap water
for the cleansing of acute traumatic soft tissue wounds. European Journal
of Surgery. 158, 6-7, 347-350.

Chisholm CM (1992) Wound evaluation and cleansing. Emergency Medicine
Clinics of North America. 10, 4, 665-672.

Courtenay M, Butler M (1999) Nurse Prescribing: Principles and Practice.
London, Greenwich Medical Media.

Critchley M (Ed) (1978) Butterworths Medical Dictionary. Second edition.
London, Butterworth.

Dealey C (1999) The Care of Wounds: A Guide for Nurses. Second edition.
Oxford, Blackwell Science.

Department of Health (1996) Immunisation Against Infectious Disease. London, HMSO.

Dolan B (2000) Pain management. In Dolan B, Holt L (Eds) Accident and
Emergency Theory into Practice. Edinburgh, Baillière Tindall.

Flanagan M (1997) Wound Healing. Edinburgh, Churchill Livingstone.

Hollander JE et al (1998) Irrigation in facial and scalp lacerations: does it
alter outcome? Annals of Emergency Medicine. 31, 1, 73-77.

Holt L (2000) Wound care. In Dolan B, Holt L (Eds) Accident and Emergency
Theory into Practice. Edinburgh, Baillière Tindall.

Lippert H (1999) Compendium: Wounds and Wound Management. Heidenheim, Paul Hartmann.

Manchester Triage Group (1997) Emergency Triage. London, BMJ Publishing Group.

Moscati RM et al (1998) Wound irrigation with tap water. Academic Emergency Medicine. 5, 11, 1076-1080.

Riyat MS, Quniton DN (1997) Tap water as a wound cleansing agent in A&E.
Journal of Accident & Emergency Medicine. 14, 3, 165-166.

Thomas S (1997) A Structured Approach to the Selection of Dressings.
http://www.smtl.co.uk/World-Wide-Wounds

Walsh M (1999) Disorders of the skin. InWalsh M et al (Eds) Nurse
Practitioners: Clinical Skills andProfessional Issues. Oxford, Butterworth-Heinemann.

Wardrope J, Smith JA (1992) The Management of Wounds and Burns.
Oxford, Oxford University Press.
Factors that influence wound healing

Moo Moo

2005-10-17T06:00:00.000+01:00

I have been diagnosed with a dairy intolerance, i am slightly concerned ....all i will need to do is take anti histamines for the rest of my life and it will all be fine.

So if you going anywhere with me remember the H and P and Adrenaline.....stat!

Horny

2005-09-26T05:03:00.000+01:00

Everyone will be pleased to learn that my horn is working again , a big blog thanks to M who indured working on the world smallest car in the worlds smallest space, it was like keyhole surgery. His arms are torn to bits but at least i have a horn. Thanks M your a star!

Iv lost my horn

2005-09-19T12:55:00.000+01:00

I have a problem.

I have broken my horn.

I am without a horn, i have been in a a few life and death scenarios that a horn would be very useful in the last few days. So am i going to do something about it. M is coming round tomorrow so fix my horn and it will be back.

I will feel safe to be back on the road.

Toot toot!

Letter from the Chief.

2005-09-19T12:48:00.000+01:00

I have received a commendation letter for my thanking me for my conduct in chasing the criminal see "Just another Saturday night" for further info.

Just call me Lady Nursie999 .

Manners

2005-09-19T12:41:00.000+01:00

People ignoring me are really pissing me off. If I call someone, leave them a message or text them. I expect a reply, it’s only polite.

Also if I say Good Morning in the street I expect someone to at least acknowledge I am there.

Rude people piss me off!

Right rant over..............

Why is people falling over so funny!

2005-08-21T06:48:00.000+01:00

I really cant help laughing at people falling over, i really want to stop and help them but i am trying so hard not to laugh in there face that i cant, Luckly the last few times it has happened it was in a densley populated area and lots of people ran over, im sure if they were really hurt i would kick into life saver mode but for now i will keep giggling and hope they dont notice.

Just another Saturday night!

2005-08-06T13:45:00.000+01:00

I am going to tell you what happened to me on sat evening and i dont think you will believe me but i can gaurentee you everything i say is true.

To set the scene i live in a quiet culdesac that nothing ever happens in that was until this evening.

I was with my dad in the kitchen stripping wallpaper and we heard a smashing of glass but i thought it was someone pouring out there glass for recyling and my dad looked out the door and there was nothing there.

Then my brother came down and told us a van had crashed outside. So being nosey we went outside to find a white van wedged up against two cars in the car park opposite the back of my house.

As we walked along we found a large hole in the fence of our neighbour two doors up. The fence post had been pushed at least 2 foot back and the greenhouse had got a good part of the impact as well (hence the smashing glass noise).

One of the owners of the car came over and said he had called the police and the man had got out and he was "stoned".

The man in the white van was trying hard to get it started and revving it and it wasnt going anywhere as the radiator was leaking and it had 2 flat tyres. Well thats what we thought, it kept stallling until it sprung into life, he put it in reverse and started coming back towards where we were standing , then quickly started going forward and missed another car, done a big U shape and headed thru the gap in two parked cars, headed thru one garden, just missing the cherry tree and hitting the next house and stopping.

Their was a very shocked man cutting his grass and we later learned that he had just that moment sent his children in for their dinner.

I ran over to see everyone was ok that was my first thought but as i got there a saw the driver trying to jump the fence. So my first reaction was to grab him but i just missed him so i came back out the path and started to chase him,

Anybody that knows me knows im not the most athletic person but by god i ran and managed to catch up with him, remembering he was stoned and just got out of a crashed van. He decided to hide in a garden, i knew i wasnt alone because there was my dads friend shouting "get him L get him". We cornered him in the garden and thats when it hit home "what if he has a knife" or something.

He barged past us running and as he did i stuck out my foot and sent him flying at that point K (my friends dad) jumped on him and i grabbed his feet and we stayed there until the police arrived which was only a few minutes, in that time he was very apologetic and told us he wasnt driving!

They then took him away as he drove past us in the car he was sleeping unawares of what he had actually done.

In the aftermath of the incident we went back to look at the van and it had hit the gas box on the front of the house and there was gas leaking but no actual damage to the house. Not one person was hurt which was a miricle.

The fun part of the day was listening to everyones post accident analysis, some of my favorites were "i had visions of children being splattered""It could have been children like ten pins", the story was already growing arms and legs and it made life a little more exciting for some people.

When i was interviewed by the police they told me that he was going to get the book thrown at him and he still claims he wasnt driving...........Kids "dont do drugs" and adults "dont have nightmares now."

ps excuse the spelling its late

Caution Drug Added

2005-08-01T17:00:00.000+01:00

Wow i found this out about Piriton AKA Chrolopenamine and i am quite concerned

http://netdoctor.msn.co.uk/uk/msn/articles/medicines/100002083.shtml

I would like to draw your attention to the side effects section.

I think i might be scare mongering but i felt i had to share this with you!

Dont have nightmares.

How much Fun can u have with a Chocolate Willy

2005-08-01T12:52:00.000+01:00

Willy Wonka and the Chocolate Factory is my fav film of all time and anyone you ask will tell u. I have now seen the new Charlie and the Chocolate factory (Note name change) movie twice this weekend. I have to say " I LOVE IT". I love the first one and i love this one.

I always said nothing would ever beat the first one and Gene Wilder was a Wonka legend but im afraid to say Depp has done the role proud and is strangly attactive, looking hypoxic and wearing purple latex free gloves (a medical link there for my medically minded readers).

The oompa loompas are quite scary and not as jaundice looking this time round but they still are all singing and all dancing but wear PVC outfits which is quite off putting.

It was so much truer to the book and everything that wasnt in the first was mentioned this time. I really liked the new scenes and the fact Wonka was not so mean and moody and more quirky and a little less dark.

I was so impressed if i wasnt on nightshift i would be going again tonight.

Right i am off now to snack on a Wonka Fudge Whipple Scrumdiddlyumtious Bar.........mmm mmm!

Men are so Demanding!

2005-08-01T08:38:00.000+01:00

I have been demanded over dinner tonight that i must BLOG more. I have decided it is in my best interest to do this or i will get another kick up the arse!

The countdown!

2005-06-23T07:20:00.000+01:00

i would like everyone to know on the 28th and 29th of October i will be wearing a dress http://www.bridesmaidsdirect.co.uk/ (its the one called Corina in Claret if your interested), its not going to be pretty, i have many concerns including high healed shoes and strapless bras.

Im doing it because i love my sister but i have drawn the line at a fur cape !

Lets Sleep and be Merry

2005-06-20T08:42:00.000+01:00

As people who know me know i spend a lot of time in my bed, i have been known to sleep for 19 hours at a time (without a pee no less) and as my beloved bed is broken i have no choice but to purchase a new one. I think of it as an investment as i spend half my life in it and research shows us that we spend a third of our lives in bed

So i have purchased a new bed today.I was very excited about the whole thing . I spent an hour in the shop with a very helpful sales person with my pillow trying them all out.

It was an experience , lying down with the sales person asking what your bed would be used for ......business or pleasure. I think she thought i was cheeky when my reply was sleeping!

She was very passionate about beds and i got the feeling she knew her subject inside out and i bowed down to her superior professional judgement.

There is so much choice, divan, pine, frame, leather and then there is the matress soft, firm, orthopedic, handwoven or quilted. Then you have the storage, with or without drawers, 2 or 4 drawers. Continental or standard. The you have single,queen, double, king or superking sized.

You have no idea the dilema i had.

I have decided on a fine fellow that i think will do me proud.

It is a Kingsize, hand tufted, firm, fully super sprungbase, siletnight Minelli with 4 drawer storage.

Let the sleeping begin.

Saying Goodbye

2005-06-19T05:31:00.000+01:00

i have just watched another young person die!

You might say that i should get used to it in my profession but it never gets any easier, you nurse people , they become people u spend all your working life with, which anyone that works will know is a great deal of time.

You know their likes and dislike, u know how many sugars they take in their tea, what time they like to wake up, when they are in pain, when they need some relief from their over bearing but total loving reletives. You are close enough to know what they want and when they want it but dont care enough not to walk away when your shift is done.

They tell you and show you everything you are invited into thier very personal and itimate space and they take u in and embrace you.

People are so kind and another great one has gone, people that are 32 shouldnt die, thats only 7 years older than me and thats what brings it home to me and probably upsets me more, that sounds selfish but its how i rationalise it.

Right im away to practice my happy face to start back on the ward tomorrow!

RIP

Eating, Laughing and Abuse

2005-06-16T09:08:00.000+01:00

I have just returned home from a very amusing nightout with a group of friends and other random people that i dont care for very much.

We had a lovely meal at the water front and the conversation was filled with talk of vomit, scrotums being ripped off by dogs and the controversy that surrounds the EJ concert (the Macbeth of our District). As well as putting the StAAA world to right , i am so glad we are all perfect.

I had a really nice time and J and A are so funny and took great fun in abusing me and prodding me with hard objects and giving me a red face.

Roll on the next one........... lets make it lunch.... all the more time for wine!

Live8

2005-06-16T00:35:00.000+01:00

I won live8 tickets for London ! i dont think i will be selling them on ebay.........dam Geldof!

People

2005-06-10T00:52:00.000+01:00

I think people are funny......well maybe even bizarre.

How they change around different people and have different personas for different people and times and days of the week.
Some of people have a very stern exterior but are all mushy in the inside and usually the least confident of all.
Homosexuals are very butch and in control when they are at work or with other not gay people and when they are with their partners they are as "camp as xmas" a side they would not normally show.
Some people are wild and fun and outgoing when they are with their friends but when their partners turn up they are very serious and in control.

It goes under the same catagory as mood swings, they are just ridiculous and people make excuses for other people bacause they have had a bad day or the usual "time of the month" deal with it and get a grip.

This annoys me.......... people should be themselves and u shouldnt have to pussy foot round them till u find out which role or mood they are in before communicating

Hello

2005-04-15T00:34:00.000+01:00

Hello to my first blog

Here is to many more