Long before I even considered becoming a nurse, in fact before I was born, before most of you were born, back when John F. Kennedy was a shiny new president, Miss Daisy started her career as a nurse in the emergency room.
Back when ambulance drivers were usually morgue attendants, police officers, or drivers from the hospital, before the doctors were board-certified, before pulse oximetry, defibrillators, telemetric monitoring, ultrasound, CT, or CPR.
When an IV meant a needle, not a catheter, the IV bottles were glass, and so were the test tubes, and you spun your own labs, sterilized your own instruments, and sharpened your own needles between injections, she was taking care of the same cast of characters as you and me, except they all had short haircuts and narrow ties, and women wore dresses.
Including the nurses.
And dress, shoes, and those stupid caps came in any color you wanted to wear, as long as it was pristine blazing sterile white. Hospitals housed nurses in dorms (because calling them sharecropper houses on the plantation was a bit too close to home) and they had rules and a curfew.
I spent most of the last 10 years working alongside Miss Daisy in triage, at one of the busiest EDs in the country, and I'm here to tell you there isn't anything that gets by her any day of the week.
There may be some few of you out there so smart they never learned anything from anyone else, but instead figure it all out for themselves. That isn't me. From nursing instructors, Red Cross instructors, supervisors, charge nurses, co-workers, colleagues, tech, doctors, and anybody else, I've been the beneficiary of learning what they could pass along.
And that includes, in no small part, someone who's been a nurse in the emergency room for over 5 decades.
Nursing Tip: When the hospital House Supervisors refer to one of your co-workers as "Mom" in her presence, and they aren't related, you might want to pay attention to her.
I bring this up, because I found out today that after all that time, she's finally decided to retire from the boundless fun and good times that are the modern emergency department shift.
So wherever you are, there's a nurse or twelve that's probably helped you more times than you can count, and done it without cutting you off at the knees or embarassing you, when you asked for help, and paid attention to them.
My humble suggestion is that you don't wait until some misty day in the far-off future to pass along your appreciation for their help, their wisdom, and their example. They certainly deserve it, and you owe no less than giving your heartfelt thanks.
If it were up to me, Miss Daisy would get a parade through town. She certainly rates it.
As it is, I'm going to leave a polite suggestion that the CEO and VP of Nursing might want to get behind a little more than a gift card to Starbuck's for her on her last day. And then I think it's time for me to make a trip to the flower shop before I swing by the ED on my day off.
Friday, May 10, 2013
Thursday, May 9, 2013
Hot Baby
Hello again, motherfathers.
It's your turn today.
I realize that just because it's probably covered in "What To Expect: Baby's First Year" in half a dozen places, there's no excuse for thinking any of you parents have actually READ anything like that. Because that would just be silly, right?
So, baby has a fever.
How would you know? A rare device, known as a thermometer.
So maybe, just for the helluvit, buy one, read the directions, and learn how to use it.
And pay attention to why we do rectal temps on peds under 12 months, because it's the most accurate, not because we want to molest your child's diapers.
So if it's 101 or higher, it's really a fever. Not 99. not 99.9.
101.
What to do, what to do??
Here's a Top Secret - Presidential/Codeword level solution, that's usually only available to highly skilled professionals, for treating the enormous medical emergency that is most fevers for children from 6 months to 6 years of age:
CHILDREN'S TYLENOL
What's that? You say you have that at home? Well, let me fill in the gaps in your parental caregiving: it only works when you GIVE IT to your child. (!)
Easy there, have a seat, put your head between your knees, all that blood rushing to your head can give you a little rush at times, right? Take a deep breath, because now we're going to go full-tilt CRAZY:
You can even give it AGAIN, every 4 hours!!
OMG, who knew?!? I mean seriously, it isn't like it isn't written on the bottle, on the paper inside the box, and on the outside of the box. How would anyone find it that way, right? I mean, if it was REALLY IMPORTANT, clearly they'd have hired skywriters to come and fly over your house once a week, or even sent the Goodyear blimp over the neighborhood during cold and flu season.
But wait! There's MORE!!
I know this is news to many new parents, but fevers don't usually go away after one whole dose of Tylenol. But that's okay, motherfathers.
You can not only give it at home, and keep giving it at home, you can keep doing it for UP TO THREE DAYS!!
Contain yourselves. I KNOW how much wild fun it is to bring all three-four-five of your not-sick children, along with the one sick one, sign them all in "since you're here anyways", and sit around for a few hours with all the kids who might have RSV, flu, meningitis, whooping cough, not to mention all the suicidal adults, and the ones with blood spurting out of their heads (and then there are the patients like that, too!).
But instead of not-getting-a-babysitter, and parading the whole clan down to visit us for a not-being-sick waiting room TV party, you could actually take a stab at managing the lethal tropical disease "fever" at home for those three days, and see if it breaks on its own. And trust me, it won't hurt our feelings one bit.
Now to really blow your mind:
1) you can give accurate weight based doses, instead of age based doses of acetaminophen (Tylenol). Holy crap!
just
a) pay attention to your child's weight at each regular doctor's checkup, or >gasp!< get a bathroom scale of your very own, and then
b) follow the AAP doctor's recommendation of giving 10mg of Tylenol per kilogram your baby weighs!
So if kiddo weighs 8 kilos, that'd be the 0.8 line on the dropper in the Tylenol bottle.
If kiddo weighs 16 kilograms (35 pounds and change) that'd be two droppers full to the same 0.8 line!!
Wow! Math! It's like...Rocket Science!!!
2) if your child is over 6 months of age, and has no kidney or liver issues, or other concerns (your pediatrician can cover this in 30 seconds at a checkup)
you could ALSO give Children's IBUPROFEN liquid!
***Pay attention, read the label, the dosage and frequency is different than Tylenol.***
For instance, ibuprofen is every 6 hours, whereas Tylenol is every 4.
But hold on to your hats:
You could, for example, check for fever, and give Tylenol at 12.
Then check for fever, and if it's back, give ibuprofen at 3.
Then check for fever, and if it's back, give Tylenol at 6.
Then check for fever, and if it's back, give ibuprofen at 9.
Then repeat all of that again, every 12 hours, for three days, and only THEN come in to see us. And following that example, never overdose your child, but still keep them comfortable by treating them every 3 hours instead of every 4 or 6. It's a science miracle!
What's that? You say the fever keeps coming back?
If you give the medicine, and the fever doesn't go down a half hour later or so, THAT is a good reason to come in sooner.
If you give the medicine, the fever goes down, and comes back in 3-4 hours, THAT is called a normal fever. Which is why you keep checking, and keep medicating it. 'kay?
Now, at the other end, when the fever gets over 103, there's a few things you might try.
First, for mi amigos whose ethnicity saw their parents and ancestors originating from anywhere between, say, El Paso and Tierra Del Fuego, you could, as a suggestion, remove the t-shirt, pants, onesie, socks, booties, mittens, jacket, scarf, fur cap, four blankets, and the three rolls of Reynolds Wrap great grandmama burrito-wrapped your bebe inside. Wait about 5 minutes, then re-check your nino/nina.
If it's really over 103, it's time for a tepid (not hot, cold, or icewater frigid, just a wee bit comfortably cooler than body temp) bathtub trip. In WATER. Not alcohol, or any other thing. Please don't wait until your child's "Motherfather, I'm Freakin' ROASTING!" Febrile Seizure Attention-Getting Alarm goes off. Trust me on this.
Now, if you've done all this first (Thank you! Thank you!), and/or your child is less than a month or two old, it's Friday/Saturday/Sunday night, or a three-day holiday weekend, and/or your pediatrician is on vacation in Timbuktu, or your child had the febrile seizure, or is also throwing up the medicine and everything else for more than a day, or also has a screaming headache/stiff neck/can't stand the bright light, or is tugging their ear(s), or is being treated for any form of oncology problem, thanks, and come right on down to see us.
But don't think you have to torture your kid by not treating their fever, just so we'll "see it".
If you tell us your kid had a fever, we believe you. Having them come in screaming, and with lava shooting out of their heads, really isn't necessary to sell us on the idea that sometimes babies get sick.
All we ask is that you take a crack at handling the simple stuff, for your sanity, and ours.
It's your turn today.
I realize that just because it's probably covered in "What To Expect: Baby's First Year" in half a dozen places, there's no excuse for thinking any of you parents have actually READ anything like that. Because that would just be silly, right?
So, baby has a fever.
How would you know? A rare device, known as a thermometer.
So maybe, just for the helluvit, buy one, read the directions, and learn how to use it.
And pay attention to why we do rectal temps on peds under 12 months, because it's the most accurate, not because we want to molest your child's diapers.
So if it's 101 or higher, it's really a fever. Not 99. not 99.9.
101.
What to do, what to do??
Here's a Top Secret - Presidential/Codeword level solution, that's usually only available to highly skilled professionals, for treating the enormous medical emergency that is most fevers for children from 6 months to 6 years of age:
CHILDREN'S TYLENOL
What's that? You say you have that at home? Well, let me fill in the gaps in your parental caregiving: it only works when you GIVE IT to your child. (!)
Easy there, have a seat, put your head between your knees, all that blood rushing to your head can give you a little rush at times, right? Take a deep breath, because now we're going to go full-tilt CRAZY:
You can even give it AGAIN, every 4 hours!!
OMG, who knew?!? I mean seriously, it isn't like it isn't written on the bottle, on the paper inside the box, and on the outside of the box. How would anyone find it that way, right? I mean, if it was REALLY IMPORTANT, clearly they'd have hired skywriters to come and fly over your house once a week, or even sent the Goodyear blimp over the neighborhood during cold and flu season.
But wait! There's MORE!!
I know this is news to many new parents, but fevers don't usually go away after one whole dose of Tylenol. But that's okay, motherfathers.
You can not only give it at home, and keep giving it at home, you can keep doing it for UP TO THREE DAYS!!
Contain yourselves. I KNOW how much wild fun it is to bring all three-four-five of your not-sick children, along with the one sick one, sign them all in "since you're here anyways", and sit around for a few hours with all the kids who might have RSV, flu, meningitis, whooping cough, not to mention all the suicidal adults, and the ones with blood spurting out of their heads (and then there are the patients like that, too!).
But instead of not-getting-a-babysitter, and parading the whole clan down to visit us for a not-being-sick waiting room TV party, you could actually take a stab at managing the lethal tropical disease "fever" at home for those three days, and see if it breaks on its own. And trust me, it won't hurt our feelings one bit.
Now to really blow your mind:
1) you can give accurate weight based doses, instead of age based doses of acetaminophen (Tylenol). Holy crap!
just
a) pay attention to your child's weight at each regular doctor's checkup, or >gasp!< get a bathroom scale of your very own, and then
b) follow the AAP doctor's recommendation of giving 10mg of Tylenol per kilogram your baby weighs!
So if kiddo weighs 8 kilos, that'd be the 0.8 line on the dropper in the Tylenol bottle.
If kiddo weighs 16 kilograms (35 pounds and change) that'd be two droppers full to the same 0.8 line!!
Wow! Math! It's like...Rocket Science!!!
2) if your child is over 6 months of age, and has no kidney or liver issues, or other concerns (your pediatrician can cover this in 30 seconds at a checkup)
you could ALSO give Children's IBUPROFEN liquid!
***Pay attention, read the label, the dosage and frequency is different than Tylenol.***
For instance, ibuprofen is every 6 hours, whereas Tylenol is every 4.
But hold on to your hats:
You could, for example, check for fever, and give Tylenol at 12.
Then check for fever, and if it's back, give ibuprofen at 3.
Then check for fever, and if it's back, give Tylenol at 6.
Then check for fever, and if it's back, give ibuprofen at 9.
Then repeat all of that again, every 12 hours, for three days, and only THEN come in to see us. And following that example, never overdose your child, but still keep them comfortable by treating them every 3 hours instead of every 4 or 6. It's a science miracle!
What's that? You say the fever keeps coming back?
If you give the medicine, and the fever doesn't go down a half hour later or so, THAT is a good reason to come in sooner.
If you give the medicine, the fever goes down, and comes back in 3-4 hours, THAT is called a normal fever. Which is why you keep checking, and keep medicating it. 'kay?
Now, at the other end, when the fever gets over 103, there's a few things you might try.
First, for mi amigos whose ethnicity saw their parents and ancestors originating from anywhere between, say, El Paso and Tierra Del Fuego, you could, as a suggestion, remove the t-shirt, pants, onesie, socks, booties, mittens, jacket, scarf, fur cap, four blankets, and the three rolls of Reynolds Wrap great grandmama burrito-wrapped your bebe inside. Wait about 5 minutes, then re-check your nino/nina.
If it's really over 103, it's time for a tepid (not hot, cold, or icewater frigid, just a wee bit comfortably cooler than body temp) bathtub trip. In WATER. Not alcohol, or any other thing. Please don't wait until your child's "Motherfather, I'm Freakin' ROASTING!" Febrile Seizure Attention-Getting Alarm goes off. Trust me on this.
Now, if you've done all this first (Thank you! Thank you!), and/or your child is less than a month or two old, it's Friday/Saturday/Sunday night, or a three-day holiday weekend, and/or your pediatrician is on vacation in Timbuktu, or your child had the febrile seizure, or is also throwing up the medicine and everything else for more than a day, or also has a screaming headache/stiff neck/can't stand the bright light, or is tugging their ear(s), or is being treated for any form of oncology problem, thanks, and come right on down to see us.
But don't think you have to torture your kid by not treating their fever, just so we'll "see it".
If you tell us your kid had a fever, we believe you. Having them come in screaming, and with lava shooting out of their heads, really isn't necessary to sell us on the idea that sometimes babies get sick.
All we ask is that you take a crack at handling the simple stuff, for your sanity, and ours.
Wednesday, May 8, 2013
You Put A What In Your Where?
Last time, we focused on new holes in your outside.
Today, we'll look at the other end of things, so to speak. That hole that came already installed when you came from the factory.
Sorry, yes, we're going there. Or rather, you've already gone there, or will someday. Ask me how I know...
See, the thing is, if you've seen something in the average supermarket or hardware store, the odds are that someone somewhere has tried to insert in someplace rather...awkward. And that probably includes ladders and paint buckets, though I have no actual experience with that patient. Yet.
But I'm still relatively young, so who knows.
I know you think it's terribly clever when you cryptically write "Personal problem" on your sign in sheet. But it's not, because we're going to ask for the details. And then, my charge nurse and 5 docs in back are going to call me and ask me what's going on with the sign in on the tracker. So pardon the entendre, but just put it out there.
We're not going to announce it over the outside PA or anything.
Back in the day, when x-rays were still on film instead of computerized digital miracles, we used to have an x-ray viewing room. When an x-ray tech said, "Hey, check this out" I thought nothing of it. But upon seeing over a foot of latex product from Doc Johnson waaaaay too far up someone's alimentary canal, I was glad I hadn't been drinking a cup of water or coffee. And I was really glad the lad involved was in another module, because I couldn't possibly have kept a straight face for two seconds.
Worse, the accomplice/girlfriend was there with him, and he/they had waited three days hoping things would work themselves out, to no avail. Surgical removal, sports fans.
Another time, one of our docs treated a gentleman who tried to plausibly maintain that he'd just happened to be changing a light bulb, naked, at 2 AM, slipped, and fallen in such a way that the intact lightbulb had boldy gone where no man had gone before. When no one over the age of 30 seconds was buying the story, he angrily proclaimed "So?! I'm not GAY or anything!"
My response is, no of course you aren't. And it wouldn't matter if you were.
What you are, is Curious George's stupid cousin, minus the prehensile tail.
And heaven help you when all bulbs are those spaghetti swirls, let alone if the glass used isn't up to spec. Yikes.
Don't think it's all guys though. (Actually, they're only about 90% of cases.) When you're a female who sits on a plastic chair, and everyone keeps looking for their cell phone going off on vibrate until they all realize it's you, well, welcome to the club.
The club of people with light bulbs up their keester, lost toys gone astray (they don't all end up on an island near the North Pole), or batteries up in your urethra (yes, really!), just among the more noteworthy exemplars.
So, as a PSA, a few tips:
1) I'm not judging your choice of playgrounds or toys, but if you end up in the ER, you're doing something (probably several things) wrong. I've heard rumors there are books and manuals, which you might wish to consult before your next excursion in the bedroom turns instead to a vist to one of our gurneys. "Trained professionals. Closed course. Do not attempt at home." isn't just for car commercials.
2) Whenever personal lubricants are involved, please kids, use a safety rope! Slippery things will get away from you, and you can't wish them back once they do.
And "Oops!" is not a safeword.
3) Before inserting anything anywhere, bust out a smidgen of logic, and mentally wargame out all the possible decision trees of what happens if your chosen implement(s) breaks, shatters, lodges, disappears, or what have you. Then work around those problems so they don't happen because they can't.
4) This is especially true if you're the accomplice: If your relationship isn't strong enough to withstand a possibly red-faced mutual trip to the ER despite following #1-3 above, then mayhap the original adventure might have been skipped as well, or at least kept a lot more on the vanilla side of the spectrum. Find something more fun to bond over than one of you waking up nauseated in post-op, when the surgeon returns your piece of errant property to you. Matter of fact, if you're going to blow $10,000 on a date, make it Paris or Tahiti, not Main Surgery.
Today, we'll look at the other end of things, so to speak. That hole that came already installed when you came from the factory.
Sorry, yes, we're going there. Or rather, you've already gone there, or will someday. Ask me how I know...
See, the thing is, if you've seen something in the average supermarket or hardware store, the odds are that someone somewhere has tried to insert in someplace rather...awkward. And that probably includes ladders and paint buckets, though I have no actual experience with that patient. Yet.
But I'm still relatively young, so who knows.
I know you think it's terribly clever when you cryptically write "Personal problem" on your sign in sheet. But it's not, because we're going to ask for the details. And then, my charge nurse and 5 docs in back are going to call me and ask me what's going on with the sign in on the tracker. So pardon the entendre, but just put it out there.
We're not going to announce it over the outside PA or anything.
Back in the day, when x-rays were still on film instead of computerized digital miracles, we used to have an x-ray viewing room. When an x-ray tech said, "Hey, check this out" I thought nothing of it. But upon seeing over a foot of latex product from Doc Johnson waaaaay too far up someone's alimentary canal, I was glad I hadn't been drinking a cup of water or coffee. And I was really glad the lad involved was in another module, because I couldn't possibly have kept a straight face for two seconds.
Worse, the accomplice/girlfriend was there with him, and he/they had waited three days hoping things would work themselves out, to no avail. Surgical removal, sports fans.
Another time, one of our docs treated a gentleman who tried to plausibly maintain that he'd just happened to be changing a light bulb, naked, at 2 AM, slipped, and fallen in such a way that the intact lightbulb had boldy gone where no man had gone before. When no one over the age of 30 seconds was buying the story, he angrily proclaimed "So?! I'm not GAY or anything!"
My response is, no of course you aren't. And it wouldn't matter if you were.
What you are, is Curious George's stupid cousin, minus the prehensile tail.
And heaven help you when all bulbs are those spaghetti swirls, let alone if the glass used isn't up to spec. Yikes.
Don't think it's all guys though. (Actually, they're only about 90% of cases.) When you're a female who sits on a plastic chair, and everyone keeps looking for their cell phone going off on vibrate until they all realize it's you, well, welcome to the club.
The club of people with light bulbs up their keester, lost toys gone astray (they don't all end up on an island near the North Pole), or batteries up in your urethra (yes, really!), just among the more noteworthy exemplars.
So, as a PSA, a few tips:
1) I'm not judging your choice of playgrounds or toys, but if you end up in the ER, you're doing something (probably several things) wrong. I've heard rumors there are books and manuals, which you might wish to consult before your next excursion in the bedroom turns instead to a vist to one of our gurneys. "Trained professionals. Closed course. Do not attempt at home." isn't just for car commercials.
2) Whenever personal lubricants are involved, please kids, use a safety rope! Slippery things will get away from you, and you can't wish them back once they do.
And "Oops!" is not a safeword.
3) Before inserting anything anywhere, bust out a smidgen of logic, and mentally wargame out all the possible decision trees of what happens if your chosen implement(s) breaks, shatters, lodges, disappears, or what have you. Then work around those problems so they don't happen because they can't.
4) This is especially true if you're the accomplice: If your relationship isn't strong enough to withstand a possibly red-faced mutual trip to the ER despite following #1-3 above, then mayhap the original adventure might have been skipped as well, or at least kept a lot more on the vanilla side of the spectrum. Find something more fun to bond over than one of you waking up nauseated in post-op, when the surgeon returns your piece of errant property to you. Matter of fact, if you're going to blow $10,000 on a date, make it Paris or Tahiti, not Main Surgery.
Tuesday, May 7, 2013
Wound Care 101 For Dummies
For today, a few thoughts on that hole you made in your slipcover:
Prior to the dawn of the 20th century, and inoculations and antibiotics, "simple" cuts and scrapes that turned septic accounted for a respectable number of annual deaths.
So for your general fund of knowledge, if you cut, punctured, burned, got bitten by anything*, or otherwise screwed up the factory finish on your shiny pink carcass, unless you were bathing in Betadine at the time, it's infected.
Now, mind you, your ordinary immune system can handle quite a bit, but there's nothing quite as good as prevention when it comes to infections, which is 100 times better than treatment after you gave it a good head start. So let's cover the highly secret, only available to medical professionals, revealed in secret lectures during training, method to prevent a lot of trouble for you:
Go to the sink or shower, and wash out the wound. Using soap isn't a bad idea either.
If you have phisodermahexagoo, great, but plain old soap isn't bad either.
If you have a bottle of Betadine (Solution, NOT Scrub), and you aren't allergic to iodine, please, alternate that with the washing, i.e. water-betadine-water.
Quite literally, lather-rinse-repeat.
Every medical student learns "The solution to pollution is dilution.", right?
So keep washing, and washing, and washing, until it's really next-to-godliness clean.
"But I'm BLEEDING!"
Yeah, yeah, call the waaahmbulance, and get over it. The treatment for losing a pint of blood is...wait for it...a glass of orange juice and a cookie. That's how the Red Cross treats people who donate a full pint, 24/7/365. Unless you're spurting blood forcefully, you aren't going to lose a pint washing the wound.
While you're washing it, take note:
Is it all the way through the skin? (i.e. can you see some of your stuffing down inside there, like fat, muscle, tendons, bone, etc.)
If that answer is "Yes", you've already answered the "Do I need stitches/staples?" question.
Finish washing it out, cover it with clean gauze pads, and wrap it securely. You may need to apply firm pressure for several minutes, and elevate the part higher than your heart, to get the bleeding to stop. If we're talking arms, legs, or head lacerations, there isn't much likelihood that you can't control the bleeding, unless you have underlying issues like being a hemophiliac, or if you're taking aspirin or coumadin every day to decrease your risk for things like clots, strokes, and heart attacks. If that's you, take a few more minutes with the pressure and elevation.
Once things are stabilized, have someone take you to the ER.
If they don't stabilize, call 911 to take you to the ER.
And when you get there, one of the first ten questions we'll ask is "When was your last tetanus shot?"
If it was less than 5 years, you're good.
Between 5-10, or for larger wounds, you may get a booster.
If it was more than 10, OR YOU DON'T KNOW, you're getting a booster.
{Hint: Write "Tetanus booster", and the date, on a Post-it, and stick it to the back of your driver's license. Then you'll have it, without having to remember it.}
The description of someone who dies of tetanus (old term "lockjaw") is one I reread recently, from an early 1900s era description. Picture someone bent like a bow, with their head and heels touching the bed, and their body arched to the ceiling, as all their muscles go rigid (tetany) until they finally die from asphyxiation from paralysis of the muscles of breathing, fully conscious, dehydrated, hungry, and in incredible pain, with no possible cure, as they suffocate. That's what happens when you don't get your booster, if tetanus takes over. It doesn't live on rusty nails, it's everywhere. The spores sit dormant on everything forever, including in the dirt on your skin, and if they get in you, and make a home, and you don't have current immunity from inoculation, put your affairs in order.
Or stop crybabying, and take the shot.
I usually ask my patients: Shot? Or Horrible Death? Shot? Horrible Death?
I have yet to be turned down, although I've seen some godawful crybabying and whining.
Please don't be That Guy.
(Though if you're the 6' 275# Crip with four gunshot wounds, who's crying about a 1" needle like I was going to castrate you, I'll probably blog about you too, just like that giant pussy.)
That's it. They numb the area with a local anesthetic (another couple of shots) then when you can't feel it, they clean it out some more, make sure you didn't slice anything else more important, like tendons or blood vessels, they stitch or staple it closed, you get them out in a few days: problem solved.
Keep it clean, dry for a couple of days to let scabbing seal the holes, and watch for infection signs, then keep the follow-up appointment to take them out. This isn't rocket science.
Now, about all those other things you want to do.
Hydrogen peroxide: it bubbles up, and looks all sciency and high-tech.
Unfortunately, it only kills organic stuff, and only what it hits. It doesn't penetrate very well. And it stings, because it's killing healthy tissue. It's better than rubbing doggie poo in the wound, but it's not a good choice unless your only alternative is the doggie poo.
(Save it for getting the blood stains out of clothing - like scrubs; ask me how I know - carpeting, and upholstery. Like if you need to move the body before the cops get there.)
Alcohol: kills germs, if left in place for 10-15 minutes. During which time it's slightly more comfortable than pouring scalding lava on the wound, and that's once again because it's also killing healthy tissue. Save this for people you really, really loathe, and be sure to duck after you put it on, because they're going to swing at you - once they let go of the ceiling.
Merthiolate: (or, as Bill Engvall calls it, "monkey blood"). A tincture (weak solution) of iodine, popular with people from circa 1930-1960. If you're going to use iodine, don't dabble. Get Betadine, and go full strength. You're supposed to be doing first aid, not art class.
Everything else that's not water, betadine, or topical antibiotic ointment: probably belongs in the same category as doggie poo.
This includes butter, Crisco, dog spit (hey, ever notice that dogs eat their poo?), and most other magical witchdoctor concoctions your grandaunt, shaman, or witch doctor told you would work. The only exception is topical honey, provided it's covered with the same clean dressing afterwards, you're on a desert island, and there's no drug store or ER anywhere.
If your wound is superficial, not requiring stitches, your tetanus shot is up to date, and you decided to skip the ER visit, put some topical antibiotic ointment on the injury, dress it with a clean gauze and a good wrap, and change the dressing daily, watching for any signs of infection.
If you see any, come in anyways.
Ditto if you waited over 12 hours for something you knew needed stitches, but you're lazy or brain-challenged. We aren't going to stitch it up after half a day, but you may still want/need the tetanus booster or antibiotics, especially if you noticed it's growing red streaks up your arm/leg, or it's huge, hot, painful, and/or draining nasty pus.
For the other 90 million people who can't grasp this, we'll be ready and waiting to scrape the peanut butter, drywall spackle, axle grease, and every other wild thing out of the holes and treat the wound. For the few folks who read this and pay attention, thanks. This'll just be our little secret, 'kay?
*("anything" includes, but is not limited to, power tools, power fools, people, dogs, cats, small pets, large pets, wild animals, fish, birds, reptiles, insects, velociraptors, vampires, werewolves, Bigfoot, and alien embryo implants bursting from your chest. Clear?)
Prior to the dawn of the 20th century, and inoculations and antibiotics, "simple" cuts and scrapes that turned septic accounted for a respectable number of annual deaths.
So for your general fund of knowledge, if you cut, punctured, burned, got bitten by anything*, or otherwise screwed up the factory finish on your shiny pink carcass, unless you were bathing in Betadine at the time, it's infected.
Now, mind you, your ordinary immune system can handle quite a bit, but there's nothing quite as good as prevention when it comes to infections, which is 100 times better than treatment after you gave it a good head start. So let's cover the highly secret, only available to medical professionals, revealed in secret lectures during training, method to prevent a lot of trouble for you:
Go to the sink or shower, and wash out the wound. Using soap isn't a bad idea either.
If you have phisodermahexagoo, great, but plain old soap isn't bad either.
If you have a bottle of Betadine (Solution, NOT Scrub), and you aren't allergic to iodine, please, alternate that with the washing, i.e. water-betadine-water.
Quite literally, lather-rinse-repeat.
Every medical student learns "The solution to pollution is dilution.", right?
So keep washing, and washing, and washing, until it's really next-to-godliness clean.
"But I'm BLEEDING!"
Yeah, yeah, call the waaahmbulance, and get over it. The treatment for losing a pint of blood is...wait for it...a glass of orange juice and a cookie. That's how the Red Cross treats people who donate a full pint, 24/7/365. Unless you're spurting blood forcefully, you aren't going to lose a pint washing the wound.
While you're washing it, take note:
Is it all the way through the skin? (i.e. can you see some of your stuffing down inside there, like fat, muscle, tendons, bone, etc.)
If that answer is "Yes", you've already answered the "Do I need stitches/staples?" question.
Finish washing it out, cover it with clean gauze pads, and wrap it securely. You may need to apply firm pressure for several minutes, and elevate the part higher than your heart, to get the bleeding to stop. If we're talking arms, legs, or head lacerations, there isn't much likelihood that you can't control the bleeding, unless you have underlying issues like being a hemophiliac, or if you're taking aspirin or coumadin every day to decrease your risk for things like clots, strokes, and heart attacks. If that's you, take a few more minutes with the pressure and elevation.
Once things are stabilized, have someone take you to the ER.
If they don't stabilize, call 911 to take you to the ER.
And when you get there, one of the first ten questions we'll ask is "When was your last tetanus shot?"
If it was less than 5 years, you're good.
Between 5-10, or for larger wounds, you may get a booster.
If it was more than 10, OR YOU DON'T KNOW, you're getting a booster.
{Hint: Write "Tetanus booster", and the date, on a Post-it, and stick it to the back of your driver's license. Then you'll have it, without having to remember it.}
The description of someone who dies of tetanus (old term "lockjaw") is one I reread recently, from an early 1900s era description. Picture someone bent like a bow, with their head and heels touching the bed, and their body arched to the ceiling, as all their muscles go rigid (tetany) until they finally die from asphyxiation from paralysis of the muscles of breathing, fully conscious, dehydrated, hungry, and in incredible pain, with no possible cure, as they suffocate. That's what happens when you don't get your booster, if tetanus takes over. It doesn't live on rusty nails, it's everywhere. The spores sit dormant on everything forever, including in the dirt on your skin, and if they get in you, and make a home, and you don't have current immunity from inoculation, put your affairs in order.
Or stop crybabying, and take the shot.
I usually ask my patients: Shot? Or Horrible Death? Shot? Horrible Death?
I have yet to be turned down, although I've seen some godawful crybabying and whining.
Please don't be That Guy.
(Though if you're the 6' 275# Crip with four gunshot wounds, who's crying about a 1" needle like I was going to castrate you, I'll probably blog about you too, just like that giant pussy.)
That's it. They numb the area with a local anesthetic (another couple of shots) then when you can't feel it, they clean it out some more, make sure you didn't slice anything else more important, like tendons or blood vessels, they stitch or staple it closed, you get them out in a few days: problem solved.
Keep it clean, dry for a couple of days to let scabbing seal the holes, and watch for infection signs, then keep the follow-up appointment to take them out. This isn't rocket science.
Now, about all those other things you want to do.
Hydrogen peroxide: it bubbles up, and looks all sciency and high-tech.
Unfortunately, it only kills organic stuff, and only what it hits. It doesn't penetrate very well. And it stings, because it's killing healthy tissue. It's better than rubbing doggie poo in the wound, but it's not a good choice unless your only alternative is the doggie poo.
(Save it for getting the blood stains out of clothing - like scrubs; ask me how I know - carpeting, and upholstery. Like if you need to move the body before the cops get there.)
Alcohol: kills germs, if left in place for 10-15 minutes. During which time it's slightly more comfortable than pouring scalding lava on the wound, and that's once again because it's also killing healthy tissue. Save this for people you really, really loathe, and be sure to duck after you put it on, because they're going to swing at you - once they let go of the ceiling.
Merthiolate: (or, as Bill Engvall calls it, "monkey blood"). A tincture (weak solution) of iodine, popular with people from circa 1930-1960. If you're going to use iodine, don't dabble. Get Betadine, and go full strength. You're supposed to be doing first aid, not art class.
Everything else that's not water, betadine, or topical antibiotic ointment: probably belongs in the same category as doggie poo.
This includes butter, Crisco, dog spit (hey, ever notice that dogs eat their poo?), and most other magical witchdoctor concoctions your grandaunt, shaman, or witch doctor told you would work. The only exception is topical honey, provided it's covered with the same clean dressing afterwards, you're on a desert island, and there's no drug store or ER anywhere.
If your wound is superficial, not requiring stitches, your tetanus shot is up to date, and you decided to skip the ER visit, put some topical antibiotic ointment on the injury, dress it with a clean gauze and a good wrap, and change the dressing daily, watching for any signs of infection.
If you see any, come in anyways.
Ditto if you waited over 12 hours for something you knew needed stitches, but you're lazy or brain-challenged. We aren't going to stitch it up after half a day, but you may still want/need the tetanus booster or antibiotics, especially if you noticed it's growing red streaks up your arm/leg, or it's huge, hot, painful, and/or draining nasty pus.
For the other 90 million people who can't grasp this, we'll be ready and waiting to scrape the peanut butter, drywall spackle, axle grease, and every other wild thing out of the holes and treat the wound. For the few folks who read this and pay attention, thanks. This'll just be our little secret, 'kay?
*("anything" includes, but is not limited to, power tools, power fools, people, dogs, cats, small pets, large pets, wild animals, fish, birds, reptiles, insects, velociraptors, vampires, werewolves, Bigfoot, and alien embryo implants bursting from your chest. Clear?)
Monday, May 6, 2013
Walking In Glory
I had intended to resume something more like regular posting this past weekend.
Life had other plans.
I don't generally blabber deeply personal details.
But this weekend, my beloved mother, described by more than one person outside our family as the Katie Elder of my clan, after nearly a 90-year run, and in declining health recently, passed quietly and quickly in her own bed, at home, relatively painlessly, and with family and friends at the bedside.
Rather than being overwhelmed with grief, I am thankful for the easiness of her passing, the ending of her struggle, and the fact that she went exactly as she wished, where she wished, and how she wished, without any fuss or fanfare, and without being a burden on anyone.
I know where she's spending Eternity, and she'd booked those reservations over a lifetime, so the only sadness involved on my part is that the suddenness didn't permit me to be there at the end, and thus the inability to say that final goodbye.
At some point, when things calm down, I may perhaps compose a proper tribute, but if you mixed equal parts June Cleaver, Granny from the Beverly Hillbillies, and Maureen O'Hara, you'd get Mom. She was tough as nails and feisty as kittens, and the red hair and Irish ancestry wasn't just for show.
She lived through three sons, long enough to see grandchildren and great-grandchildren, who if they do no more than live a life as well-regarded as she lived hers will be well-off indeed.
Life had other plans.
I don't generally blabber deeply personal details.
But this weekend, my beloved mother, described by more than one person outside our family as the Katie Elder of my clan, after nearly a 90-year run, and in declining health recently, passed quietly and quickly in her own bed, at home, relatively painlessly, and with family and friends at the bedside.
Rather than being overwhelmed with grief, I am thankful for the easiness of her passing, the ending of her struggle, and the fact that she went exactly as she wished, where she wished, and how she wished, without any fuss or fanfare, and without being a burden on anyone.
I know where she's spending Eternity, and she'd booked those reservations over a lifetime, so the only sadness involved on my part is that the suddenness didn't permit me to be there at the end, and thus the inability to say that final goodbye.
At some point, when things calm down, I may perhaps compose a proper tribute, but if you mixed equal parts June Cleaver, Granny from the Beverly Hillbillies, and Maureen O'Hara, you'd get Mom. She was tough as nails and feisty as kittens, and the red hair and Irish ancestry wasn't just for show.
She lived through three sons, long enough to see grandchildren and great-grandchildren, who if they do no more than live a life as well-regarded as she lived hers will be well-off indeed.
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