Ask a nurse anything.

Originally posted by justsaying
reply to post by Cosmic911

 

Clinic instructor, huh? Please try to remember what it was like to be in your student's shoes. I had one clinic instructor from hell who made me want to check myself into a mental hospital, it was my first semester and I had no idea what I was doing and she did her best to rattle me. All the others were fantastic and inspired me and gave me the confidence I needed to push on in school. I bet you will be one to inspire, but my thinking for some of the teachers is that they are so enmeshed into their nursing careers and have done it for so long that they forget what its like to get all this new information and how to put it together

Good luck with the ER job, hope that goes well for you!

I'll still never understand why certain instructors torture their students. My motivation for teaching are those aha moments. That makes it all worth it. I've been precepting new nurses and paramedics for years. I love it. Yes, there are times when I want to send a student home to go get the brain they clearly forgot on their way in to clinical but that does no one any good. The teachable moments...that makes my day. I'm sorry to hear about your experience. You know it's true nurses eat their own. But til this day I still remember the instructors that inspired me.

Dear free nurse,
Is it true that we all have some sort of cancer in us? When does treatment become necessary? Are people ever treated for cancer unnecessarily?

reply to post by earthdude


Really good question earthdude. In a manner of thinking yes we all have "cancer" in various degrees in that we have mutated cells at any given time. Normally the body destroys these as a function of the immune system or the cell is programmed with a kill switch that makes it pop, and not make anymore bad cells. In fact that process is called apoptosis, kinda wierd huh? Cancer is usually caused by a genetic predisposition, and an environmental factor. in other word you have to have a faulty gene, and a irritant or stimuli that makes cells go rogue.

Which brings me to another answer to the X-ray debate. Yes X-rays cause a few more mutated cells, even at very low dosages, but so does airborn contaminants, background radiation, and normal fluid, and electrolyte imbalances. The amount of damage done by a CT scan is insignificant compared to the course of the diseases we are looking for. There is risk in everything. You cannot get out of bed in the morning without assuming risk. You may be one of the unlucky few that gets a wierd, rare cancer from multiple medical X-ray exposures, but the incidence is not high enough to warrant the discontinuation of their use. They do much, much more good than harm.

A lot of times when people discover they have cancer they get understandably scared, and will do ANYTHING to get rid of it, again understandably, and yes a lot of medical companies profit from that histeria, and search for any form of hope no matter how expensive.

Personally if I developed cancer the type, stage, and course of the disease would effect my decisions. If I had stage 3 or 4 pancreatic cancer, forget it. It would be party time for my last few months. I would only seek comfort, and palliative treatment. If it were an early form of prostate or skin cancer I would treat it aggressively.

There will never be a 1 shot-cure all-panacea for cancer because there are hundreds of forms, and thousands of subtypes, and everyone's immune system responds differently. Today we see a lot more cancer in our populace for a lot of reasons. For instance we live a lot longer so we have more time to develop cancer. We have better diagnostic tools so we find a lot more cancer, and yes we have changed our environment, and that causes some cancers. If you live past the age of 80 you have a 100% chance you have some form of cancer somewhere. It might not be what kills you even, but it's there.

reply to post by Cosmic911


I loved half of my instructors, and I could have driven a wooden spike through the heart of the decapitated corpse of the other half. I had one instructor who was just mind bogglingly incompetent, one that was psycho, and a third that was just plain mean. On the other hand I had 2 or 3 that were instrumental in making me the kick ass nurse I am today. The good ones are like gold, appreciate them, and learn all you can from them. Look at the bad ones as a severe warning of what not to become.

If you have a bad one on a rotation lay low, fly under the radar, and just play their game if you can figure it out. If you have a good one soak up every morsel of information, and advice that you can. I worked with a former instructor of mine for several years(one of the good ones). She is now a personal friend, and we share advice, and learning with each other, so make those connections, some will last a lifetime.

reply to post by cavtrooper7


I've never been a fan of SSRIs either. I worked for the VA up until about 2 weeks ago. I have just changed jobs, and given myself quite a hefty raise in the process. In the VA system they are officially recognizing gulf war syndrome, but the plan of care is complex because it isn't the same for everyone, or caused by the same exposure in everyone. It is kind of a catch all/blanket term for "Something this guy got into in the middle east." We know it's there, but it's hard to figure out exactly what "it" is in a lot of cases.

BTW if you are a vet THANK YOU!!!! for your service. I mean that from the bottom of my heart. I might not work for the VA anymore, but I love my veterans.

reply to post by Binder


I'm an EMT and a paramedic student, i was just wondering if the place you are working has had as many drug shortages as the places I've worked at have? it seems like during every hospital clinical i have there are more and more drugs that the hospital has ran out of and cant get at the time because there is a drug shortage.

also what do you think about the AHA taking Lidocaine off of the ACLS first line drug for cardiac arrest and replacing it with amiodorone? i have seen lidocaine work many times and it seems better then amiodorone. do yo think the makers paid off the AHA to pull lidocaine and replace it with their own drug?

reply to post by Kail918


Hey Kail918, congrats on going to paramedic school. I'm a Nurse/Paramedic as well. As Binder will tell you also, once you get into this field you will never stop learning!!

also what do you think about the AHA taking Lidocaine off of the ACLS first line drug for cardiac arrest and replacing it with amiodorone? i have seen lidocaine work many times and it seems better then amiodorone. do yo think the makers paid off the AHA to pull lidocaine and replace it with their own drug?

I'll chime in on this one as I'm an AHA instructor for CPR, ACLS, & ACLS-EP (Experienced Provider). This is an old issue that still seems to persist even after almost a decade. When addressing these kind of issues we should refrain from anecdotes as quantitative facts or evidence. We need to look at the hard facts and keep emotions out of it. Having said that, we know AHA makes recommendations and changes, it seems, at a drop of a hat, and can be somewhat whishy-washy at times. Yep, I agree, Lidocaine had been a Class IIb action for quite some time, then, Amiodarone comes along and Lidocaine gets bumped down to a Class III. Also, its not that Amiodarone is "their drug." What looks fishy is that the makers of Amiodarone financially endorsed the study. That's a little hinky-hinky for most of us. Those studies should have been conducted independently. No question of bias.

What you want to do Kail is review the ALIVE Study and the ARREST trial. (I included a link). As Binder and I'll tell you, what we're really concerned with is one-thing SURVIVAL-to-DISCHARGE and how neurologically intact our patients are. Quite simply, the reason for the change is that Amiodarone was more effective than Lidocaine for patients with refractory ventricular fibrillation in SURVIVAL-to-ADMISSION. Although this is good, it doesn't necessarily mean these patients survived rolling past the emergency department doors. I don't believe anyone has studied that, and that, would be most important. What is good is that maybe some of those families got just a little more time with a loved one to say goodbye. Another benefit is that perhaps some of those patients became organ donors, and as you know working EMS, none of the patients we "work in the field" have a chance of donating any organs or tissues.

And lastly, to just blow your mind, you should realize there have been NO controlled studies evaluating the effectiveness of vasopressors in cardiac arrest patients...EVER! And yet we push enough Epinephrine to return a pulse to a rock! Hahaha

Anyways, great question! Gotta run for some grub! I'm sure Binder has a lot to contribute with his experience! Here's the link ALIVE ARREST

reply to post by Kail918


I think Cosmic did a bang up job responding to that one. I have often felt exactly as you do though. Even though we are not to practise based on anecdotal evidence it is hard to ignore. Cosmic is right the reason for the switch to Cordarone was long term survival. The one thing I don't like about Ami though is the insane long half life, and no antidote if you were to (God forbid) ever have an inadvertant overdose. You're kinda screwed, and some of Ami's side effects are kinda scary too, but after using it as a mainstay the last 4 or 5 years I have come to see that it does work well.

I agree with Cosmic though that sometimes survival to discharge is not always what you are going for. In some instances it is appropriate to accomplish short term resuscitation even if long term survival prognosis is grim. I didn't realize that part about the pressors, thanks for learnin' me somethin' Cosmic.