Attack TB where it lives

UPTON, NY — Attempts to eradicate tuberculosis (TB) are stymied by the fact that the disease-causing bacteria have a sophisticated mechanism for surviving dormant in infected cells. Now, a team of scientists including researchers from the U.S. Department of Energy’s (DOE) Brookhaven National Laboratory, Stony Brook University (SBU), Weill Cornell Medical College, and The Rockefeller University has identified compounds that inhibit that mechanism — without damaging human cells. The results, described in the September 16, 2009, issue of Nature, include structural studies of how the inhibitor molecules interact with bacterial proteins, and could lead to the design of new anti-TB drugs.

via Inhibitors of Important Tuberculosis Survival Mechanism Identified.

This is just cool.  Although they will probably find out later that it causes zombie-fication…

The Work Week in Quotes

Some weeks are better than others.  But what can turn a bad week into a decent week is the things patients and your co-workers say.

“So is this one of them vibratin’ beds” asked the extremely odd dude being admitted.  “No sir, we don’t have Magic Fingers in the hospital.” replied his nurse.

“So, is he in sinus?” asked the nurse on getting report on a patient who is known to be in atrial fib after being told that the rate is in the 40’s.  “Yes,” replied the other nurse, “he’s in sinus, but it’s really irregular.”  Patient comes up in afib.

And my favorite for the week…

“Sorry, we’re all out of Dilaudid.  How about a lollipop?”  What we wished we could say to the obvisouly drug-seeking patient who thought they were staying at the Hilton and we were nothing but Pez dispensers of IV pain medication.

Deep Fried Delights

I’ve got this pain in my chest, *gasp* feels like an elephant sitting on it, *uhhhh* now it’s in my arm too, and I feel a little short of breath.  I just need another one of these:

Chicken-fried bacon
This was sold at the same stand where we found the country-fried pork chips, so we picked up a basket. Whoever named these the 2008 Best Taste Winners must have been seriously off their medication; chicken-fried bacon proved to be the very definition of too much of a good thing. The thick-sliced bacon fried in a crazy heavy country batter was so rich that one of our testers could only eat a single slice, and another managed only a single bite. At the risk of offending The A.V. Club’s bacon-is-God readership, this was where bacon jumped the shark. Grade: C- [Image via Flickr]

Job security?  Only if you live in Texas.

Read all about it at:

Texas Taste Test: Walkin’ in the deep-fried wonderland of the Texas State Fair | Features | | A.V. Austin.

True Health Care Refrom – TBATM

The Blog that Ate Manhattan: TBTAM on Healthcare Reform.

Great read.  And far too true.  While I may not totally agree with Mad as Hell Docs (not sold on single-payer), they tie in with the whole idea of cutting out lobbyists and making this a discussion between the us and our docs.  To Hell with Big Insurance, Big Pharma and the lot.  My favorite quote:

Healthcare won’t get fixed as long as the stakeholders in health care with the biggest voice in its reform are the insurance and pharmaceutical industries, medical device makers, lawyers and others whose business thrives on the increasing health care expenditures of the American public.

Asking these folks to help us reform healthcare is like asking Master Card, Walmart, Verizon and Best Buy to help figure out your monthly budget.

Damn straight.

h/t once again to Dr. Wes!

The kids are dying!…

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Shortage of shots as more kids die of swine flu – Swine flu-

What a way to sensationalize tragedy.

Yes, it is a tragedy when kids die.

Yes, it is unfortunate that we don’t have enough vaccine available.

Yes, some people believe that vaccines are bunk, especially the flu shot.

Yes, the hysteria is starting to rise.  It’s everywhere.  Makes one want to stay isolated inside the house and never leave, open the door with a N95 and turn the foyer into a positive-pressure space.  Makes me just turn off the news and news websites and pop a Xanax.

But why focus on kids?  Easy:  kids pull at our heart strings.  Kids are the easiest way to sway the public’s opinion.  Sad but true.

And I don’t need a special graphic to tell me that H1N1 is widespread in Oregon.  I just go to work.

Charge Nurse Headaches

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One of the main things that I hate having to deal with as a charge nurse is the managerial side when it comes to my staff.  Most of the time, they’re a breeze.  We all get along relatively well and function as a cohesive unit more often than not.  Sure, there are personality differences, style of nursing differences and the differences of how people deal with crises, but for the most part we’re a pretty easy-going well-adjusted group.  Until you do something to piss someone off.

I had such an episode last week that left me fuming.  Luckily, my ride home cooled me off a bit, but even now I’m still pissed about it.  It was all about a staffing decision.  For some reason, our census had been low.  Like really low.  Frighteningly low.  Low enough to where we were having to decide on 3 nurses and an aide or 4 nurses and no aide.  This includes the charge nurse.  Lucky for me, my day shift counterpart knew my preference and went with 4 nurses and no aide.  For the first time in eons, the aide got canceled.  Compared to the rest of us getting canceled once a pay period or more, it’s nothing.  If we had gone with 3 nurses and an aide here’s how it would have broken down:  2 nurses with 4 patients each, me with 2, plus being in charge of 2 units (us plus our obs unit), plus unit secretary and being relief for the telemetry tech’s lunch, breaks and bathroom trips.

Maybe comparatively it’s not that bad, but for our unit, it is a lot of work.  Additionally, we had no one available except myself to admit, and by our staffing guide, we didn’t qualify for another nurse until we got 2 more patients.  It could have been very bad indeed.  So we went with 4 nurses. I was CNA, charge nurse, secretary, tele tech breaker and jack of all trades.  It worked beautifully.  We even had a couple of admits and things still went great.

The next night the situation was the same.  Again, the same choice was made.  The same aide got canceled – but she was able to pick up hours in the ED.  So after 2 nights of plenty of shit (literal and figurative) she comes up in the morning and starts laying into me.  She’s complaining she was canceled, that she’s the only bread-winner in the house, what right do we have to cancel her – all legitimate issues.  But then she says, “I’m going to talk to the union about this.”

You see, the nurses at my facility have chosen repeatedly to not be union, but almost all of the other staff, including CNAs are.  I’m all for working things out and trying to explain what happened, but when you threaten me with “going to the union” that’s just not cool, I turn off.  So I say, “That’s your right.  We made this decision based on nursing judgment to go with 4 nurses instead, based on the needs of the unit.  Besides Derrick (our manager) is backing us on this.”  I was calm.  I was pleasant.  I was brusque.  And I walked away before what I was truly thinking came out.  That would have been something like this:

“You’re pissed that you missed one night of work?  Big fucking deal!  We’re missing at least a shift a pay period, sometimes more.  And believe me, having the extra nurse was far more helpful than you could ever be.  Can you give meds?  Can you take off orders?  Can you admit a patient and settle them?  No, no and no.  I chose to do it this way to better support my nurses, to ensure that we had a safe environment for our patients.  So go ahead, run crying to your union, Derrick’s got my back.”

But I didn’t.  I kept it in.  But I’ve thought about it too much since then.  But I still know I made the right decision.  Why?  The nights we had no aide, I passed meds for the nurses who were busy, I put in orders when they couldn’t, I watched tele while my tech (ab)used the bathroom, I did all the things that a CNA can’t (won’t) do.  The thing that sucks is that she is one of my better aides and still she would be pretty much useless.

In spite of all of this, I’ve been tore up inside.  Doubting myself.  Worrying that maybe Derrick doesn’t have my back.  Worried that maybe I made the wrong choice.  And pissed that I’m so worried about it all.  I haven’t been back to work since so I don’t know what has come down the line, but I know I’m at the bottom of the hill and shit does roll downhill.  But I guess that’s why I make the big bucks…

And as for other headaches, let’s just say, when your other 3 nurses are the weakest on the unit and there is nothing you can do about it, is a headache all it’s own.

Stents for Mr. Floppy?

UPDATE 1-Medtronic to study stent in erectile dysfunction | Stocks | Reuters.

The study is intended for men who have not responded well to PDE5 inhibitors such as Viagra, Cialis and Levitra.

I figured that was just Nature’s way of saying, “Throw in the towel Rock!”

I can see the PMH now…

65 y/o male, history of coronary artery disease with coronary stents x3 and pelvic stents x2, hyperlipidemia, hypertension, diabetes, erectile dysfunction (resolved)…

or answers on the MRI checklist…

Uh, yeah, I got them stent thingies in my hips or something ’cause I couldn’t get it up no more and Vigara didn’t work…

I mean, really, let’s handle the hard, err..difficult topics in medicine: depression, hair loss and ED.  Got to have your priorities in the right place!

h/t to Dr. Wes

Flu Hysteria!


OMG! The flu is here!  Run for the hills while you still can!  Save yourselves! *cue mass hysterical screaming*

OK.  Everyone feel better?  I get it.  We’re trying to vaccinate, isolate and and not duplicate the scenario from 1976.  But truly, the flu is a nasty little bugger this year.  And that’s just H1N1, not even the seasonal flu.  It seems to be targeting the ones who are usually not affected by it.  The young, the 20’s, children especially those with health conditions (kind of a given though), pregnant moms and of course the elderly.  In my workplace, no one has been confirmed with it, but I have heard of several pregnant health care workers who developed full-blown ARDS and ended up ‘tubed in the ICU due to the flu.  Not pretty.  But for all our mass hysteria, not too bad yet.  And nothing really that far out of the range of normal flu mortality.  And compared to the 1918 flu, what we have here is but a fart in the wind.  Sure, we’re having to use droplet and contact precautions a lot more and I’ve had to trim the goatee a little more to make the masks fit better, but we’re not seeing a huge increase in the flu.  But enough.

I finished Flu: The Story of the Great Flu Pandemic, by Gina Kolata, a couple of days ago and it chilled me.  Millions dead. Those dying, died fast and ugly, literally drowning from massive pulmonary edema.  But I think one area where the book shines is the (cautionary?)tale of the 1976 flu debacle.  Remember?  The one where the government embarked on a massive program of flu vaccination because the highly respected elder statesmen of public health cried “Wolf!!!” over a couple of cases of swine flu.  Millions of vaccine doses later, a couple hundred extra cases of Guillian-Barré Syndrome and some deaths that may or may not be attributable to the vaccine and an epidemic that fizzled faster than Howard Dean’s Presidential ambitions, led to a higly charged atmosphere of dread and suspicion over the latest novel flu virus to hit our shores.  Will this one be the BIG one?  Or another fizzle?

So the talking heads, the CDC and infection control practitioners across the country gear up to warn of our impending doom at the hands of H1N1.  And yes, it may be nasty, but we don’t know for sure.  So go get your shot(s).  And to quote Dr. Mark Crislip,

2. I never get the flu, so I don’t need the vaccine. Irresponsible dumb ass. I have never had a head on collision, but I wear my seat belt. And you probably don’t use a condom either. So far you have been lucky, and you are a potential winner of a Darwin Award, although since you don’t use a condom, you are unfortunately still in the gene pool.

And some CDC stuff for the uninitiated (i.e. those not having to wear masks every day for work).

Respiratory Hygiene/Cough Etiquette in Healthcare Settings

Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting

*cue ominous music*

Just remember, you can’t out run the flu…

*cue spooky Vincent Price-laughter*

Photo Credit:
© Stephane Tougard |

Why I’m Not a Neuro Nurse

‘Cause sometimes they’re just a little too freaky.  Too many weird things happen inside that bony vault of ours that we can’t understand, much less fix.  Take a CVA.  Simple thing, right?  No blood flow.  Same as a MI.  One we can fix relatively easily and they’re back out eating Big Macs in 48 hours.  The other renders the person spouting word salad out of a drooping mouth while being unable to feel their left side and many times there ain’t a damn thing we can do to fix that.  No stents, t-Pa only if you know the last normal and even that isn’t a sure bet, usually all we can do is support what is left.

But what really hammered this unlove of neuro was a situation this week at work.  Chicky comes in after having trouble moving their right hand, some drooling and slurred speech.  By the time she hits the ED, everything has resolved itself.  Classic TIA.  Now we all know that having a TIA increases your risk of having a full-blown CVA exponentially, so she gets admitted to us on our stroke protocol for further work-up.  So I’m walking past the room doing my last set of rounds just at shift change when her nurse pops her head out and says, “Can you give me a hand?”

“Sure,” I say walking into the room.  And there she is, Ms. TIA, not moving the right arm and talking a little like a drunken sailor.  But she’s alert and oriented, following commands, just some focal deficits, that are nearly exactly the same as the ones that brought her in.  Her nurse asks, “Do I need to call a RRT?”

“Not yet,” I start.  “Get a good NIHSS assessment going and I’ll page her doc.”

She starts up on that as I go to page the doc.  As I head back in, the nurse looks at me and  says, “She’s completely resolved!  Totally back to baseline.”  Sure enough, 100% neuro intact.  Not a single deficit.  Went from a 2-3 on the scale to a 0 (the higher the number the worse the symptoms), in a mater of 3 minutes.  Completely freaky.

“Well,” I say, “let’s put her back on bedrest and make her NPO, the 24 hour clock just reset itself.”

We were both a little freaked out by it.  I’d never seen that before, to go from having (mild) stoke symptom to complete resolution in a manner of minutes.  Cool, but freaky.  Ms. TIA however, bought herself another 24 hours of bedrest, nothing to eat or drink and a stat trip to the MRI machine.  Yeah, don’t want to do that again anytime soon.