Weather Follies

One thing I love about living in Portland is how much people freak out at the thought or forecast of snow. It’s like the outbreak of a zombie apocalypse, hurricane arrival or other weather/Act of God shenanigans. People flock to stores buying supplies like it is the end of the world. They hit local tire shops to put on winter tires and buy chains. It is madness.

C’mon people, it is snow. It falls, sometimes it sticks, you slow when you drive, don’t act like an idiot and things turn out OK. But no, people drive like crazy, common sense goes out the window and folks get hurt.

I went to northern Arizona over Christmas and encountered real snow (yes, snow in Arizona), not this puny wannbe snow that we get in Portland. But there people acted normal, drove responsibly and everyone got home safe. Then I come home and 3 weeks later and deal with this stupidity. Oh well.

Here’s what I’m talking about:
Arizona 1:

Arizona 2:

Portland 1:

Current Weather:


Ah, You’re So Sweet

Insulin and syringe

Image by momboleum via Flickr

Anyone who reads the news, watches the news, or is involved in healthcare knows that diabetes is a huge and growing epidemic. Sometimes you just know they’ve been brewing things for sometime, in this case it was probably true.

Admitted with polydipsia, blurred vision and dehydration and a glucose >600mg/dl. Did I mention that multiple family members on both sides of her family tree had diabetes too? Any guesses to the hemoglobin A1C?


So far off that our machines couldn’t process how high it really was. With a little math that works out to an average blood glucose of 456mg/dl. That’s about the highest I think I’ve seen, if not ever, at least in a very long time.

It’s Like It’s the End of the World.


Nothing can bring such madness as this one simple word.  Even though it is just a threat of snow,  nothing on the ground and people act like it is the Blizzard to End ALL Blizzards.

Snow haunted me through nursing school.  No mater if there was 2 inches or a foot, I had to go.  Nothing says fun like a drive to school in a 1973 VW Bug at 6am when it is 24° out and windchill to 0° all while lugging my massive Med-Surg text, A&P book, plus the other assorted miscellany needed for a day of school out to the car while looking like Ralphie’s little brother due to the amount of clothes I was wearing.

There she is, the little red one with that light dusting of snow.  That little car got to everyone of my clinical dates (even the one I got pulled over before), to class everyday except the day I broke my key thanks to ice.  Nothing says fun like scraping the inside of a windshield so that I could see out.  Sure, I would have to sit there and warm it up for 30 minutes before even attempting to drive, but I drove in all sorts of nasty weather in Flagstaff.

It was never a question of going to school.  So I learned how to drive in the snow.  Learned how to pry my frozen fingers off the wheel when I got to school.  I learned how to carry the 60lbs books and other crap we were required to carry.  Nursing school taught me far more than the required information needed to become a nurse:  it taught me to deal with adversity.

It isn’t easy, just like nursing isn’t easy.  It breaks us down to build us back up.  Remember when you first stepped on a floor for clinicals?  You were freaked out, like our city in the face of a storm, but as the day went, you grew more comfortable, it grew easier and soon you found yourself thriving in the new and different environment.  Now when you step on the floor you know what needs to be done.  You know how it needs to be done.  That’s knowledge brought on by the act of nursing, the practice.  You are able to deal with the adversity that faces us everyday because you’ve been through it all.

Now I’m off to stock up on groceries, run around like crazy tracking down a heater and generally acting like an idiot – there’s snow coming!

Friday 12-Lead

Patient was a 30-something year old white female admitted for pancreatitis.  History of alcohol and  illegal drug abuse and yes, pancreatitis.  Currently undergoing fluid resuscitation with normal saline infusing at 250ml/hr.

Medications of note include a dilaudid (hydromorphone) PCA device with dosing of 0.2mg/dose with time lock out of 10minutes and verapamil 80mg PO twice daily.

Telemetry tracing shows normal sinus rhythm in the 70’s with a prolonged QT around 620ms (calcuated QTc of 650ms).  QT had increased since start of shift from around 360ms to current.

The following 12-lead is captured:

QT/QTc is measured at 622/671ms by the machine.  Quick manual calculation confirms this.

Patient is still asymptomatic and vital signs are stable.  She is just pissed you woke her up.

What is the probable diagnosis?  What needs to be done?  Should we call cardiology?  Call and wake up the EP doc?  Pacer pads?  Let her sleep?  Do nothing and pray she doesn’t have a R-on-T PVC?

Answers and discussion to follow in a day or two…

Medicine Like 1699

Was helping a colleague out with a chart check late one dark and stormy night and came across a progress note from the chaplain.  Intrigued by the content and noting he was responding to an order in the system, I went searching for the order itself.  A couple of pages down I found it and it read:

Spiritual Care Consult – Reason: possible demonic possession.

Now granted, the patient was all sorts of crazy, alternating between catatonic states with rabid manic outbursts.  They looked much like the freaky chick from “The Ring”.  Acting like stark raving mad lunatic may seem to generate a need for an exorcism, but we’re not that society any more.  While I think that putting people in the stocks for petty crimes might be a good thing and that we’re using leeches for medical therapy,  maybe we’ve moved past the time where issues of the psyche were cured by the exorcisms of the “unclean” spirit.

Or have we?

Cold with a Captial “F”

We’ve been having a little bit of a cold snap. Daily highs are in the 20’s, maybe inching into the low 30’s. This is Portland, OR – not Portland, ME. There is something terribly wrong with this. I mean how can this be with all of the talk of “Global Warming”? According to the ‘Net it is 19 degrees at my house at only 10pm. I can’t begin to imagine how cold it is going to be on my way home in the morning. At least it’s not snowing…

UPDATE:  Here’s the screen shot when I got home.

Walked to and from the bus.  It didn’t seem that cold though…

Paging Doctor Obvious

I know that your residents have told you in great detail that you must be careful around the nurses. They must be led to the right decisions and when you are not available, be given adequate, concise and precise instructions for the successful administration of medications and interventions to heal you patient. But really? Did you really need to write this order?

Hold lorazepam for respiratory depression or oversedation.

It’s not like we’re going to say, "Hmmm…Mrs. Smith is only breathing 11 times a minute and won’t stay awake for more than a brief moment, but she seems anxious. Maybe I she just needs a little more lorazepam…" Maybe some might though. But the vast majority of us do have the common sense not to do something as boneheaded as that, we don’t need it spelled out for us.

And also, taking 4 hours to write admit orders is just not kosher. Learn to speed it up a bit buddy.