Divemedic

So there I was…

I was working in Yellow the other day and triage sent me an 80 year old woman whose family brought her in because she had pressure sores on her bottom. She’s a paraplegic and had bleeding pressure sores on her hind end, because frankly, the family doesn’t turn her enough.

We get her into the bed, and the patient responds only to pain, her blood pressure is 86/42, her HR is 70 and V paced, her RR is 40. I called a medical alert. Less than a minute later, I had a doctor, two staff nurses, a charge nurse, a paramedic, and a technician. I asked the Dr for orders to give a liter of fluid, and it was granted. He told me to give a liter of saline, followed by a liter of ringer’s.

I started two IVs and drew blood cultures, a CBC, a CMP, a lactic acid, and a type and screen.

For my medical readers: Her labs came back with all sorts of critical results. Her hemoglobin was 4.3, lactic acid 3.8, troponin was 202.

By this time, she had almost liter onboard and her blood pressure was 76/48. I got the doctor to order 1 unit of emergent O+ blood, followed by two more units of type appropriate blood. The only problem was I had to discontinue the fluids because she was showing signs of fluid overload and congestive heart failure. Her SpO2 began dropping and I had to start oxygen.

It wasn’t long before she was on Levophed. I tried talking to the family about end of life and signing a DNR, but they insisted that she was “a fighter.” I spent the next 8 hours trying to keep her alive and stabilize her. I had two other patients who had to wait awhile because nearly all of my time was being taken by this patient. When she went to CT, I went with her, and the report came back showing all sorts of gas bubbles in her chest and abdomen from the large amount of sepsis. None of the surgeons would touch her because she was too sick. Simply put, she is dying. I was incredibly happy when the time came to transfer her up to the intensive care unit.

By Divemedic, ago

More on the Cop Ambush

More to the story on the cops who were ambushed in Eustis last week. The cops entered the house and split up. They obviously didn’t clear the rooms very well, because one of the occupants got behind one of the cops and shot him in the back. The other cop fled, and the arriving backup didn’t have the balls to go in and rescue their comrade.

When the wounded cop ran out of ammo, the occupants of the house simply walked up and shot him. When the dead cop’s phone rang, the occupants answered it to find out it was the dead man’s wife. They taunted her.

Local media is making a big deal out of the fact that the home had a stockpile of guns, ammunition, food, and bottled water, and lacked cell phones, regular phones, or a television. OK, a stockpile of guns, ammo, food, and water describes most of the households in Florida.

By Divemedic, ago

Real, or Memorex?

Ever since her selection to be the Democrat candidate for President, the Harris campaign has appeared to be an unstoppable juggernaut of popular support. Here is one picture, purportedly showing a huge outpouring of support for her, as she arrives on Air Force 2;

Until you zoom in and take a look at the crowd:

Oopsie, that’s an AI altered picture. Zooming in to the engine, there is no crowd appearing in the reflection. Unless the entire crowd is made up of vampires, which is impossible, because vampires can’t survive in direct sunlight.

The left is saying that anyone who notices this is engaged in a misinformation campaign. Don’t believe your lying eyes- Harris is the most popular candidate ever. They cite Snopes as the authoritative source that this picture is totally not fake, and there were actually over 15,000 people there. After all, if the MSM says it, and Snopes fact checked it, that means it totally happened.

There is no isvestia in Pravda, and there is no pravda in Isvestia.

By Divemedic, ago

More Reports from the ED

This past week was a busy one in the ED. We are seeing a lot more cases of COVID as of late. I was working in “fast track” one day, which is where our minor illnesses go. I saw six different patients who were positive for COVID. None of them were serious enough to be admitted, and were sent home with instructions to get lots of fluids, rest, and take OTC medications to control symptoms. So we are seeing lots of COVID patients, but none of them are seriously ill.

If you want to know more about how emergency medicine is done, read on. If that doesn’t interest you, then there will be other posts.

The ED is organized chaos. There is a lot that goes into a large emergency room that is seeing hundreds of patients a day. How this is accomplished is that the ED is divided up into zones, each color coded to indicate the acuity of the patients within it.

Gray Zone

Gray is not really a treatment zone. This is where patients are checked in and triaged. The gray nurses decide which treatment zone a patient will be sent to. It’s staffed with two technicians, two nurses, and a registration clerk. Security is also here, because this is where people decide to be assholes. If the ED is really busy, a doctor and an additional nurse (called the pit nurse) get assigned here and began treating the easiest cases out of two exam rooms (called the pit) in gray. The idea of the pit is for people with simple requests like toothaches, wound rechecks, and medication refill requests be treated and discharged within 30 minutes of arriving.

Green Zone

The “Green” zone, also called Fast track, is a subunit of the ED and is entirely made up of patients who the triage unit believes can be treated and discharged in less than two hours. Fast track itself contains three sections:

  • Treatment. This area consists of 12 rooms staffed by two or three nurses. The nurses here are usually nurses who are still learning how the ED works. It’s a great area for nurses new to the ED to develop the skills and workflow that makes the ED more difficult and challenging than some other units. The idea of this area is to get the patient assessed, treated, and discharged in less than two hours. The team nursing concept is used in this section, so nurses see a lot of patients in a very fast paced environment. It isn’t unusual for a nurse to see 30 or 40 patients in a 12 hour shift.
  • If the patient is not really ill, but we are waiting for some test like the results of a CT scan or some lab work that will take a bit of time, they are moved to RPZ (Results Pending Zone) to await a further clinical decision. RPZ is like purgatory, where a patient waits for the results of those tests to see if they will be discharged or admitted. The patients here have received medication and have been assessed and found to be stable. RPZ is staffed by a single nurse and can contain as many as 12 patients awaiting results, who sit in reclining chairs and watch TV while they wait. There are two rooms here that are used so that the providers can talk privately to patients to discuss lab results.
  • Holding. This area is for those times when triage got it wrong, and the patient will be there for longer than two hours. Things like blood administration, medications than take awhile, or patients waiting for an inpatient room on one of the hospital floors. Holding is three rooms, staffed by a single nurse. When I am in fast track, I am usually (but not always) the holding nurse.

Fast track moves a lot of patients through it, over 150 patients a day. The cases are usually mild: toothaches, STI’s, lacerations requiring stitches, FLU like symptoms, and other mild illnesses go here. For that reason, this section sees more COVID cases than any other zone. If the pediatric patient load decreases to the point where they close pediatrics, the children go here for treatment. If patient load drops further, fast track gets closed at either 11pm or 1am. There is one charge nurse that is assigned to both green and purple together.

Purple Zone

Across the hall from green is the purple zone, or pediatrics. It is exactly what it sounds like. It consists of 8 rooms and a pediatric triage room. This zone is staffed by 3 nurses. This is a secure unit that is located behind locked doors. When the ED is especially busy with pediatrics, the gray nurses will send pediatric patients to a separate waiting room so they don’t have to be seated next to the druggies and other people in the gray zone waiting room.

If there aren’t enough pediatric patients, this zone gets closed at 9pm, and pediatric patients go either to the red, orange, or green zone. It’s rare for them to go anywhere other than green, as kids usually aren’t all that ill.

Yellow/Blue Zone

This zone is called “subacute” but it usually is anything but that. With a name like subacute, you would think that this area has patients with complaints that aren’t that serious, but you would be wrong. Some nasty stuff happens in here, and I swear that some of the rooms in this area are located on top of an Indian burial ground or something, because they seem to be cursed. If Red/Orange is full, then any other high acuity patients who come in wind up in Yellow or blue. This area contains 36 rooms that are staffed by 9 to 12 nurses, a charge nurse, and 1 or 2 technicians.

Red/Orange Zone

This zone is called acute care. The patients who are deemed to be the sickest come here. If EMS brings in a patient in cardiac arrest, they come here. Severe respiratory distress comes here. This unit contains 36 rooms that are staffed by 14 nurses, a charge nurse, 3 paramedics, a respiratory therapist, 3 patient care technicians, a clerk, and a lab technician. Three of the rooms are called trauma rooms and are kept empty as much as possible. The most unstable patients are initially put in them, stabilized, and then moved to other treatment rooms as soon as possible. Additionally, there is a room that can be accessed through a decon shower room, and a psychiatric room that is the classic “rubber room,” but thanks to a court case from another hospital deeming that to be inhumane, that room is no longer used for that purpose.

Other staff

Staffing for providers varies, but there can be as many as 6 doctors, a pharmacist, and 2 midlevel providers (Nurse Practitioner or Physician Assistant) in this ED. Also included here are 2 pharmacy technicians, some transporters to move patients around, and two janitors for cleaning rooms. There is also Xray and CT, which are staffed by another 6 technicians, and the lab which is staffed with 4 more technicians, as well as the radiologist who is offsite, but interprets all of the imaging that is done.

So there you have it- a 100 room Emergency Department that, when fully staffed, contains 10 providers, 40 nurses, 20 or so technicians, and 8 to 10 other personnel.

And yeah, this is a filler post, with most of the content written for the day when I needed a post but didn’t feel like writing that morning. (To be honest, it’s because I am out mowing the lawn and doing other honeydew chores this morning.)

By Divemedic, ago

Going to SCOTUS

There are millions of Ford F150 pickup trucks on the roads of America. More than 41 million F-150s have been sold since the truck was introduced 76 years ago. The F series has been the best-selling truck in the U.S. for 47 years, and the best-selling vehicle of any kind in the U.S. for 42 years. If you walk out your front door and look around, you will probably seen a few F150s within the first few minutes outside.

That’s important, because with all of that popularity, one needs to remember that there are more AR patterned rifles in the US than there are F-150 pickups. Despite those facts, the Fourth district court of appeals has allowed that state’s ban on the AR-15 to remain in place because, the court ruled, the AR pattern rifle is “highly unusual.”

This means that the concept of Assault Weapons bans is heading to SCOTUS and is likely to appear on the court’s docket this term. The case, Bianchi v. Brown, is being brought by the Firearms Policy Coalition, the Second Amendment Foundation, the Citizens Committee for the Right to Keep and Bear Arms.

By Divemedic, ago

Tasers

There are many people who ask: “Why do you need to carry a gun? Can’t you just have a TASER? There is no need to kill someone.” Well, here is a great video that explains why TASERs aren’t really effective all that often. (Sorry, YouTube has age restricted this video and it can’t be embedded.)

Note that this guy took two solid Taser hits, shook them off, and then attacked the cop. The cop then had to shoot this critter. Even after being shot three times, he still managed to keep fleeing for another 31 seconds. Sadly, Norway lost another of its fine, upstanding children.

By Divemedic, ago

Is Replacement A Theory?

Ask the people of London. In 1961, about 97.7 percent of the city’s residents were white. By definition, the races are listed as:

  • White
  • Asian
  • Black
  • Mixed

By 1997, that number had dropped to about 75 percent, and that is when the gun ban went into effect.

By 2021, that number dropped to 53.8 percent, with 14.7 percent being white, but not British. So in sixty years, the population of London went from 97 percent white and of UK descent, to only 36.8 percent white of UK descent.

Now the civil war has begun, but it appears to be too little, too late.

Are we also being immigrated out of existence here?

By Divemedic, ago

Better Off Without

Monongah, WV is a small town with a population of 972 people. It’s crime rate is 5 per 100,000 people, or one seventh the crime rate of the US, which is 35 per 100,000. Last year, there were no reported murders, auto thefts, burglaries, rapes, or robberies. In other words, a typical American small town with little to no crime. The only real crimes in the town are physical fights, and even those occur at half the national average.

Last Thursday, some random guy with a drop leg holster and a generic “Police” t shirt that anyone can buy for $16 on Amazon tried to pull a woman out of her car in this town. She demands to see his police ID, and the man refuses, so she drives away- 30 yards to her mother’s driveway.

When he catches up to her, he tells her that he is going to “fucking shoot” her if she doesn’t roll the window down. When a bystander overhears this, she yells something that sounds like “We should take your badge,” to which the cop replies “Fuck you.”

It turns out that he is the chief of police. Go watch the video here. I will wait.

Yep, he is Monongah, WV Chief of Police Nathan Lanham. Or he was, but more on that later. He is threatening to kill someone over what? Police can’t use lethal force as a compliance device. Lethal force is not reasonable to effect a traffic stop. He feels safe enough to tell bystanders to f/o while turning his back on the ‘threat’. What he is doing would be called aggravated assault, which is a forcible felony.

At what point is it morally justified for someone to step in and shoot this fat fucking tyrant? I assure you that, should someone find me on the jury after they do this, I would NOT vote to convict. It seems that the people of Monongah feel the same way.

There aren’t even any ballistic panels in the carriers, and officer Bitch Tits is in an Amazon Tshirt

She was arrested and charged with felony fleeing in a vehicle with reckless indifference to the safety of others. The charges were dismissed after she spent 5 nights in jail because she couldn’t come up with $125,000 in bail money. Even though charges have been dropped, Beth Delloma says that she remains terrified that the rogue officer will attempt revenge on her in the future.

The arrest report states that he was in uniform and driving a marked vehicle. He says he activated his “marked patrol vehicle’s emergency equipment to conduct a traffic stop.” None of those statements is true. That’s called perjury, which is also a felony. With officers like this, it is hard to argue that the people of Monongah are safer with a police department than they are without one.

At any rate, the public outcry once this video went public was so great that there was a town meeting on Monday night, with the citizens showing up, demanding that Lanham be fired, but he resigned before they could do so. The odd part is that it also appears that he was a cop in the nearby town of Rivesville, WV and three other towns while also working as Monongah police chief.

In fact, as of 5/14/24, Lanham was no longer with Rivesville. He was named Chief of Monongah PD on 5/25/24.

Why do cops feel the need to wear clothes looking like they are about to assault Fallujah, or else looking like complete slobs? What ever happened to neat police uniforms?

By Divemedic, ago