I came home to start anesthesia. Why did I not go to CRNA school?? Anesthesia was amazing and best rotation yet! Those doctors are the most calm people you will ever meet. My LMA skills rocked, my oral airway skills rocked, but my intubation skills could not have been any more terrible. By Wednesday I finally started to get it. I watched every you tube video, read every how to, and even tried to get Mat to let me practice an awake intubation (something about his terrible gag reflux)! But finally I got it! And loved it! It reminds me of placing a foley! The anathesiologist didn't have the same reminder... But he had never placed a foley. Sometimes it just accidentally slips in the wrong hole! Anesthesia was great on teaching me the tools of the trade. I absolutely love the bougie! That thing DR. Evans keeps in his book bag. And pre oxygenation is a girls best friend. Studies show if you pre-oxygenate patients for 2 minutes and keep a nasal cannula on them while you intubate you can extend your time to about 6 minutes before hypoxia. If you can't get it by then well...no comment! No worries everyone still had there teeth! Oral airways are also a girls best friend when bagging the butter balls aka Roanokes well fed people.
Friday, August 8, 2014
Trip home and anesthesia!
We were able to go to Portland, Spokane, and back to Portland for the 4th of July! We tried to see everyone we possibly could in 8 days! So good to be home...so good to see friends and family! Had some fantastic non fryed food and got plenty of hugs! I loved walking into Deaconess to suprise the night shift. It felt like I should sit down and just start charting as if I was never gone! Home sweet home!
Worst blogger ever! Where have I been? Ortho!
Yes I know! Last blog? I probably should just give this up as you have probably given up on reading! But today Mat and I have been in Roanoke for officially 6 months! We've made it. I feel like I should catch you up or atleast tell you about the exciting parts (and I have lots of time on this car ride)!
I can't even begin to tell you all my stories but I will try to catch you up without terribly boring you.
May was a month of orthopedics! Two weeks straight baby...of fractures, dislocations, wash outs and OR time. Orthopedics is not my expertise or my favorite...but I really enjoyed the relocations and the splinting. And learned how much I don't know about orthopedics! I completed two very long 24 hour shifts. Well one 25 hour shift and one 24.My fellow colleagues learned Alissa gets pretty cranky at hour 16, very cranky at hour 20, and has a foul mouth at hour 25! At hour 24...I was holding the 300 lbs man's leg, for the third time as we were relocating the ankle for the 3rd time and splinting it for the third time as the man was drunk off ketamine and kept hitting on me as I was leaning against his sweaty belly, holding his 100llb thigh, dripping sweat myself and then the resident forgot some splint material! Really? He heard words I never knew I could say! I didn't understand why I was holding the thigh instead of yanking on the ankle as he got it wrong the first 2 times and 2 hours later. And if you can imagine I told him how I felt. Needless to say the man ended up in surgery and I finally got some sleep and a shower. I relocated a hip, a couple of shoulders, washed out some open fractures, reduced many distal radius, hematoma blocks, met a lot of cute old ladies with hip fractures, and learned to love to work with plaster. Nothing is more satisfying the reducing a blue ankle that then turns pink again.
2 weeks was plenty long on that rotation. Lots of floor calls, lots of dilaudid, and my favorite consult from a floor nurse who stated "he feels like he wants to vomit but can't" at 4am! Give him some white chocolate pudding for crying out loud!!
Friday, March 21, 2014
Fire Fire Fire!!!
Time is flying bye! Only a few more weeks and some patient responsibility will hopefully be able to fall into my hands. Supposedly of course (if all my credentialing goes through on time). Feel like I am losing my IV skills, med skills ect quickly. I am still unsure of the exact reasoning for all of this shadowing and pre-hospital experience. I think they are wanting us to create great relationships with pre-hosptial folks, earn some trust, and of course help create the big picture. I have learned lots over the last two weeks and had a kick a** time with EMS. And for all those old people you know you pile up junk in the halls and stairs...encourage them to clean it out!! So hard to carry a patient through halls, over piles, and down steep stairs. Now I understand why all the fireman show up...to move all this stuff. Okay let me began my EMS/Cardiology stories. I hopefully can explain it like you were there.
On Monday morning I arrive at the fire station about 0.4 miles from our loft. I was following Capt. Thompson. His job is to jump in his pickup truck when there is a code or a large fire. Basically anything fun and exciting he goes. But he told me anytime bells and whistles went off I could jump in which ever truck was going. The station has a engine truck, ladder truck and ambulance. They all trade off between the trucks and ambulance meaning they are all EMS and fire trained. There was really nothing going on until about noon and they were all loving that I was there as I was supposedly the "white cloud." At noon the engine check light went off with the loud horn and whistle. The firemen truly keep their boots inside their pants outside the truck and have to be ready in the truck in 90 seconds. This means I had 90 seconds to get to the truck, open the door, jump in and buckle up. The door to the truck is so high, I actually have to jump to reach the handle. Thank goodness when I opened the door the stairs rolled out. And thank goodness I didn't have a miniskirt on as I would never have gotten in (don't worry I would have never worn a mini skirt to the fire station, just saying so high I did the splits getting in)!! I quickly strapped in and put my headset on. Off we go lights, sirens, and lots of honking! My heart was racing as we were flying through downtown weaving in and out of cars! I quickly identified stupid drivers, drivers who have their music too loud, and drivers who just don't pay any attention at all. My heart was racing!!! I was going to my first fire!!! I was worried about my role... do I get to hold the hose? Will I have to try to rescue people? Do I have to stay in the truck? We arrived in front of the library downtown. Everyone jumped out of the truck and so did I. My instict was to start sniffing...but I couldn't smell any smoke...where was the fire? We looked all around and found some construction workers putting water on some dirt, but they were only keeping the dust down. Finally, to my right was a small plant in the flowerpot smoking. Looked as if a cigarette was "still burning." They took this tiny water can and put it out. Basically peeing on it! All this hipe, fast firetruck, lights and siren, heart pounding and all we got to do was put out a ciagarette. I could not believe it. A man comes running out of the SS office to say he would have put the fire out but he can't leave his station or he will get fired. The fireman asked, "sir you just left your station." The man ran back. I knew that people call EMS for dumb stuff and they transport them. People come into the ED for dumb stuff...but a smoking plant? Really? No worries, another plant saved, it remains green today.
We all piled back into the truck and started heading away from saving the day and rescuing the plant!! But right before our eyes down the road was a large area of smoke coming from what looked like to be the freeway area. And this time I smelt smoke!!! Is this the real thing? The captain (the man who sits shotgun) called into dispatch and asked if it was a fire along the freeway. Dispatch responded back and said that there was a large three mile fire on the west side of the freeway. The captain shouted," we are on our way."!! And in a split second we were hauling ass down Jefferson Street lights and sirens quickly getting on the on-ramp for the freeway. I think I yelled out a little WOOT WOOT! Now flying in a helicopter does get my heart pounding and gives me a great adrenaline high. But I think going 60 mph in a firetruck might beat that!!! We arrived on first area where there was fire. The right side of the freeway was engulfed in smoke. Cars were flying by on the left hand side so we jumped out the right-side door. "Stay close to the truck Nurse Woman," they yelled! The four fireman grabbed the hose, shovel, and watering cans and quickly start putting out the fire. They were all working so hard. I stood by the truck planning my escape route if the fire got too close! So much smoke! And man did it stink!!! A fireman yells over to me "Alissa how you doing?" Waving my hand back and forth in front of my face I said, "Can you hurry and put this fire out all this smoke stinks!!!" They all started laughing... We (meaning they) spent about 20 minutes out there fighting fire and then moved on about a mile down the road and did the same thing. After about an hour the entire freeway was completely out. We definitely saved the day!! Sounds as if someone was dragging a chain along the freeway and sparks caught the freeway on fire. The best part was when the man in his tie-dyed pajamas jumped the fence and started to help fight the fire! I could see his amazing pajama pants through all the smoke! We left the scene and began driving back to the station but soon got a loud horrible noise over the headphones (its this loud large honk that will send anyone off their seat). This means we get another call!!! WOOT WOOT. I am no longer the white cloud. Dispatch reports that there is a large fire in the Wells Fargo building in downtown Roanoke. I was completely nervous as this building is right next to my loft and it is the largest building in Roanoke. I was already thinking bad thoughts of a mass causality disaster from the fire. I quickly texted Mat and told him that the Wells Fargo was on fire!! He ran to the nearby bridge to watch. We were the first engine to arrive and on scene and again jumped out and went sprinting into the parking garage. The security guard motioned "over here over here." Of course I was expecting a large fire and flames pouring out the building! But in fact it was a rubber piece the size of an eraser smoking!! That's it!! I couldn't believe it!! Once again they spritzed it with the watering can and told the other 12 firetrucks that showed up everything is okay and the smoke is put out!! We leave the scene and start heading back to the station when Capt. Thompson and his little pick up truck stopped in the middle of the intersection and motions me into his truck. In the middle of the intersection I jump out of the large fire truck and go sprinting through traffic and jump into his truck. I was eating up all this excitement and didn't even shut the fire truck door! We take off going mach 20 through town again to a carbon monoxide leak in the lady's house. Turns out there was no rotten egg smell and everything was going to be okay!!! I think you have to have a good nose to be a firefighter. After a very quiet morning and incredibly amazing firefighting afternoon I got to go home! Can't believe I get paid to ride fast in the fire truck!!
Tuesday I was at a different station across town. It was the "white trash," part of town. Nothing exciting all day. Rode the ambulance to a lady who said she got bit by a dog but had no puncture or sign of a bite. Weird!! Another couple other calls that were about as exciting as the dog-bite.
Wednesday I went back to the fire station near our loft. It became feeling like home as I got to know everyone! Turns out Mat works with one and his boss is the cousin of another. They took extra good care of me!! I got to go grocery shopping in the ladder truck with the fireman (check and check off my bucket list) and then played on the firetruck the rest of the day. They took me to an empty parking lot to see how far the ladder can extend. There is no way I could climb strait into the air for 100feet. NO WAY. They wanted me to climb to the top and take a picture looking strait down. I got sweaty palms just thinking about it!! No way!! The ladder truck is soooo cool! The truck is 1.2 million dollars. Amazing!! Got to see the jaws of life and play with them (they are the only truck to carry them). They are 55 pounds. I couldn't hold it up too long! Got to see all the crazy tools to stabalize the car before they retrieve patients. All this stuff I had no idea went on in the field. I got to learn how to fill the firetruck up at the fire hydrant, and lots of other cool stuff that had nothing to do with ED, but was so cool! No crazy calls that day...but I had the opportunity to learn lots about the fire truck and what goes on in saving patients from fire, or car accidents. We got to go to false alarm fire in the ladder truck lights and sirens through town and once again this was amazing. The ladder truck actually moves through town better then the engine truck as they have one person who drives the back. This allows the truck to turn much sharper corners. For teaching me everything and putting up with me for so many hours I baked them a cake when we got back to fire station with homade frosting.
Friday was code after code after code day! This is whereI learned how hard it is to carry old people out of a very full house and still do CPR. They have a special device that does the CPR compressions for them. This devise works much better than the one we used to have at Deaconess and it was much smaller. I loved it. I supposedly saved an old man's life with Narcan (as the daughter and paramedic were screaming "you saved him you saved him")! And I got to go have lunch with the head Chief Fireman of Roanoke at Red Robin. His daughter is in nursing school so we had lots to talk about!!
This week I have been in the cardiac unit at Roanoke Memorial. It is just not the adrenaline rush of Lifeguard Helicopter or Firetruck and EMS. This has been a great learning opportunity to just concentrate on cardiac and EKGs (12 hours of EKG reading) but I was finding a lot of it way over my head. I think I feel like I learned a lot about EKG and feel I may be able to explain how to read them now. Not enough to compete with Danny though!! Once I understand what each lead is looking at on the heart it all started to make sense. I got to spend some time in the Cath Lab as well as watch a TEE. Don't think I could do this job everyday and their 13.5 hours shifts are way too long. But it was fun to concentrate on cardiac only for a week. Next week I get to go to ophthalmology and also on Thursday I get to pretend I am a patient at the PA school and have ulcerative collitis. I am going to be a drauma queen for sure!!!
I hope everyone is having a wonderful week!! I am continuing to learn lots not only about medicine but about healthcare in general. Mat is doing well with his job...spending some time at Regis Hair Salon, Motherhood Maternity, and Advanced Auto. His stories continue to crack me up. Mat and I are heading to Virginia Beach for the weekend! Hoping for warm weather so we can stick our feet in the sand! We miss you all! GO GONZAGA!!
On Monday morning I arrive at the fire station about 0.4 miles from our loft. I was following Capt. Thompson. His job is to jump in his pickup truck when there is a code or a large fire. Basically anything fun and exciting he goes. But he told me anytime bells and whistles went off I could jump in which ever truck was going. The station has a engine truck, ladder truck and ambulance. They all trade off between the trucks and ambulance meaning they are all EMS and fire trained. There was really nothing going on until about noon and they were all loving that I was there as I was supposedly the "white cloud." At noon the engine check light went off with the loud horn and whistle. The firemen truly keep their boots inside their pants outside the truck and have to be ready in the truck in 90 seconds. This means I had 90 seconds to get to the truck, open the door, jump in and buckle up. The door to the truck is so high, I actually have to jump to reach the handle. Thank goodness when I opened the door the stairs rolled out. And thank goodness I didn't have a miniskirt on as I would never have gotten in (don't worry I would have never worn a mini skirt to the fire station, just saying so high I did the splits getting in)!! I quickly strapped in and put my headset on. Off we go lights, sirens, and lots of honking! My heart was racing as we were flying through downtown weaving in and out of cars! I quickly identified stupid drivers, drivers who have their music too loud, and drivers who just don't pay any attention at all. My heart was racing!!! I was going to my first fire!!! I was worried about my role... do I get to hold the hose? Will I have to try to rescue people? Do I have to stay in the truck? We arrived in front of the library downtown. Everyone jumped out of the truck and so did I. My instict was to start sniffing...but I couldn't smell any smoke...where was the fire? We looked all around and found some construction workers putting water on some dirt, but they were only keeping the dust down. Finally, to my right was a small plant in the flowerpot smoking. Looked as if a cigarette was "still burning." They took this tiny water can and put it out. Basically peeing on it! All this hipe, fast firetruck, lights and siren, heart pounding and all we got to do was put out a ciagarette. I could not believe it. A man comes running out of the SS office to say he would have put the fire out but he can't leave his station or he will get fired. The fireman asked, "sir you just left your station." The man ran back. I knew that people call EMS for dumb stuff and they transport them. People come into the ED for dumb stuff...but a smoking plant? Really? No worries, another plant saved, it remains green today.
We all piled back into the truck and started heading away from saving the day and rescuing the plant!! But right before our eyes down the road was a large area of smoke coming from what looked like to be the freeway area. And this time I smelt smoke!!! Is this the real thing? The captain (the man who sits shotgun) called into dispatch and asked if it was a fire along the freeway. Dispatch responded back and said that there was a large three mile fire on the west side of the freeway. The captain shouted," we are on our way."!! And in a split second we were hauling ass down Jefferson Street lights and sirens quickly getting on the on-ramp for the freeway. I think I yelled out a little WOOT WOOT! Now flying in a helicopter does get my heart pounding and gives me a great adrenaline high. But I think going 60 mph in a firetruck might beat that!!! We arrived on first area where there was fire. The right side of the freeway was engulfed in smoke. Cars were flying by on the left hand side so we jumped out the right-side door. "Stay close to the truck Nurse Woman," they yelled! The four fireman grabbed the hose, shovel, and watering cans and quickly start putting out the fire. They were all working so hard. I stood by the truck planning my escape route if the fire got too close! So much smoke! And man did it stink!!! A fireman yells over to me "Alissa how you doing?" Waving my hand back and forth in front of my face I said, "Can you hurry and put this fire out all this smoke stinks!!!" They all started laughing... We (meaning they) spent about 20 minutes out there fighting fire and then moved on about a mile down the road and did the same thing. After about an hour the entire freeway was completely out. We definitely saved the day!! Sounds as if someone was dragging a chain along the freeway and sparks caught the freeway on fire. The best part was when the man in his tie-dyed pajamas jumped the fence and started to help fight the fire! I could see his amazing pajama pants through all the smoke! We left the scene and began driving back to the station but soon got a loud horrible noise over the headphones (its this loud large honk that will send anyone off their seat). This means we get another call!!! WOOT WOOT. I am no longer the white cloud. Dispatch reports that there is a large fire in the Wells Fargo building in downtown Roanoke. I was completely nervous as this building is right next to my loft and it is the largest building in Roanoke. I was already thinking bad thoughts of a mass causality disaster from the fire. I quickly texted Mat and told him that the Wells Fargo was on fire!! He ran to the nearby bridge to watch. We were the first engine to arrive and on scene and again jumped out and went sprinting into the parking garage. The security guard motioned "over here over here." Of course I was expecting a large fire and flames pouring out the building! But in fact it was a rubber piece the size of an eraser smoking!! That's it!! I couldn't believe it!! Once again they spritzed it with the watering can and told the other 12 firetrucks that showed up everything is okay and the smoke is put out!! We leave the scene and start heading back to the station when Capt. Thompson and his little pick up truck stopped in the middle of the intersection and motions me into his truck. In the middle of the intersection I jump out of the large fire truck and go sprinting through traffic and jump into his truck. I was eating up all this excitement and didn't even shut the fire truck door! We take off going mach 20 through town again to a carbon monoxide leak in the lady's house. Turns out there was no rotten egg smell and everything was going to be okay!!! I think you have to have a good nose to be a firefighter. After a very quiet morning and incredibly amazing firefighting afternoon I got to go home! Can't believe I get paid to ride fast in the fire truck!!
Tuesday I was at a different station across town. It was the "white trash," part of town. Nothing exciting all day. Rode the ambulance to a lady who said she got bit by a dog but had no puncture or sign of a bite. Weird!! Another couple other calls that were about as exciting as the dog-bite.
Wednesday I went back to the fire station near our loft. It became feeling like home as I got to know everyone! Turns out Mat works with one and his boss is the cousin of another. They took extra good care of me!! I got to go grocery shopping in the ladder truck with the fireman (check and check off my bucket list) and then played on the firetruck the rest of the day. They took me to an empty parking lot to see how far the ladder can extend. There is no way I could climb strait into the air for 100feet. NO WAY. They wanted me to climb to the top and take a picture looking strait down. I got sweaty palms just thinking about it!! No way!! The ladder truck is soooo cool! The truck is 1.2 million dollars. Amazing!! Got to see the jaws of life and play with them (they are the only truck to carry them). They are 55 pounds. I couldn't hold it up too long! Got to see all the crazy tools to stabalize the car before they retrieve patients. All this stuff I had no idea went on in the field. I got to learn how to fill the firetruck up at the fire hydrant, and lots of other cool stuff that had nothing to do with ED, but was so cool! No crazy calls that day...but I had the opportunity to learn lots about the fire truck and what goes on in saving patients from fire, or car accidents. We got to go to false alarm fire in the ladder truck lights and sirens through town and once again this was amazing. The ladder truck actually moves through town better then the engine truck as they have one person who drives the back. This allows the truck to turn much sharper corners. For teaching me everything and putting up with me for so many hours I baked them a cake when we got back to fire station with homade frosting.
Friday was code after code after code day! This is whereI learned how hard it is to carry old people out of a very full house and still do CPR. They have a special device that does the CPR compressions for them. This devise works much better than the one we used to have at Deaconess and it was much smaller. I loved it. I supposedly saved an old man's life with Narcan (as the daughter and paramedic were screaming "you saved him you saved him")! And I got to go have lunch with the head Chief Fireman of Roanoke at Red Robin. His daughter is in nursing school so we had lots to talk about!!
This week I have been in the cardiac unit at Roanoke Memorial. It is just not the adrenaline rush of Lifeguard Helicopter or Firetruck and EMS. This has been a great learning opportunity to just concentrate on cardiac and EKGs (12 hours of EKG reading) but I was finding a lot of it way over my head. I think I feel like I learned a lot about EKG and feel I may be able to explain how to read them now. Not enough to compete with Danny though!! Once I understand what each lead is looking at on the heart it all started to make sense. I got to spend some time in the Cath Lab as well as watch a TEE. Don't think I could do this job everyday and their 13.5 hours shifts are way too long. But it was fun to concentrate on cardiac only for a week. Next week I get to go to ophthalmology and also on Thursday I get to pretend I am a patient at the PA school and have ulcerative collitis. I am going to be a drauma queen for sure!!!
I hope everyone is having a wonderful week!! I am continuing to learn lots not only about medicine but about healthcare in general. Mat is doing well with his job...spending some time at Regis Hair Salon, Motherhood Maternity, and Advanced Auto. His stories continue to crack me up. Mat and I are heading to Virginia Beach for the weekend! Hoping for warm weather so we can stick our feet in the sand! We miss you all! GO GONZAGA!!
Monday, March 10, 2014
Kansas City Missouri to Cincinnati Ohio
We awoke to a beautiful Kansas City Missouri super sunny and bitterly cold. It was zero out. We stopped at latte land for a nice cold latte. Rule number one always ask for extra hot when you hear others asked for extra hot. We have been using our phones the entire way for the fastest and best route for each stop. I am always the navigator and today was no different. We headed on the on-ramp to approach the freeway when Siri asked us to cross 5 lanes of rush hour traffic "now" and take the exit 100 feet ahead! I laughed pretty hard as Mat was trying to make this impossible endeavor. Cars were storming us left and right. We only made it two lanes and gave up. We exited in a not so nice part of Kansas City. Probably should have stayed low in the car but after 30 min we made it out safe and alive. Thought this place had tornados... Why are these shacks still standing? We proceded on hwy 70 between Kansas City and St. Louis. Mat was so amazed of all the cops. Not 30 seconds later lights and sirens and we pulled over. The first time Mat has gotten pulled over and was actually going the speed limit. Tabs are updated, seat belts on, no phones in use. WTH? Why us? Well I rolled down my window in the 0 degree weather, barely. The tall officer said Mat gets too close to a semi before passing it. "3 second rule." Ya okay officer...(5 lanes of 9 am traffic, bumper to bumper and he was waiting too long to pass). "Sir I need you to go sit in my car, it's how we do things around here." So now Mat was sitting in a cop car ( he did inform me this was a first). The cop said where are you from... Wow you have made quite the drive...duh cop!! So I tried to get a picture of Mat in the car as that would look good for the family and good on a resume. But there was too much crap in the car that was in the way. Mat was back there for about 7 minutes while I was just blown away about what was going on. Does he get to come back! Is not passing a semi soon enough equal to jail time? Soon enough Mat returns shaking in his boots! I just started laughing!! He informed me we both don't have warrants from Washington, and that there are 1 million cameras in cop cars, and the guy had a dog too (good thing he wasn't wearing the same clothes he was wearing in Denver Colorado). So basically this guy saw WA plates and wanted to see what we were running from!! We continued on the highway for many hours. Today was a 9.4 5 Hour Dr. and it seemed even longer. The only thing that kept us awake where the funny signs once again. I saw a fireworks stand that was an outlet mall. Not sure I'd ever want to buy fireworks at any sort of outlet. We saw the world's biggest boot collection in about four different towns not sure they'll communicate that they have the world's biggest boot collection. We also saw the biggest Winchime and the biggest golf tee which mad mats day. Today was definitely the day of "the biggest." Mat finally let me drive. But he felt carsick and became very bored very quickly. But I did finish out quite a bit of a drive today. We saw the arches in St. Louis as well as as the NASCAR speedway, some cool horserace track it must be famous somehow, and bypassed Indianapolis! at 7 PM finally arrived at IKEA. We begin some shopping for a bed and a dresser. Because we have lots of room in this car, not! Our car is completely completely completely full! I think that Mat the semi driver has to stick his head out the window to pass now! Good thing Miley can curl up into a small snake. Went to bed after watching the State of the Union address now living on the east coast so we should be more politically involved! Off to bed! We just can't believe we only have one more day. Kind of sad. Pretty fun to see the country on the places we definitely want to go back to and the places we know we don't need to see again like the state of Kansas. It's hard to believe we've already crossed the state of Washington Idaho Montana Wyoming Colorado Kansas Missouri Illinois Indiana and Ohio. And seen lots of rest areas! Until tomorrow!!
Lifeguard days!!
Well this week was an absolutely amazing experience. I hope I can display in words how amazing it was. I'll do my best...here we go.
A little background. Lifeguard is Carilion Clinic's helicopter company. They have three stations in the area and take both pediatrics and adults. I am told that the other large hospitals on the east coast only have 2 helicopters including Duke, Wake Forest, UNC, and UVA so Carilion always has to "one up" them. The station I was at was at Smith Mountain Lake, about 45 minutes outside of Roanoke on a super windy back road that will make anyone car-sick. Lifeguard flies with one Nurse, a Paramedic, and a pilot. What a dream job. Okay scene is set. Back to the story.
I drove up early while watching the sun rise, only to find out it was too cloudy and 1 inch of snow was on its way. So they sent me home. Tuesday was a little more clear so I headed back up again. My first hour consisted of getting my helmet, my survival kit to placed in my jump suit, and learning how to survive a helicopter crash. I learned how to shut down the 10 switches in case of a crash and how to break out windows. I was just hoping I wound remember to breathe in case of a crash...there was know way I was going to find all the switches. We sat around for about 4 hours awaiting a call. Finally, at about noon we got a call. Now you don't get to know what call you are going for until you are in the helicopter and in the air. This way weather does not tempt you do make a bad call and go on a call that weather would make too dangerous. Pretty good plan. During the Virginia Tech Shooting they ran out to the helicopter but said they couldn't go as it was too windy. A few hours later they found out it was for the shooting and felt horrible but knowing that they would have flew in extremely bad weather. Anyways we took off, I was five-harnested in, helmet plugged in so I could hear the dispatch. "This is lifeguard we have 4 people aboard, no warnings no restrictions we are ready for the call." We were headed to a rurual hospital for a STEMI (acute heart attack) and taking them to RMH (Roanoke Memorial Hospital). Super easy, stable transfer. On the way back to the station the piloit did some tricks for me as he used to be an air-show pilot for the army. He made me scream in my microphone as we tipped strait up in the air and then strait down with all the bells and whistles going off. "Danger, Danger." I about had to change my pants. Super fun though. No calls for the rest of the day. I intubated every manican they had and learned some great techniques.
Day 3. We did not get a call till later in the day. I tried every thing to get a call. Ate lunch, started homework, people ran to the grocery store, ya da ya da. Finally the bells and whistles went off and we ran to helicopter, pushed it out of the garage, did the walk around, jumped in, helmets on, plugged in, strapped in. In about 5 minutes we were in the air. "Yes lifeguard you are going to an on scene trauma for a logging accident." WOOOOOOTTTTTTT WOOOOOTTTTT. I knew this was gonna be good. It was about a 30 minute helicopter ride and I was enjoying it once again as it was a beautiful sunny day. We could see for miles. On arrival we were to land in a cemetery. Now this was pretty funny as I have never seen so many flowers as the wind from the helicopter blew them all over the place. Wonder if they found which flowers went where. We could not land at the site as it was too swampy. So the ambulance was to bring him up from the site to us. We waited for a few minutes and they came. We were in po-dunk county where there are only volunteers. This was Lincoln 555 minus 10. But they were great. I opened the ambulance doors to find a man with his leg positioned near his ear and it wasn't moving. My exact words were "holy shit." Pulses of the foot were thankfully intact! Airway....clear and screaming. Sounded as if the butt end of the tree kicked out and hit him in the hip. That leg was not wear it belonged....and that was obvious. The nurse tried doing conscious sedation so we could try to reduce it but he started screaming immediately. We were afraid he would not fit in the helicopter. I thought my 500 square foot loft was small.....there is about 30 square feet in the helicopter. Well as reducing him was not going to happen we splinted his leg to his shoulders and took about 5 of us to get him in the helicopter. We gave him pain meds the entire way and I may or may not have started my first IV at 3,200 feet. Buuu YAAA. Now that was a great ride. I was super pumped and so was my adrenaline. Nothing like throwing you into a trauma and then add a little helicopter on top of it. Great time with lifeguard!!! And got some amazing pictures to go with!! Glad I got to have this experience. Might have to go spend more time with them. Found out this man's head of his femur was down by his sacrum and he fractured his acetabulum.
Thursday and Friday I took ATLS. A little background for that is that they only started letting NPs and PAs take the class 2 years ago. Trauma surgeons teach it and really are particular about the class. For every PA or NP in the class there must be 4 doctors. We learned chest tubes, surgical cricothyroidotomys, and central lines. I was a challenging class. The final consisted of "victims" who were moulaged.
Mat and I spent the weekend at Smith lake hiking around and letting Miley swim, and on Sunday went for a mountain bike ride up at Carven's Cove. Carven's Cove was truly amazing. Although you can't even stick a toe in, or let your dog in as it is against the rule. I have never heard of a lake where it is illegal to swim. Not because of the snakes and it is very clean water. Just because...hmmmm.
This week I am riding with the firetrucks....should be great stories to come.
A little background. Lifeguard is Carilion Clinic's helicopter company. They have three stations in the area and take both pediatrics and adults. I am told that the other large hospitals on the east coast only have 2 helicopters including Duke, Wake Forest, UNC, and UVA so Carilion always has to "one up" them. The station I was at was at Smith Mountain Lake, about 45 minutes outside of Roanoke on a super windy back road that will make anyone car-sick. Lifeguard flies with one Nurse, a Paramedic, and a pilot. What a dream job. Okay scene is set. Back to the story.
I drove up early while watching the sun rise, only to find out it was too cloudy and 1 inch of snow was on its way. So they sent me home. Tuesday was a little more clear so I headed back up again. My first hour consisted of getting my helmet, my survival kit to placed in my jump suit, and learning how to survive a helicopter crash. I learned how to shut down the 10 switches in case of a crash and how to break out windows. I was just hoping I wound remember to breathe in case of a crash...there was know way I was going to find all the switches. We sat around for about 4 hours awaiting a call. Finally, at about noon we got a call. Now you don't get to know what call you are going for until you are in the helicopter and in the air. This way weather does not tempt you do make a bad call and go on a call that weather would make too dangerous. Pretty good plan. During the Virginia Tech Shooting they ran out to the helicopter but said they couldn't go as it was too windy. A few hours later they found out it was for the shooting and felt horrible but knowing that they would have flew in extremely bad weather. Anyways we took off, I was five-harnested in, helmet plugged in so I could hear the dispatch. "This is lifeguard we have 4 people aboard, no warnings no restrictions we are ready for the call." We were headed to a rurual hospital for a STEMI (acute heart attack) and taking them to RMH (Roanoke Memorial Hospital). Super easy, stable transfer. On the way back to the station the piloit did some tricks for me as he used to be an air-show pilot for the army. He made me scream in my microphone as we tipped strait up in the air and then strait down with all the bells and whistles going off. "Danger, Danger." I about had to change my pants. Super fun though. No calls for the rest of the day. I intubated every manican they had and learned some great techniques.
Day 3. We did not get a call till later in the day. I tried every thing to get a call. Ate lunch, started homework, people ran to the grocery store, ya da ya da. Finally the bells and whistles went off and we ran to helicopter, pushed it out of the garage, did the walk around, jumped in, helmets on, plugged in, strapped in. In about 5 minutes we were in the air. "Yes lifeguard you are going to an on scene trauma for a logging accident." WOOOOOOTTTTTTT WOOOOOTTTTT. I knew this was gonna be good. It was about a 30 minute helicopter ride and I was enjoying it once again as it was a beautiful sunny day. We could see for miles. On arrival we were to land in a cemetery. Now this was pretty funny as I have never seen so many flowers as the wind from the helicopter blew them all over the place. Wonder if they found which flowers went where. We could not land at the site as it was too swampy. So the ambulance was to bring him up from the site to us. We waited for a few minutes and they came. We were in po-dunk county where there are only volunteers. This was Lincoln 555 minus 10. But they were great. I opened the ambulance doors to find a man with his leg positioned near his ear and it wasn't moving. My exact words were "holy shit." Pulses of the foot were thankfully intact! Airway....clear and screaming. Sounded as if the butt end of the tree kicked out and hit him in the hip. That leg was not wear it belonged....and that was obvious. The nurse tried doing conscious sedation so we could try to reduce it but he started screaming immediately. We were afraid he would not fit in the helicopter. I thought my 500 square foot loft was small.....there is about 30 square feet in the helicopter. Well as reducing him was not going to happen we splinted his leg to his shoulders and took about 5 of us to get him in the helicopter. We gave him pain meds the entire way and I may or may not have started my first IV at 3,200 feet. Buuu YAAA. Now that was a great ride. I was super pumped and so was my adrenaline. Nothing like throwing you into a trauma and then add a little helicopter on top of it. Great time with lifeguard!!! And got some amazing pictures to go with!! Glad I got to have this experience. Might have to go spend more time with them. Found out this man's head of his femur was down by his sacrum and he fractured his acetabulum.
Thursday and Friday I took ATLS. A little background for that is that they only started letting NPs and PAs take the class 2 years ago. Trauma surgeons teach it and really are particular about the class. For every PA or NP in the class there must be 4 doctors. We learned chest tubes, surgical cricothyroidotomys, and central lines. I was a challenging class. The final consisted of "victims" who were moulaged.
Mat and I spent the weekend at Smith lake hiking around and letting Miley swim, and on Sunday went for a mountain bike ride up at Carven's Cove. Carven's Cove was truly amazing. Although you can't even stick a toe in, or let your dog in as it is against the rule. I have never heard of a lake where it is illegal to swim. Not because of the snakes and it is very clean water. Just because...hmmmm.
This week I am riding with the firetrucks....should be great stories to come.
Thursday, February 27, 2014
Month 1...Completed!
Mat started his job last Monday. Every Monday morning he has a safety meeting where they get to learn "all about safety." He learned how to walk on ice. Now you may laugh at this as this is an easy thing for Western folk...but I truly believe this was an appropriate learning point for the southerners. You should see them walk on ice...no joke. Mat told me "you slide your feet not pick them up." I would like to tell Roanoke folks "you won't fall through the ice on the concrete, and pick up the pace." He is enjoying his job...as it is not the same as working for Darrell and now he actually has to talk to people. He has "real great" people to work with (I say that with a southern accent) and gets his own van. I call it his molester van, but it truly is nice. He came home on the first day and said "Alissa I couldn't understand the electricians." Now we have heard rumor that some of the accents from down deep in Virginia are so thick you need a translator. We didn't believe it. Mat has confirmed this is true. He met some nice meth head while working at cash and carry, got to save K-mart from a leaky roof, and even spent some time at Motherhood Maternity replacing ceiling tiles. He gets a list in the morning of work orders and then heads out to complete them. They are really liking him as he is fixing things the right away and giving them suggestions on what truly needs to be fixed. Mat thinks he lucked out on getting this job, but I truly think this company lucked out on getting him.
It's so funny that I come home and say "you have to hear about my day" and Mat says "wait till you hear about mine." It's fun sharing our daily stories.
I have been packing my head full of information from lectures for the last two weeks. Between how to calculate anion-gap (so over my head) to reading EKGs (getting better), Chest X-rays (good here), how to deal with penetrating chest wounds, to how to call CPS. Woowh! Every hour each day is a new speaker, new topic. Kind of overwhelming but I am sure it is all important. We spent 8 hours the other day learning how to do a FAST exam. I was just excited to know what FAST finally stood for...Focused Assessment with Sonography for Trauma. The black and white image looks a little bit more clear now knowing what I am looking at. We also learned how to place lines with ultrasound (way easier then I thought). Everyone looks with everything with bedside ultrasound. I am just pumped when I find a kidney. I spend two weeks in a ultrasound rotation this summer. Thank goodness. Instead of telling you about terrible lectures and good ones I just am going to sum up what I took away the last two weeks. Hear we go.
1) Never, ever, for any reason call a seurgon at 2am and tell him a story of why the patient came in. All he wants to know is the diagnosis and why the patient needs surgery (this was a 1 hour lecture).
2) Never soak a wound in iodione or hibacleanse as the risk for infection greatly increases. Lots of tap water or NS flowing over the wound is best.
3) Never order a D-dimer if you suspect this patient has a PE.
4)CK-CKMB are worthless in diagnosis of Acute Coronary Syndrome or MI. Don't order!
5) Camo is Virginia's State Color
6) If a patient has a high lactate they are septic.
7) Some super sweet splint techniques.
8) The presenter can launch his presentation to your Ipad while he is lecturing and have you participate in question/response.
I got to travel to Christensburg to do a 3 hour shift of shadowing at another Carilion Hospital called NRV. The lobby has waterfalls and the cafeteria has a spiral staircase. Shadowed a PA who saw 3 patients. Not too exciting. Followed a Peds ED MD on monday for 4 hours at Carilion in Roanoke. That was super fun and we saw a lot of sick kids (actually sick). I wish I could describe to all of you how big this ED is. Lets just say it may take a few months before I know my way around. While I was there on monday they were holding 33 to be admitted the next day and it was only 6pm. I thought 7 was bad!!! It was a super busy completely crazy ED...I so wanted to jump in and get my hands dirty.
Miley has been chewing off her fir, so I finally ran her to the vet to find out she has some stressed induced parasite infection that is plugging her hair follicles and making her hair fall out. I guess moving her across the country caused this. So now she is on a parasite fighting medication for the next 28 days!! Poor thing. Otherwise she is doing well and thinks its great fun that we have to go outside with her every time she needs to go pee.
All and all we have been having fun. We have been trying to go for a run each day and enjoy this downtown experience by walking to dinner on the weekends. We had an amazing burger where the crispy cream doughnut was the bun. Best thing ever. Picture to follow. Still looking for a new place to call "church" as the cinnamon rolls down here just aren't nearly as good. Hope all is well with all of you. Had the best time face-timing with the Deaconess gals last week. We miss you all and plan to have better stories after next week. Wish me luck on my helicopter rides. I start monday!!
Friday, February 14, 2014
3 Weeks Already!!
I apologize for not updating you earlier in the week but computer training is very boring. Mat's mom and grandma B came on Friday from North Carolina as they were there on vacation/work. Grandma B had a great opportunity to go to Dale Jarretts hall of fame party and Trudi has clients she was visiting in NC. What an honor to be able to go to Jarretts private party.
We went out to dinner at a really fun burger place just down the street. This has ornate burgers including fried bologna with coleslaw on your burger. And the best part is we are able to walk. Grandma B and Trudi stayed at the Roanoke hotel. This is the oldest building in Roanoke and it is beautiful. It is only a bridge and a block away. We didn't think 500 ft.² could hold four people and one dog but later we find out it truly does. It was really nice to see familiar faces! We didn't know how much we truly missed faces we knew. We had a blast with them exploring Roanoke on the roads and through the restaurants. Lots of great meals and good laughs. I even got to treat my first patient (grandma B) as she slid into home plate on the sidewalk. Hope the steri-strips provide minimal scarring! On sunday they were suppose to fly out but due to mechanical problems they were able to stay with us one more night. And yes...we all fit in 500 square feet.
Monday was Epic training again. This is a very smart and fantastic computer program that is suppose to make charting easy. In the ED, they have "scribes" who are real humans who's job is to do the charting for the practitioners. I guess this helps you get your charting done much faster. Tuesday was lecture from 8-5...whoowh hadn't done that in a while. We first met with 2 ED nurses who gave us the "lay of the land." They warned us to be nice to nurses as they can throw us under the bus or help us out. I truly feel they scared the other two fellows. Later I found out we get to spend 2 days learning what ED nurses do. Hahahah! My program director said, "Alissa I know you were and ED nurse but it may give you a different perspective." I said, "yeah I will show them the Alissa-way to do everything." He said, "Oh God." As he knows no ED nurse likes to be told how or what to do and I will be the first one to tell you that. The ED has a 2 or 3 patient per nurse ratio pod in groups of 3 pods. Each group has a paramedic and a tech. And yes...techs can transfer telemetry patients to the floor. This is mind-blowing....not all EDs have 4 patient pods. The paramedics do all neuro checks, IVs, and triages. Nurses pass meds and do assessments. Seems pretty organized. Following the nurses lecture we had 8 other doctors come and give lectures. It was great and you learn so much from their great cases. A pediatrician told us about last month how she had a "not acting right" two month old with mild abdominal tenderness. Turned out she had and ovarian torsion. WOW! Never would have put that on my differential for a 2-month old. We learned what to say to patients, how to be nice, all being important in not getting sued.
Wednesday I was sent home early in preparation for the storm. Mat read in the newspaper that it was crucial to go get our eggs, milk, and bread. So we did this at 1 PM on Wednesday just to follow suit. We thought this was some crazy idea and the snow wasn't going to scare us. By 5 PM that day almost all grocery stores in Roanoke Virginia where out of milk and bread. I can now say you know you live in the south when they announce overhead "y'all come and get your meat now down here." Couldn't have heard anything funnier. That night we got about 11 inches of snow. I got a call from my fellowship director that I do not have to come in on Thursday due to this devastating snowstorm. Mat and I took a walk around town on Wednesday evening and everything was shut down. We enjoyed watching the man ride his moped in a few inches of snow down the street. Guess he didn't see the warning for the last three days that there was going to be this devastating snow storm. Nothing was open downtown and a busy street was now bare. Southern folks truly take this white stuff seriously. Thursday we got 8 inches for a grand total of 19 inches before 3pm and another call that I did not have to come in on friday due to this large amount of snow. 5 day weekend here we come!!! Thursday night Mat and I really didn't have much good food for dinner and all grocery stores were still closed. So we went to a local burger joint downtown that was jam packed with everyone else who didn't go to the grocery store. The burgers are crazy. I had nachos in-between my burger. Amazing!
So basically to end all Mat and I have been locked up in 500 square feet for the last 3 days. I think it is more like 400 square feet now. Things just started opening up today as people started to un-bury their cars. I do have to admit this is an unbelievable amount of snow for this area whom is not equipped to handle it. We have enjoyed walking around the piles in town wishing we would have packed some sleds, or even some boots!
Hope y'all have a great weekend. Some fun pictures to follow.
We went out to dinner at a really fun burger place just down the street. This has ornate burgers including fried bologna with coleslaw on your burger. And the best part is we are able to walk. Grandma B and Trudi stayed at the Roanoke hotel. This is the oldest building in Roanoke and it is beautiful. It is only a bridge and a block away. We didn't think 500 ft.² could hold four people and one dog but later we find out it truly does. It was really nice to see familiar faces! We didn't know how much we truly missed faces we knew. We had a blast with them exploring Roanoke on the roads and through the restaurants. Lots of great meals and good laughs. I even got to treat my first patient (grandma B) as she slid into home plate on the sidewalk. Hope the steri-strips provide minimal scarring! On sunday they were suppose to fly out but due to mechanical problems they were able to stay with us one more night. And yes...we all fit in 500 square feet.
Monday was Epic training again. This is a very smart and fantastic computer program that is suppose to make charting easy. In the ED, they have "scribes" who are real humans who's job is to do the charting for the practitioners. I guess this helps you get your charting done much faster. Tuesday was lecture from 8-5...whoowh hadn't done that in a while. We first met with 2 ED nurses who gave us the "lay of the land." They warned us to be nice to nurses as they can throw us under the bus or help us out. I truly feel they scared the other two fellows. Later I found out we get to spend 2 days learning what ED nurses do. Hahahah! My program director said, "Alissa I know you were and ED nurse but it may give you a different perspective." I said, "yeah I will show them the Alissa-way to do everything." He said, "Oh God." As he knows no ED nurse likes to be told how or what to do and I will be the first one to tell you that. The ED has a 2 or 3 patient per nurse ratio pod in groups of 3 pods. Each group has a paramedic and a tech. And yes...techs can transfer telemetry patients to the floor. This is mind-blowing....not all EDs have 4 patient pods. The paramedics do all neuro checks, IVs, and triages. Nurses pass meds and do assessments. Seems pretty organized. Following the nurses lecture we had 8 other doctors come and give lectures. It was great and you learn so much from their great cases. A pediatrician told us about last month how she had a "not acting right" two month old with mild abdominal tenderness. Turned out she had and ovarian torsion. WOW! Never would have put that on my differential for a 2-month old. We learned what to say to patients, how to be nice, all being important in not getting sued.
Wednesday I was sent home early in preparation for the storm. Mat read in the newspaper that it was crucial to go get our eggs, milk, and bread. So we did this at 1 PM on Wednesday just to follow suit. We thought this was some crazy idea and the snow wasn't going to scare us. By 5 PM that day almost all grocery stores in Roanoke Virginia where out of milk and bread. I can now say you know you live in the south when they announce overhead "y'all come and get your meat now down here." Couldn't have heard anything funnier. That night we got about 11 inches of snow. I got a call from my fellowship director that I do not have to come in on Thursday due to this devastating snowstorm. Mat and I took a walk around town on Wednesday evening and everything was shut down. We enjoyed watching the man ride his moped in a few inches of snow down the street. Guess he didn't see the warning for the last three days that there was going to be this devastating snow storm. Nothing was open downtown and a busy street was now bare. Southern folks truly take this white stuff seriously. Thursday we got 8 inches for a grand total of 19 inches before 3pm and another call that I did not have to come in on friday due to this large amount of snow. 5 day weekend here we come!!! Thursday night Mat and I really didn't have much good food for dinner and all grocery stores were still closed. So we went to a local burger joint downtown that was jam packed with everyone else who didn't go to the grocery store. The burgers are crazy. I had nachos in-between my burger. Amazing!
So basically to end all Mat and I have been locked up in 500 square feet for the last 3 days. I think it is more like 400 square feet now. Things just started opening up today as people started to un-bury their cars. I do have to admit this is an unbelievable amount of snow for this area whom is not equipped to handle it. We have enjoyed walking around the piles in town wishing we would have packed some sleds, or even some boots!
Hope y'all have a great weekend. Some fun pictures to follow.
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