Welcome to the Emergency Room

It's scary how accurate this is

Ways to lose face (two lessons from the ER)

Make that, two ways to lose your face.

1. Do not taunt, prevoke, anger, or piss off a pit bull. I happen to be a huge fan of pit bulls. I love their sweet flat cow faces and the way that they seem to smile. But they can look like this (my favorite - the white ones that look a little pink):

or like this:

And can leave you looking like this if you rub them the wrong way:

Note: this is not a picture taken from Vanderbilt Emergency Room, but it's scary how uncanny the resemblance is to the patient I may or may not have seen the other day, who saw fit to get into it with a pittie. Just add an endotracheal tube and subtract a lot more nose.

Pittie: 1, Patient: 0.

2. Sledding is great fun. I have very fond memories of going to Great Grandma James' house and sledding down the great long hill onto the frozen lake every year on Christmas Day. Sledding should be done on hills that end in grass, a fence, or, like in Dousman, WI, a frozen lake. Sledding should look like this:

Your sledding route should not, however, end in the interstate. The most busy interstate of Nashville. I repeat: do not go sledding on the interstate. That is a terrific way to lose your face.

Take it from me - if you're stupid, you're bound to lose face in more ways than one.

First Aid 101 - You Got Burned

I've done it. You've done it. You've splashed boiling water, you've touched the brownie pan straight out of the oven, you fallen asleep in the lounge chair by the pool. We've all gotten burned. However, what now? Aloe isn't a fix-all, so what do you do? Since I don't want to go down the path of heat stroke and sun poisoning, I'm going to mostly leave sunburns out of this. We'll talk about that another time.
There are a lot of myths out there about burns (e.g. Don't you slather a burn with butter?) so here's the rundown.

Immediately....Stop the burning. Are you outside in the sun? Get in the shade or inside. Are you touching something hot? Stop touching it. Is there something hot on you (e.g. wax, spaghetti sauce, tar, etc.)? Cool it. Run a burn under cool water for 10 minutes minimum. When wax cools, it hardens and will easily come off. After it's cool and you can pick off the wax and then run the affected skin under cool water. (note: This does not mean ice water. cool water.) If you have tar on yourself, a) what are you doing with tar on yourself? and b) mayonnaise. Just like peanut butter is the key to getting gum out of your hair, mayo is the answer for taking tar off skin. It's true. Apparently we (we being Vanderbilt, not my family) used to keep a big tub of mayo in the trauma bays for precisely that reason. Fun fact.

While you're running your burn under cool water for 10 minutes minimum, assess the burn. There are four degrees of burns. A first degree burn involves only the epidermis - the top layers of skin. A first degree burn appears reddened and is tender. A mild to moderate sunburn is usually a first degree burn. Aloe should suffice.

A second degree burn involves the middle layer of skin called the dermis. Second degree burns usually manifest themselves as painful, superficial blisters. Ouch. Aloe should also do the trick here, although there are some really sweet "after burn" topical treatments with lidocaine in them that will cause some superficial numbing. You may want to try that as well.

Third degree burns involve the subcutaneous tissue. Nerves and muscle are damaged by the burn and usually appears charred (i.e. brown or black) in appearance. Yiggity. Go to the ER. The good news? Due to the damaged nerves, third degree burns can be predominantly painless. The bad news? Hair follicles are destroyed and wherever you got burned will now forever be bald. Mrr. Fourth degree burns are really bad news. Shocker, I know. Fourth degree burns, or full-thickness burns, are the deepest burns and involve not only skin and muscle tissue, but tendons and ligaments as well. Fourth degree burns are generally white and waxy in appearance. See the picture below - the middle of that burn is a fourth degree. The outer, brown edges are third degree. And the I'm not sure what the pink dotties are on the other leg - my best guess is that they're skin graft sites.

The biggest and baddest sequlae of a fourth degree burn is when the burn is completely circumferential and goes all the way around, say, a leg or arm. The stricture and consequent loss of blood supply to the extremity is called compartment syndrome and threatens the life of the limb and possibly of the person. The treatment involves something called a fasciotomy and you don't want that. You also don't want to see a picture of it either, so I didn't include it. If you're curious, Google Images will more than quench your thirst.Let's talk for a brief second about chemical burns. If they are minor, the treatment is dilution of the area with massive amounts of water. Best bet is to hop in the shower for a good 30 minutes or more. Don't try to "neutralize" an acid with a base or vice versa because you'll probably end up causing a not-so-awesome chemistry 101 experiment and your skin is not the place for that. That being said, any chemical burn is a legit reason to seek the professionals so you can feel justified in coming to the ER (or at least going to the doctor) if you've had any kind of chemical burn.

Whatever you do, don't....use ice. Cool water is not the same as cold water, ice water, or straight up ice. If you place ice straight on burnt skin it will cause further tissue damage.

Butter your bread, not your burns. Butter and oils actually retain heat and can prolong the burning. If you want to stick with old school remedies, use milk. Soaking a (first degree) burn in milk will soothe it. Slathering yourself in butter will only result in you more burned...and covered in butter. Insult to injury.

Don't pop your blisters. Burns love to get infected so don't mess with your blisters. This goes for blisters of all origin. Let them heal on their own.

Seek the professionals if....You've received an electrical burn. Even the smallest electrical burn is considered a third degree burn. Both entry and exit wounds are possible and can have deadly consequences.

If you've received a chemical burn and you are having trouble seeing, breathing, if you're dizzy or having chest pain. Come see us.

If your burn covers a portion of your body larger than a quarter (for a child) or a silver dollar (for an adult). If you were sunbathing naked for a little too long and now every inch of you is red and angry, sorry, but you're just going to be miserable for a few days and probably want to make best friends with a big bottle of aloe. If you have big festering blisters all over your back or beyond, come see us.

There's a way to measure the total surface area (TSA) of body burned called the Rule of Nines. Here's a picture:

So, if you've burned your entire right leg (front and back) you've burned 18% of your body. If the TSA number scares you, seek medical attention.

You can never be too careful when it comes to dealing with your burns. As mentioned previously, most any burns are a totally legitimate reason to seek medical attention. Always err on the side of caution with these puppies. And please please please wear sunscreen. Anything SPF 15 or greater will do.

Next time: Epistaxis: The fancy word for "nosebleed."

xoxo

Nurse Nerdy - a fine example

There are so many delightful things about this. Everyone knows about the overly-marketed "word" decorations. Life. Love. Dream. Believe. Family. Happy. To be fair, it's Christmastime and I've always loved the word "joy" and have considered buying that as a word decoration. (on a side note, I never did purchase said word decoration because I received an amazing homemade Christmas hanging quilt with the word "joy" on it courtesy of my fantastic Grandma MJ - Thank you!!)

However, instead of conforming to the masses, try something a little subtler. Something that requires a little more sophisication and a little more imagination. Like this:

At first glance one might say, "Well this is ugly. It's cold and modernist and silver and not at all my style." However (and this is a big however), one's opinion might change when they learn this is the serotonin molecule. That's right. The neurotransmitter. Of the approximately 40 million brain cells, most are influenced either directly or indirectly by serotonin. This includes brain cells related to mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and some social behavior. It's widely believed (although officially not proven, because apparently such studies cannot be performed on live brains) that a lack of serotonin can cause dysfunction in these areas and can lead to depression. It is also belived that an increase of serotonin (caused by selective serotonin reuptake inhibitors (SSRI's) like Paxil, Prozac, Celexa, etc.) can lift many symptoms of anxiety and depression. It's like a Happy word decoration without being a Happy word decoration! I love it!

And that, my friends, is nurse nerdy.

First Aid 101 - Eye Scream

Inspired by an article in Real Simple, I'd like to start a series of posts where I talk about common injuries/maladies that can happen to all of us. We've all been there. An accident happens and there's that moment of time where you freeze (bleeding finger and all) and think "Do I need to go to the hospital? What do I do?" I am going to set up these posts in three simple steps.

1. Immediately...

2. Whatever you do, dont....

3. See the professionals if....

And hopefully these are fun and helpful!

The obvious disclaimer has been said, but I will say it again for good measure. If you feel like you need to seek medical attention immediately please do so and if you are experiencing an emergency please call 911 or go to your nearest Emergency Room. I hear Baptist is very nice.

First Aid 101 #1: Eye Scream - It's all fun and games till someone gets it in the eye.

If you have eyelashes (and I'm betting you do), you've gotten something in your eye before. Here's what to do.

1. Immediately....irrigate irrigate irrigate! If it's an easily pluckable eyelash, feel free to pluck it out, but for the love of conjunctivitis, wash your hands first! With soap and water! Believe it or not, our hands (and especially our fingers and fingernails) are unbelieveably grubby, so before you snatch that eyelash out, wash your hands thoroughly.

If it's not an eyelash, but a splash of something that's not sterile saline or a mystery crumbly irritant, drop everything you are doing and irrigate. I don't care if you are checking out at Publix and you just got the new Harry Potter movie for free because it was rung up wrong and that's their policy (thanks Publix!), or if you are on a date and it took you an hour to get your make-up right! You can always put on new make-up, you can always blow your nose if water gets in it. What you can't do is unscratch your cornea. So irrigate. Take your contact out, if possible, lean your head under the nearest water source (whether that be a sink, a bottle of water - hopefully brand new and sans your backwash, or, preferrably, a bottle of sterile saline solution like what you soak your contacts in) and irrigate. See picture.

Do this for a long time. Many minutes. Especially if you've splashed a some kind of chemical in your eye. Like I said, you may get a little messy, but you must do this for the health of your eyeball.

2. Whatever you do don't... RUB YOUR EYE. I don't care if itches like crazy, you can't rub your eye. You will scratch your cornea, the outermost protective layer of your eye. Or you can shove whatever's into there into the conjuntiva where it'll be really hard to get out and it'll just sit there, driving you crazy.

Also by itching and therefore scratching (especially with grubby hands) you are just asking for an infection. Conjunctivas (pronounced con-JUNC-tiva, NOT con-junc-TIVA like so many people like to do here in the South) love to get infected and the eye drops for those are expensive so please, just irrigate and don't rub your eye.

3. See the professionals if....you splash a chemical (like Draino, bleach, etc.) in your eye, or you are working with chemicals and accidently touch your eye. Mild dish soap? You're okay. But anything that might be harsh or corrosive, start irrigating immediately while heading to the ER. You might need for it to be professionally irrigated/treated. Come into the ER immediately (and please have someone drive you as you clearly need your eyes to see where you are going) and we can help you. Also, if you have irrigated and still are experiencing unsubsided burning, swelling, or have vision changes, please come in and see us (pun intended). Also, if you have had an accident where somehow something has penetrated your eyeball LEAVE IT IN! Do not attempt to pluck it out. There is no plucking. We pluck, you don't pluck. Got it? Good. And, by the way, that goes for any kind of stab/puncture wound anywhere. Always always leave it in and have it professionally removed. You never know what artery the knife, PVC pipe, wristwatch (ahem, Harold Crick) is occluding so you don't bleed to death. Sure, there are not arteries in your eyeball big enough for you to exsanguinate, however you could end up doing more damage, so please listen to the Beatles and let it be.

Hope you enjoyed this first post! Coming up: You got burned!

Welcome to Lila, RN!

Hello friends! Some people refer to their occupations and say, "That's not who I am, it's just what I do." I, in fact, feel (and I imagine most nurses, teachers, doctors, etc.) the opposite. I feel that my job as an Emergency Room nurse is very self-defining. Caring for people in a thrilling and unpredictable environment is so right up my alley it's scary.

So I decided to start a new blog, filled with funny (non-HIPPA-violating) stories, medical advice that is in my scope to dish out, and other varieties of what my mother (also an RN) and I call "nurse nerdy," an adjective that describes things that nurses love more than, say, a lay person. For example, the first time I got to pack my first open wound with iodoform gauze instead of watching a doctor do it for the millionth time and how I squealed a tiny squeal and may or may not have even done a little girly clap when I was asked to do it. That's nurse nerdy.

My hope is that in addition to my posts, you readers may bring some questions to the table, which I would then love to answer, or research further and then answer.

The obvious disclaimer is that if you feel like you need to seek medical attention, please do so, and if you are experiencing an emergency, get off your computer and call 911. That out of the way, please enjoy!