Saturday, July 01, 2006

Random Musings

Gosh, it's nice to have my brain back.

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Buck's traction for a dwarf is not easy.

For those of you who don't know or don't remember, Buck's traction is a type of traction used for femur (thighbone) fractures. You get a one-size-fits-badly foam rubber boot with a metal bar across the bottom and velcro straps across the front, and once you put that on, you attach the traction ropes and weights.

Unfortunately, there are two problems when you're doing that for a person who's smaller and differently-shaped than the creators of the Buck's traction setup anticipated. First, dwarves' legs are shorter and usually a bit bowed. Second, they're short people. Traction depends on a straight run of rope to hold a fractured leg properly; if the person in traction is only about three feet tall, there's a lot of rope that can catch on the bed and in the sheets. Unless you put the person more than halfway down the bed, you're going to have Trouble, with a capital T, and that rhymes with M, and that means I had to be the MacGyver of Traction yesterday.

It works like this: grab the Buck's boot. Note that the metal stabilizer bar comes only halfway up the boot and then runs across the bottom. Good deal. Cut the top part of the boot away with a #11 scalpel. Now we have a shorter boot. Excellent. Grab two catheter leg-bag kits and scavenge the Velcro wraps out of them. Use those to help tighten the boot around the lower leg. Now you've got the boot on.

Remake the bed so that the bottom sheet lies flat and is held in place with a top sheet, folded lengthwise and tucked very tightly, so there are no wrinkles across the bottom third of the bed. Then fold another top sheet crosswise and lay it across the patient. This covers them without smothering them. Do the same with a blanket. One of the patient's feet will necessarily be outside the covers, but oh well.

Snag a fresh coil of traction rope. Measure twice, cut once. Set up traction. In order to keep things clear, use paper flags marked "TRACTION ROPE" to label the, you guessed it, traction rope as it goes down the length of empty bed. Adjust weight to be sure it's hanging freely.

Pat self on back. Collect accolades from co-workers, the patient in question, and the orthopedic surgeon. Eat a bar of chocolate.

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Somebody put a lock cap on a lumbar drain the other day. They disconnected the lumbar drain (which is supposed to be a sterile, closed setup) from the bag, locked off the drain with the cap from a syringe, and sent the patient out to have a smoke. This did not happen on the neuro unit, obviously.

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New squick I never thought about before: watching a doc put in a couple of really deep retention sutures, through skin and subcutaneous fat, with a curved needle and 2.0 vicryl. I felt a little queasy.

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Speaking of squick, this is probably the single most potentially-gross thing I've run across in a while...

I had a patient in a few weeks ago for a shunt. We use them when the pressure of fluid in the brain gets to be too high; the shunt pulls fluid off the brain and sends it into the abdominal cavity. Anyway, this guy had a shunt placed and came to me post-op. I knew he'd been in prison a couple of times and had had some close calls with regards to bullets.

One of his shoulders had a patch about the size of my palm. The skin was thickened and whitish, with what looked like embedded pieces of doveshot or gunpowder in it. The whole thing looked for all the world like Dick Cheney had taken a bead on him. I thought it was a gunshot scar. So, "Did you get shot here?" I asked.

"No," he replied, "That's a big ol' blackhead. Last time I was inside, my cellmate squeezed part of it, and something popped out and hit the wall of the cell."

I managed to warn him against doing that again, as sebaceous cysts like that are sterile as they are, but can get badly infected if you try to pop them. Then I got a wheelbarrow and took my jaw out of the room.

Eugh.

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9 comments:

DisappearingJohn said...

First of all, HEY I CAN COMMENT ON THE MOST RECENT POST!!!!!

Second, great work on the Buck's traction, although I still can't picture it, because every time I read it I get stuck on the "troube with a capital T, and that rhymes with M" part; cause, frankly, there ain't no part of that sentence that rhymes with M, and, after a long night like the one I had, things like that mess with me...

Actually, none of the things you mention as "squick-ers" do it to me. I can handle blood, pus, vomit, you name it... Everything but sputum... I just can't stand lung butter... I can handle suctioning trachs, because thats a closed system, and I don't have to look in the suction cannister. But ask me to collect a sample; EWWWW. I could never do respiratory...

Anonymous said...

*grin*

Creative problem solving at work. Much better than 'it can't be done.'

I have been reading for a bit now, and honestly, you're helping me with the state I'm in. I'm at the point where I know I have a problem, and I should do something to fix it, but there's this part of me that says I can deal with it alone and that I don't need anybody's help. That yeah, it's a problem, but it's not that serious.

It helps to read the words of somebody else that echo my own thoughts... about how when it comes on slowly you just adjust to things as being 'normal' and you never realise how whacked you've become.

Thank you.

Ms Geriatric said...

We, in Fruit and Nut Country, are reading your blogs. I may yet go to Nordies for MOB attire.

As for Anonymous, be aware that The Condition comes on and convinces you that it's Your Fault and you should Do Better.

If your first care provider sneers, then find another. It took over a half-century to realize that I can argue with The Doctors.

Anonymous said...

Why is it that I get drawn into reading blogs and later find out the writer is bipolar?
Here is another http://www.moronosphere.com/hiromi/
No nursing but seems to be going through the same kind of emotions. But why is that I 9not bipolar) like reading this kind of stuff. Anyway keep up the blogging

woolywoman said...

I'm dying to know. What happened to the guy's ICP? What happened to the neurosurgeon's ICP when s/he found out? What happened to the nurse's ICP- the one who capped it and let the guy smoke- although I suppose if they hadn't clamped it and he stood up, he could have herniated when his brain juice ran into the bag...geeze, and we need two nurses just to do the sample for daily C&S- one to sample, and one to tell on you if you break your sterile technique. I used your frog soup metaphor and got a coworker to refill her anti-D's. Are there any nurses that are NOT on them?

Jo said...

Anon, I have no clue why the blogs you read tend to be written by bipolar people. I'm sorry to disappoint you, though; I'm just depressed.

Wooly, the doctor was the one on stroke precautions. The patient was fine.

Tiesha said...

I love these posts! Nice job on the traction. I remember constantly pulling people back up all shift long, the boot getting twisted...This brought me back! Can't say I've ever dealt with it with such special circumstances though.

Kate said...

I bet you wish you'd been detached from the world just a little bit longer so you didn't have to comprehend that sebaceous cyst.

Was it ... still ... you know ... active? It wasn't a scar? ... No, maybe don't tell me.

Kim said...

Hey, I wonder if most nurses ARE on anti-depressants? Hmmm....

Any studies on what percentage of RNs are on antidepressants?

I'll suggest it as a research project should anyone be in need of a topic.

I know having to deal with depression has made me much more compassionate with those patients having anxiety or depression issues in the ER.

Been there, done that and have too many T shirts already....