Assess not assault.

The picture below is of a 26 yo female. Second presentation over a week following poly-pharmacy and alcohol overdoses. Can you identify the cause if this traumatic injury? As part of our neurological assessment ( checking level of consciousness or calculating GCS for example) it may be necessary to elicit some form of noxious stimuli on our patients. These stimuli may be divided into two categories. Central and peripheral. It is important to remember that peripheral stimulation may illicit a reflex response, completely bypassing the brain and therefore not giving an accurate evaluation of cerebral function. So we should assess [continue reading this...]

Skill: assessing pupil response.

Most nurses working in critical care and acute care units carry neuro torches. We use them as part of our neurological examination and for ongoing ‘neuro obs’ to assess pupil response to light. But what are we really doing here? And how should we document it? Lets look a little closer at this particular skill. First up, the pupil isn’t actually anything at all. A hole at the centre of the iris that controls the amount of light entering the eye. The size of this hole is controlled by 2 muscles within the iris. The pupilloconstrictor (controlled by the parasympathetic [continue reading this...]

CPR: a skill we must improve.

We should really stop referring to CPR as basic life support. It is in fact essential life support. Often hospital accreditation of healthcare providers in CPR is seen as a box easily ticked off so staff can move on to more important things. Many staff are accredited annually with little opportunity to practice CPR and teamwork skills at any other time. Such a lackadaisical approach risks a wide range of standards and poor consistency between individuals, and studies seem to point to this currently being the case. As nurses we should not suck at CPR. The American Heart Association has [continue reading this...]

skin traction.

Skin traction is indicated for fractures or dislocations that require only a moderate amount of traction force for a relatively short period of time. The goals of effective skin traction are to: Prevent muscle spasm Immobilisation of the effected limb. Reduction of fracture. Skin traction must not be applied over an open wound. Take care with correct preparation of any superficial lacerations, incisional wounds or infections that will be covered by the skin traction or the bandage. Again this may lead to a decision that the traction is contra-indicated. If you are using adhesive traction tape check for potential allergies [continue reading this...]

palpating your patient's radial pulse.

To palpate a radial pulse, use the sensitive tips of your first three fingers over the expected radial pulse site. To be specific: at the wrist…lateral to the flexor carpi radialis tendon. You can use your other hand to support the patients wrist. Once it has been located, some nurses like to just use two fingers over the pulse. The pulse is felt as a pressure wave produced by ventricular ejection during systole. Interestingly this pressure wave travels down the artery much faster than the blood itself (5 metres/sec versus 40–50 centimetres/sec respectively). With increased age, or due to changes [continue reading this...]

Resource: ECG teacher.

ECG teacher is a website that contains a suite of excellent educational videos on ECG interpretation. Although some of the site requires a paid subscription to access (quizzes, revision notes, tips etc) the videos themselves are free. An excellent resource for nurses and other medical professionals wanting to get their heads around the normal and not so normal ECG. The electrocardiogram is one of the most important diagnostic tools in acute medicine. In this course, we use straightforward language and graphics to explain in simple terms how the normal ECG readout is generated and presented. We then go on to [continue reading this...]

Hair Tourniquet Syndrome.

    We recently had a young girl present after her parents could not settle her. During a thorough assessment by one of our nurses, the cause of the girls unhappiness was identified. A single human hair had wrapped itself tightly around her toe. The photo above shows the girls foot after a liberal application of hair removal cream which successfully dissolved the hair after 2 applications (over about 30 minutes). Hair Tourniquet syndrome: Hair Tourniquet syndrome is a relatively (although often unreported) common occurrence in the hospital setting. It requires high vigilance as it can quickly lead to ischaemia [continue reading this...]

when your patient arrests....CRAP yourself

For those nurses working on the wards or in non critical care areas, here is a short memory aid that I hope might be useful getting the wheels spinning until your Medical Emergency Team arrives. The important things are to Get help (I have put this second, but obviously ward alarms or a loud call for help should happen ASAP). Good quality chest compressions. Get this right and your patient has a better chance of survival. SO important. That is why I put it first. Often you see sloppy CPR being performed whilst the person performing them is trying to [continue reading this...]

killing the cardiac arrest mind donk.

OK, you have completed your Advanced Life Support (ALS) and Basic Life Support (BLS) education. Perhaps it was a few months back. Or perhaps you are due for a refresher. And then your patient arrests. When you least are expecting it. You immediately experience the arrest response mind donk. Your brain is  total beige…. and all your knowledge of the ALS algorithm seems to be folded up into an origami flapping bird that is migrating south to your sphincter. I am going to give you a rough thought-script to simplify the whole thing and get you over any mental donk [continue reading this...]

Critical Palliative Care.

Cure sometimes, treat often, comfort always. – Hippocrates. Any nurse who works in a critical care area, any nurse who has to deal with a dying patient and the family of a dying patient…..should watch this video. I would put it in the top 5 educational videos I have seen this year. But don’t watch it now. This is homework. Watch it tonight when you have time and space to give it your full attention. Critical Palliative Care is a 25 minute presentation given by Dr Ashley Shreves at this years EMCrit conference. EMCrit Conference 2013 – Ashley Shreves – [continue reading this...]

  • impactednurse.com will soon be gone. (3)
    • Zeke said: Are you keeping an archive of this site on the nurse path site?

    • jelly said: Just work a few more hundred Sundays!

    • matgrad said: Bye Ian will miss the site but as you say everything has its day. Good luck for the future.

  • Nurses are F*cking C*nts. Verbal abuse in our workplace. (32)
    • Rose said: I have read this article and found it very relevant to me and my own experience.Unfortunately a lot of people think that it is quite OK and acceptable to take out their anger and frustration against a sometimes inadequate health system on nursing staff. I also think that gender is an issue as I often feel that female nurses are...

  • Nominate Now: Social Media Nurse of the Year. (21)
    • Belynda Abbott said: I would like to nominate 3 amazing nurses that contribute to nursing and social media in many different ways: 1. The amazing Philip Darbyshire @PDarbyshire and http://www.philipdarbyshire.co m.au/index.php?option=com_easy blog&view=entry&id=44& amp;Itemid=13&utm_source=b uffer&utm_campaign=Buff...

  • When a patient leaves with cannula in-situ. (17)
    • Andy said: Good thinking! At my hospital the Oncology staff are trained/instructed to bleed CVADs before every use regardless, to remove potential clots, discard, flush, then use. Another excuse if you need it ;)

  • bully nurse. (40)
    • G Boucle said: This is not surprising at all to me! Nurses can and do bully patients, I was on the brunt of this after a surgery with spinal fusion on 5 segments! The pain was blinding, they bickered in front of me over who would change the cath bag on the floor already filled and looking about to burst, I found this extremely upsetting....

  • The art of bleeding. Art, insult…or just plain WTF? (6)
    • Contrarian said: I have seen at least one, maybe two live performances of the Art of Bleeding (they were performing at the periphery of other attention-immersive events). Of course the nurse-slut costume is a standard image, but they turn it on its head and dissect it. So, yes, as they say, while the nurse slut draws in the viewer, the viewer is...