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Tips: Blood Culture collection.

Mar 192013

The early detection and aggressive management of sepsis is vital in reducing morbidity and mortality, and the gold standard in detecting bacteraemia in our patients is the blood culture. Contamination of blood culture specimens or poor technique may lead to delay in optimum clinical decisions and management with inappropriate or unnecessary antibiotics. Not to mention wasted expenses. Blood culture bottles contain a soup of nutrients that feed a wide range of bacteria/fungi. Some bottles (including the BD BACTEC Plus media) also contain a resin to neutralise any antibiotics present in the patient’s blood in order to promote organism growth. When [continue reading this...]

things a nurse can do with a toilet-paper tube.

the funnybone. 5 Responses »

Mar 182013

things a nurse can do with a toilet-paper tube.

Nurses are renowned for being able to adapt, modify, fix and gerry-rig their clinical environment using whatever equipment or resources are available. Duct-tape may not hold the universe together, but countless rolls of medical tape pretty much hold the health system together. So in an exercise to get your mental juices flowing and to demonstrate our combined lateral thinking acumen, I am asking you to consider some uses for the humble cardboard toilet-roll tube in the clinical setting. get out a pad of paper and start brainstorming. If that sounds too much like homework, just sit the pad down beside [continue reading this...]

The Thunderbox Papers: Basic Drug Calculations.

the nurses desk: No Responses »

Mar 162013

The Thunderbox Papers: Basic Drug Calculations.

The Thunderbox Papers are a set of short pithy one page information sheets. The idea is that you stick one on your toilet door for one week and commit to learning the information during each visit. A Thunderbox refers to an old Australian ‘out-house’ or outside toilet. These toilets were often nothing more than a small drafty wooden shed containing a seat over a deep hole in the ground. Toilet paper consisted of old pages from newspapers or magazines threaded together with string and hung on a hook. I will post a Thunderbox Paper here every week or so. Stick [continue reading this...]

Note to Nurse day 2013. Help me get the message out.

the nurses desk: 1 Response »

Mar 152013

Note to Nurse day 2013. Help me get the message out.

Here is the first flyer to promote Note to Nurse day. I am asking you help me get the word out. If you have a blog: If you have a blog or website, please consider copying the following HTML code and pasting onto your site: <a href=”http://www.impactednurse.com/?p=5603″><img class=”alignnone” src=”http://www.impactednurse.com/pics5/N2Nsidebar.jpg” alt=”" width=”200″ height=”322;” /></a> This will give you a small picture of the poster (like the one in my sidebar) linking to this page. Everyone else: First, download the poster (as a pdf file) here. Then: Print it out and stick it up wherever you think it is needed (In colour [continue reading this...]

Critical Palliative Care.

clinical skills 1 Response »

Mar 152013

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...]

the Mississippi of airway management.

reflective practice. 10 Responses »

Mar 142013

I just have to tell you this story. I swear it is true. Last evening I was flying home from a Critical Care and Social Media conference in Sydney. I had settled into my window seat and was flipping through the flight magazine. It was a smaller prop aircraft and everyone was pretty much seated, the last few stragglers flopping into their seats. I love flying in these smaller planes as they cruise at a much lower altitude and you can enjoy the scenery passing by below. It was just on dusk so it promised to be a beautiful flight. [continue reading this...]

2 nurses providing critical care education.

the nurses desk: 1 Response »

Mar 132013

2 nurses providing critical care education.

I had the good fortune to meet two passionate nurse educators, Jessie Spurr and David Corkill at the Social Media and Critical Care Conference (SMACC) which ran over the last few days in Sydney. Injectable Orange: Jessie is a simulation educator and ICU nurse from Queensland who has recently started a nascent but promising blog: injectable orange. To give you some idea where Jessie is coming from, here is a snip from his first post. About two years ago, I began a relieving post that involved attending hospital governance meetings in an educator capacity. In the first meeting I attended [continue reading this...]

ETT security (part II): expert consensus.

clinical skills 1 Response »

Mar 052013

ETT security (part II): expert consensus.

Following my post on securing on how to secure an endotracheal tube (ETT) with tape, I a received a comment from Kaye Rolls a Clinical Nurse Consultant at the Intensive Care Coordination & Monitoring Unit. You can follow Kay on Twitter (@kaye_rolls). Turns out she is indeed an expert on the art (but perhaps not quite yet science) of ETT security. She is co-author of a set of guidelines published by NSW Health titled: Stabilisation of an Endotracheal Tube for the Adult Intensive Care Patient (pdf) The 3 methods currently used to stabilise an ETT are: Tying the ETT to [continue reading this...]

Schizophrenia, a tale from the inside.

ectopics No Responses »

Mar 022013

So, what is it like to have a psychotic episode? Elyn Saks is a she is a professor of law, psychology and psychiatry who speaks for the rights of mentally ill people, arguing for more autonomy and a restoration of basic human dignity in their care. In this TED talk, Elyn recounts her first episode of schizophrenia resulting in 5 months involuntary stay in a mental health ward. Reflections on her experience with physical restraints, her initial resistance to medication resulting in recurrent dips into psychosis, and finally her stabilisation, which she credits to three things: regular psychotherapy/psychoanalysis and good [continue reading this...]

Securing the Endo-tracheal Tube. One method.

tips and tricks 1 Response »

Mar 012013

Securing the Endo-tracheal Tube. One method.

There is more than one way to secure an Endo-tracheal Tube (ETT). These days the safest way will probably involve a commercially available device of which there are quite a few and most intensive care units are probably using one. But what if your units budget does not stretch to such luxuries? Or what if you just need a temporary way to secure the tube? Again there are many ways to do this, and everyone has their own particularity from white tape and a simple bow, to brown tape cut into ‘trouser-legs’ and secured around the lips (the brown tape [continue reading this...]

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mean arterial pressure. (29)
- James Senior said: Thank you, for a beautiful description of MAP…always love to use your material as a reference. James
- ofelia said: Never heard about MAP before today, I had been taking medication for high blood pressure for10 years, until I found a Dr. that told me that I could get rid of the pills with alternative medicine, been off the pills for three months now, and there are days that I worry about my readings, even though most of them are within normal...
New graduate nurses, do we need them….or not? (10)
- John said: It’s not a failure of leadership but a plan to destabilize our medical system and fully privatize it. No more medicare, user pays, just like in the U.S. Also an excuse to import foreigners, give them citizinship, then use there citizinship to increase Australia’s international debt borrowing. No, you won’t read that...
nurses fuck cancer. (3)
- Rachel said: I agree with you Fabbia. No matter how much we try to be good at educating our patients, at the end it is still up to the patient’s decision whether to follow what we have said or not. On our side, at least we know we have given whats the best for them. We can’t touch every patient’s lives always.
yes. I am going to write a book. (11)
- Brad Winter said: Nice work Ian! I hope you find your book writing mojo and get it published – it’s a new challenge and I think we all know you’re up for it. Good luck!
Nurses…show us your pouches! (10)
- Sarah said: I have a lot of pockets. A LOT. However I may be tempted over to the pouch side
killing the cardiac arrest mind donk. (3)
- Leigh said: Re: assembling the team. On the phone to reception “code (…ummm) RED in resus!!”…reception “do you mean code blue?” “YES!! that one”. Should have assembled self first. Thanks reception.
hardcore nursing revolution. (15)
- Leigh said: inspiring piece Ian! thanks. And Stephen, great summary too! “The amazing thing about us is, no information is too important for our concern; no job is too low to tackle ourselves. We are the proverbial jack of all practitioners.” love it

mean arterial pressure. (29)

New graduate nurses, do we need them….or not? (10)

nurses fuck cancer. (3)

yes. I am going to write a book. (11)

Nurses…show us your pouches! (10)

killing the cardiac arrest mind donk. (3)

hardcore nursing revolution. (15)