Tuesday, January 29, 2013


           It's not that I don't enjoy my current place of work, but it can sometimes become predictable.  And I feel myself losing all of that ICU knowledge.  The skills I'm not really worried about, placing an IV, drawing an ABG, catheterizing, wound dressing, all of those things are motor skills and can be easily relearned.  But all of that critical thinking knowledge...I'm starting to feel it slowly ebbing away.  It's like when I stopped dancing.  I can still show you the moves, but the names of those moves I can't always remember.  And the sad thing is, it's something I did for years and years.  It's the same with working in the ICU.  I did that for years and years, and now just one measly year has gone by and I find myself wondering how much I remember. 
            Last night I couldn't sleep and started thinking about all the things I used to know...it went something like this: Okay, cerebral perfusion pressure is measured by subtracting the intercranial pressure from the mean arterial pressure.  The normal number for a CPP is 70-100mmHg.  It's an indication of how much blood flow is actually getting into the brain.  So the intercranial pressure may look great, but if the mean arterial pressure is really low then the brain isn't getting very much perfusion.  Brain perfusion is pretty important...yes, I think I remember that much.
            It's almost like that book "Flowers for Algernon" by Daniel Keyes.  He went from cognitively impaired to a genius and back again.  That is a perfect example of the flux I find myself in now.  At first, in nursing school, I most definitely felt cognitively impaired.  You put the what in the where now?  Um, how many chest compressions should I be doing?  What is the point of elevating the head with no hip flexion when trying to lower ICPs?  Is that atrial tachycardia or fibrillation?  What do those things even mean anyway?  I went from drowning, to treading water, to swimming with the best of them, to being a swim instructor.  Except as a nurse.  Because I don't know anything about swimming for real.  Just trying to fit in as many analogies as possible.  But since leaving the arena of critical care, just like Algernon, I'm losing a part of myself as the knowledge slowly departs. 

Tuesday, January 22, 2013

My Soapbox

       I like my movies fluffy, happy things.  A little drama, sure, but for the most part I don't want any semblance of real life butting in.  Except for one teensy tinesy little thing. The one thing I can't handle in movies?  Improper cardio pulmonary resuscitation technique.  Drives me batty every time.  Like it or not, the masses are informed about the world by media.  The media owes it to the masses to show how CPR should be done.  Go ahead and get everything else wrong (like putting someone in an induced coma without any ventilator support) but CPR is a layman's tool and must be shown correctly.  For instance, beating on someone's chest and saying "don't die on me man! don't die!" is not an effective means of revival.  Yet it seems to work every time on television!  This "precordial thump" used to be taught in CPR classes, but has since been rescinded because of its ineffectiveness.  In fact, it has never worked.  So the American Heart Association has removed it as an option in CPR.
         Then there is the ratio of compressions to breaths.  The newest regulations actually state that if you see someone collapse, just do compressions 100 per minute without breaths, because there should be enough oxygen circulating in their system.  And brain perfusion is what it's all about.  So if you keep with compressions, the blood pressure stays elevated and thusly blood is able to make it to the brain.  Pausing for breaths causes a decline in the overall blood pressure, and for each stop to give a breath a subsequent drop in pressure happens.  However, this is a relatively new guideline, so I can understand tv hasn't caught up just yet.  But the 5 sloooow compressions to 1 breath ratio? ANCIENT HISTORY for several decades, yet I just watched a medical show perform such worthless CPR in a HOSPITAL of all places.  Who are their medical advisers?  Retired hospital janitors from the '60s?  Honestly.  I volunteer myself for hire, for mere pennies, just so this travesty will no longer be purported among the innocent masses.  If someone starts doing CPR on me, ask them first where they learned.  If it's from a movie, just let me die, it will be just as effective.

Thursday, January 17, 2013

Like a good neighbor...

State Farm really is there! 
(Disclaimer: I am not in any way being paid to post nice sentiments about my insurance agency, let alone post any type of description of them positive or otherwise.)

I'm usually not one to laud the actions of any service I pay for.  I pay for coverage, so I expect coverage.  However, money doesn't make people nice to you.  I know that first hand from the medical field.  Cough...bedside manners ...cough..cough... doctors...cough.  Yet all contact with my inurance agents have been beyond amazing.  And unfortunately, I've had lots of contact with them over the years. 
For example, when a deer hit the car I was driving.  Yes, a deer came out of nowhere and rammed into the driver's side door.  I didn't even see it coming!  And the insurance agency believed me.  I even showed them the tufts of hair stuck in the door, and we all had a good laugh. 
Another time I locked my keys in the car while out of town.  I don't have a fancy smart phone that could find me a locksmith and the ancient book of yellowpages was nowhere to be found.  So I called my insurance office.  Not only did they find me a locksmith, but the cheapest one who was closest to my vicinity.   And then another deer, probably the same one coming to finish the job, ran into me again!  More tufts of deer hair!  More laughter!
  Most recently I was in an accident involving my absent-mindedness resulting in a side-swipe type run-in.  Without going into too many details, I gave the number of the person I may or may not have allegedly hit and Claims took care of it all.  They even had to call me a couple of times for some clarification about things which may or may not have transpired and then apologized that they even had to contact me!  I felt like their only customer.  It almost makes me want to get into another accident just so I can talk with them again.  And knowing me, it probably won't take very long.

Tuesday, January 01, 2013

Jewelry Project

        I make jewelry for fun.  I love going to old consignment shops and finding vintage brooches and chains and then repurposing them into something new.  I have managed to collect a great many variety of whatnots and do-dads for my jewelry making ventures and have now ended up with a craft table looking something like this:
pardon the blueness, I am a novice picture-taker and my white balance is wacko

 So I set out to make me something crafty that would magically organize my mess of potentiality.  The following are the steps I took in tutorial format.

First, you must find a big chunk of wood.  I am told this is a 2x4.  I found it in the garage, it was left-over from our kitchen remodel.  It's pretty beat-up, but I knew I wanted a rugged feeling.

wood from kitchen demolition, I think it used to be part of the old pantry
Next, sand that rugged wood down.  I just did a brief once over with a coarse sandpaper.  This sander was the very first power tool I've ever owned.  Isn't it cute?

Cute and ORANGE! 

Next, I found some decorative woodwork at the hardware store. 
So decorative!
 Whenever you adhere wood to wood, it is always wise to use wood glue as well as nails.  Knowledge courtesy of my husband.  They do know some useful things after all!
wood glue application, in case you couldn't visualize it yourselves
 Next come the nails.  They were teeny tiny, so I used a needle nosed pliers to hold them steady while using a small tack hammer to pound them in.  No squashed fingers that way!
Now my white balance is yellow-hued! Arg!

 And there it is, all glued and nailed!  Next you'll want to prime it.  I made the mistake of trying to spray paint first, but since the wood is so porous the spray paint was just absorbed right into it.  Which just goes to show, you shouldn't skip steps because it ultimately doesn't make anything go faster. 
Outside to be spray-painted.  Before priming.  And before our large snow-fall. 

I have never used spray paint before, but it can't be that difficult to figure out, right?  Point and spray.  Well, my first spray paint attempt ended up with me getting spray paint all over my hand.  It probably doesn't do this for most people, but the nozzle basically exploded on me.  And the paint BURNS, let me tell you.  But I also have skin with the temper of a two year old, so it could just be me.
Stubby hands, now covered in paint
 So then I read the directions, which say to wear gloves.  So I did!
"Two by two, hands of blue." 
You'd think the gloves would have protected me, but for some reason I just got more spray paint on myself.  But I decided to see the positive side of things. 
Smiley Face!
 After all the spraying drama here is a close-up of the finished product.  I used a metallic bronze paint.  You can't really tell in the picture, but it shimmers a little bit in the light. 

Shimmer love!
 After letting the board dry overnight, it was time for the big power tools. My husband showed me which ones to use, but I did it all by myself! Yes I will pat myself on the back, thankyouverymuch.  First I placed the knobs along the length of the the board to figure out the spacing.  I could have probably measured out the distance but I decided to just eyeball it.  And since we know I'm a pro at that, it was no big deal.  Then I marked where the holes should be and drilled them with a power drill.  I didn't get any pictures of that part because I was on a power tool kick and too excited to take any photos.

Then you need one of these things:
I don't know what it's called so I'll just refer to it as the gouger-outer.  You put the pointy part into the hole you just drilled, pull the trigger, and this beautiful gouge is made into the wood:
This is so you can hide the bolts that fasten the knobs into the wood.  This lets the wood lie flush against the wall.  You also need to use a hack saw to cut off the ends of the screws.
I marked where the screw should be cut, then put the screws in a clamp and sawed away. Make sure you clamp the screw at the exact place you mean to saw:
Riiiight here is where you should hold the screw in the clamp
If you clamp it waaaaaay down here while trying to saw at the top, like this:
 Down here is not where you should clamp the screw
This will happen:
RIP poor screw
Luckily this was my first attempt.  Learning from mistakes, that's me!  I was able to find another screw that was the right length and doesn't look too different from the others.  It just goes with that rugged look I was aiming for:
So all of the holes are drilled, the knobs are placed and the bolts are fastened.  Find the studs in your wall where you want to hang this piece of art because once all of those chains are hanging on it, it's going to be heeeavy.  Then pre-pound three nails into your piece.  Figure out the spacing of the nails by measuring the distance between studs and then using those measurements on the wood.  You'll need two people for this part to help hold the board up while you pound.  It's also a useful idea to place a level on top of the board while fastening it to the wall to make sure it's not off kilter.
And viola!  It's magic!  Look how beautifully organized everything is:

Vintage mirror I found on one of my forays
Before:                                                   After:

Now I just need to work on the mess underneath the table!