Thursday, July 6, 2017


I loved travel nursing. So, so much. It was everything I always wanted - fun, adventure, shiny new places, mountains and lakes and friends and road trips and sunshine and spontaneity. The single downside to that job was the lack of working trauma - in the smaller non-designation hospitals, we of course saw some walk in stuff; in the larger ones I was inevitably assigned to the non-trauma sections due to being temporary staff.

As such, I've lost a good amount of trauma skill.

Or to be more precise, I've lost a good amount of confidence in my trauma skills.

Recently I started orienting back into the trauma section of my current hospital, and it's been a rough start. I know what to do, I know how to do it, but it seems like the ability to adapt to the new protocols and new ways of doing things is a steeper curve than I expected and it's been a huge drag on my outward confidence.

I started my career in an absolutely fabulous trauma hospital. I was regularly assigned to the most critical of critical-care rooms, because I was great at it. I honestly don't mean to sound self absorbed, but I was truly good at managing those type of patients.

And now that I've been out of that constant trauma game for five (!) years, it's a different beast. The specific protocols, the phone numbers to call blood bank with, the organization of crucial trays and supplies within the's all different. I'm having trouble letting go of the old ways - why is it that I can remember the phone number to the CT read room of my home hospital, but can't retain the number to the page operator? Why can I remember the location of O2 Christmas trees and the precip tray and the luer locks in the supply room of a hospital I last worked in four years ago, but can't find things in the stock pyxis without using the lookup function? Why do I still recall the phone number of the local ambulance company but can't remember the damn zip code of my own current hospital? Why could I handle the grumpy surgeons at home hospital, but still feel on edge with the ones here? If I were dropped back into patient care at my old place I'd be running the show in five minutes flat, just like before I left.

I know how to take care of a trauma. It's all that routine, hospital-specific stuff that is killing me. And I inevitably feel like I'm a shitty critical care nurse when I can't quickly locate things or numbers or policies, and thus my confidence in the patient care side of it falters.

It's frustrating as hell.

I think I'm being harder on myself than I need to be, but I'm used to being the best and it's disheartening to not be that right now.

Wednesday, July 5, 2017

Eye can't handle this...

Forewarning: don't read this if you're grossed out by eyes. Or blood. Or blood clots. Eegh.


After very little thought, I've decided that this new thing I've seen has taken the top spot in the list of GROSSEST STUFF EVER.

I've seriously never been this squeamish before, not even holding traction on crunchy bones or dealing with avulsed fingernails.

The offending thing? Canthotomy. Or more specifically, a lateral canthotomy and cantholysis with both superior and inferior canthal tendons cut for emergency decompression after a retrobulbar hemorrhage during anaesthesia.

Let me put that into basic words, for any non-medical people out there: during the numbing of the nerves behind the eye for cataract surgery, something starts bleeding. That sudden influx of large amounts of blood behind the eye builds up and tries to squeeze the eyeball out of its socket, but pesky anatomy like eyelids and tendons are keeping it in place. The pressure inside the eyeball shoots up to 90 mmHg (normal is 10-21), so an emergency procedure called a canthotomy is done. This procedure consists of cutting the lower eyelid enough to see the tendon holding the eyeball in place, and THEN CUTTING THAT TENDON. If all that doesn't fix the pressure in the eyeball, then you cut the upper lid and tendon too.

Obviously this whole process is a bad outcome for supposedly minor eye surgery but as if that's not enough the patient will uncontrollably bleed because they're on blood thinners too, so they come on in to my ER. Where the doctor will have me take down the dressing to see what's up and I will gently remove said dressing until I reach the eyelid, in which case I'll have to stop because I'm not sure if what's attached to the dressing is clot or eyelid or eyeball and oh god it was so gross I'm getting squeamish just writing this.

I made the doc take over because NOPE. And also because I don't want to be responsible for accidentally pulling someones eye out of their skull. When she got all the dressing and clot out of the way, all you could see was tendon ends, floppy lid, and what theoretically was still an eyeball but pretty much just looked like a handful of red mush.

I'll be fine if I never see (heh) that again, thanks. Once was enough to place this very solidly in the top spot of grossest stuff ever.