Did You Know You Can Pay Me for Things?

I am a Registered Nurse, have a Master of Public Health and experience in hospital floor nursing, outpatient nursing, public health nursing, and education. I am establishing a base of virtual offerings for anyone who is interested. Thanks for perusing my wares!

You can pay me for things like:

New Condition Education (Did you just get diagnosed with something the doctor didn't have time to explain well? I am happy to schedule a 1:1 videocall with you to help you better understand.) - Sliding Scale from $10-30/hr

Basic Health Education (Did the public school system screw you or your child over when it came to health ed? I can provide a basic (queer-friendly and non-fat-phobic) health education curriculum over 3 or more 1:1 videocalls.) - Sliding Scale from $10-30/hr

Nurse Troubleshooting (need some advice on setting up your living space so it is accessible for you? I would be happy to help via videocall if appropriate for the situation) - Sliding Scale from $10-30/hr

NCLEX Tutoring (Are you about to graduate nursing school in the USA? Feel like you need some extra help? I have been teaching medical and nursing students for the last 4 years and just finished a course on the new NCLEX, so if you're interested in some 1:1 help, hit me up!) - $20/hr

Historical Medicine and Nursing for Fiction (Are you writing something cool and historical that takes place less than 150 years ago? Need someone who has been quietly researching medical and nursing history for years and has a library of contemporaneous sources? I would be happy to schedule a 1:1 videocall to help!) - $30/hr

Contemporary Medicine and Nursing for Fiction (yes I know you can get it from this blog for free, but then you have to use the tumblr search feature and potentially wait a long time. A 1:1 videoconference would be much faster, don't you think?) - $30/hr

Medical Accuracy Review (did you write something you hope was medically accurate? Would you like someone to check it over and give advice to improve?)- $0.05/word for the portion reviewed

New! I also teach physical exam skills online. Great for if you missed them in nursing or medical school (I taught exam skills for 4 years to med students) or if you’re just interested as a lay person. I promise I am nicer than the last person who taught them to you!

Need something that's not on the list? Just ask!

Announcing MEDLEY: A Medical Primer for Writers (Summer Edition)

Are you a writer?

Do you need to know things about medicine for your fiction works?

Have you considered taking a 100% online class about it?

Starting Tuesday, June 4th and running for 9 weeks is MEDLEY.

Topics include:

WEEK 1: (US) Hospitals and the People Who Work in Them

WEEK 2: The Physical Exam

WEEK 3: Codes and ACLS

WEEK 4: Remote and Improvised Medicine 1

WEEK 5: Remote and Improvised Medicine 2

WEEK 6: Recovery and Aftermath

WEEK 7: Historical Medicine

WEEK 8: Mental Healthcare

WEEK 9: Bonus Episode

This is the second time I'm running this course so hopefully the kinks are nice and ironed out this time.

Price is $36 per person ($4/week).

Two scholarships are available no questions asked.

Contact me at consultingwhumper@gmail.com for more information/to sign up.

A spring I just found on my property! I’m going to try to make a mini spring house with it.

Goals

My wife and I are finally at a pretty stable point in our lives (after a year+ of things being pretty wild). So we're each making a list of goals based on the (original) NerdFitness* Goal Sheet. Here's mine:

Physical

Mental (interpreting this as mental health for myself as that is what will give me the most at this point in my life)

Work

Adventure

Courage

Freedom

Master (interpreting as "mastering a skill" instead of just a major goal)

Gratitude

Legacy

*Highly recommend if you want to do NerdFitness you use the Wayback Machine on Internet Archive to get you to somewhere in the 2014-2016 sweet spot of this being a non-commercialized site.

It's just not something they can determine initially.

The sedation and paralytics are given to prevent the person from shivering when the therapeutic hypothermia is initiated. Therapeutic hypothermia is usually only used for about 24 hours, after which the person is warmed back up to normal temps. At this time, every 24 hours or so the person undergoes a "sedation vacation" where the sedation is withdrawn to see if the person can wake up and breathe on their own. It would be during this time when an EEG or other determinations of brain death, like cold calorics, would be used.

The short answer is basically nothing and no.

Tachycardia is any heart rate above 100 in an adult. There are several different kinds of tachycardia, including sinus tachycardia, paroxysmal supraventricular tachycardia, atrial fibrillation with RVR, and ventricular tachycardia. Whether the tachycardia is bad for a person has to do with what kind of tachycardia it is, what the heart rate is, and how long the person is in that rhythm.

The first one we'll talk about is sinus tachycardia. Sinus tachycardia is a normal physiological response to the body's demand for more oxygen and nutrients. Sinus tach happens when someone has a fever, is dehydrated, has blood loss, is in shock, or is having a strong emotional response.

It's one of those things that doesn't need treated in and of itself, though figuring out and treating the cause is important. Once the cause is treated, the heart rate usually drops back down to normal.

There are also times when you intentionally bring the heart rate up above 100- for example, exercise. This is also considered sinus tachycardia. When you exercise, you want your heart rate to be in a target zone, which depending on age can be anywhere from 75-170bpm (the younger you are, the higher the target heart rate).

In the case of exercise, a heart rate of 140-160bpm for a half hour would be completely reasonable. In the case of dehydration or shock, you'd really need to fix the problem, but the heart rate itself isn't going to hurt anyone under about 60 who is otherwise healthy.

Paroxysmal Supraventricular Tachycardia (PSVT) is a condition in which the heart rate randomly increases into the high 100s-low 200s. This heart rate is so fast that the heart doesn't have time to fill with blood in between beats. Because of this, not as much blood is getting out of the heart to the brain and body, which means the person may feel faint, short of breath, or dizzy or even pass out.

People in PSVT may spontaneously convert back into a normal rhythm, or they may need a drug called adenosine given to change them back to a normal rhythm. Adenosine works kind of like a defibrillator- it briefly stops the heart in order to let it restart normally. If this happens frequently, someone may need an ablation- a procedure in which parts of the heart muscle that are causing the rapid heart rate are burned to permanently prevent future attacks.

In order to understand atrial fibrillation with RVR, you have to understand how the heart initiates beats normally. In the heart there are cells in a place called the SA pacemaker node, which send out small electrical signals that work to coordinate a beat across all the cells in the heart.

In atrial fibrillation, lots of cells outside this node try to initiate beats, which causes the top half of the heart to quiver. If a lot of these "beats" get through to the bottom of the heart, that's called Rapid Ventricular Response, or RVR. Afib RVR causes a rapid, irregular heart rate.

Afib RVR can cause the same problem as PSVT- namely that it causes the heart to beat so fast it can't refill with blood in between beats. Usually the first few times this happens the person converts out to a normal rhythm within about a week (or can be converted out with defibrillation or medications). Later this state can become permanent and has to be managed with medications that reduce the heart rate and blood thinners to prevent strokes and heart attacks, which happen because blood gets stuck and clots in the quivering upper part of the heart.

The last one, ventricular tachycardia, is the most dangerous because if not treated it can either become so fast virtually no blood is coming out of the heart (cardiac arrest) or become another dangerous rhythm called ventricular fibrillation (also cardiac arrest, but even worse).

This one is a life-threatening emergency and needs to be treated immediately with CPR (if the person is unconscious) defibrillation and medications.

This was a lot to answer your question, but all this to say that if your person is running 140s-160s because they're working out for a half hour, they're totally fine. If they're 140s-160s because of PSVT they're not fine but they're probably going to convert out of it with a medication or just time. If they're 140s-160s in RVR they're probably uncomfortable and need medical attention but they'll probably be alright. If they're in ventricular tachycardia, they need emergency care.

Of these, the only one that could really cause brain damage is the ventricular tachycardia, but it would have to be a lot faster than 140-160.

1: Any AED should work fine, even with the metal. We use AEDs on people with metal implants (pacemakers, orthopedic pins and screws, etc...) all the time so I imagine it wouldn't be much of a problem.

2: Generally if you can, you want to get the person out of standing water, get them under some kind of shelter from direct rain, and dry off at least the parts of their chest that would be in contact with the pads. But also the person's heart isn't beating so you have to weigh this against how long it's going to take to do these things.

Controversial opinion: I think we do a serious disservice to new nurses (and their patients!) when we teach them medicine for 3-4 years and then expect them to learn the nursing part on the job.

Nursing is a learned skill. No one is born with the knowledge to do nutrition management for a variety of illnesses. No one is born with the skill to build and maintain an environment conducive to healing while balancing the need to keep someone safe. No one is born with the skill to mediate family conflict or encourage a patient to talk through their problems. No one is born with the basic knowledge to hands-on manage a variety of complex illnesses, let alone the completely different skill of teaching the patient to do the same in a way that works for their needs and lifestyle.

And while I know they touch on these things in nursing school, they're hardly as much of a focus as they were 50 years ago. And I think that needs to change, even if we cut out some of the medicine.

Yes.

In fact, you're probably going to need at least the AED to get the heart beating again in a normal rhythm.

The epi is a weird one since most people don't carry it in the form necessary to work fast enough to make a difference in a cardiac arrest. Like, could you use an epi pen (or other auto-injector)? Maybe, but the dose in an adult epi pen is less than a third of the dose usually used in a cardiac arrest (0.3ml vs 1ml).

And epi pens deliver their dose into the muscle instead of into a vein, so it takes time to absorb. Even longer if the only circulation is CPR. You'd probably have to do CPR for at least 20-30 minutes before even some of the epi made it to the heart, making it all but useless.

I hear you then saying "but what if I discharged 3 epi pens straight into the heart Pulp Fiction style (or took an epi pen apart to get to the rest of the epi and injected it straight into the heart)?" Well, unfortunately, the needle is not long enough. It's only 16mm, and the average chest wall thickness is close to 40mm.

So TL;DR if your character doesn't have IV access and enough epi, I would probably just stick to the AED and CPR.

You're right in that this situation is extremely nuanced, especially when it comes to the fact that we are (as usual*) in a nursing shortage nation wide.

Staffing ratios only work when there are enough nurses to meet demand. A lot of times the goal of staffing ratios is to incentivize hospitals to hire more nurses, but if there are no nurses to hire that doesn't work. So you have to then consider alternatives, like you mentioned- either closing hospitals, or closing beds.

Consider, though, that if hospitals go the route of closing beds to maintain ratios, the acuity (care difficulty/complexity) of those patients the nurses are caring for goes up because lower acuity patients get triaged out.

The "sweet spot" of acuity to number of patients then relies on the number of nurses available to serve a population. That means that populations with a smaller number of nurses have either a higher number of patients per nurse, or a higher acuity patient load than a population with a relatively large number of nurses.

And pretty much everywhere right now, rural areas specifically, there are just too few nurses to make staffing ratios possible at scale.

So. How do you go about providing a high standard of care for patients when there are fundamentally too many patients and too few nurses? The system needs to change. I present a few possibilities below:

Bring LPNs back to the bedside in hospitals: While I don't mind Magnet as an entity and think they do some good things, IMO they royally screwed the pooch by mandating RNs (particularly BSN prepared RNs) only on hospital floors. You can make LPNs a lot faster and cheaper (10-18months, $20,000) than you can make RNs (3 years, $40,000), or BSN-RNs (4-5 years, $80,000). And while you still need an RN license to do things like push IV meds and interpret assessment findings, just about everything else can be done by an LPN. So we need to be using that resource to make more nurses fast.

Institute Team Nursing: You know how you use LPNs efficiently? It's not by giving them a group of patients and having them run around to find an RN every time they need to push an IV med. It's either by having them as a dedicated tasker (doing the time-consuming skilled tasks like wound care, catheter placement, IV placement, etc... for many RNs) or incorporating them into a team. With team nursing, you have an RN, an LPN, and an STNA/Tech all caring for 12-15 patients instead of an RN and an LPN caring for 5 each with a tech helping. The RN does the tasks only an RN can do (assessments, IV meds, plans of care) and communicates with the doctors, the LPN does most of the med pass and skilled tasks, and the STNA does the basic patient care. Since there's 3 people working together instead of separately, it's easier to find someone to help with 2-person tasks like boosting a patient in bed. You would not believe how much time this saves and how much more patient care can actually get done.

Institute Advance Practice Providers (or at least universal contact methods): I'm not saying we have a ton of these either, but you only need about one per floor. See, I can't tell you how much time I used to spend just trying to figure out who to contact about a problem, and how they wanted to be contacted. Because God forbid you text Doctor A instead of paging or page Doctor C instead of calling. Now I work on a floor with an APP and you can just go straight to them and they can either write the order you need themselves or contact the doc who can. Probably a good 15% of my time is back and I'm not even exaggerating.

Change culture around nursing duties: this is a controversial one, but as nurses are spread more thinly than ever and medical acuity has gotten so much higher, the basic care is genuinely getting worse. I have seen this happen over the last 8 years I've been in my job. So. Re-teach families how to care for loved ones in the hospital. Make it culture that if you have a family member in the hospital someone is with them. And when I say with them, I don't mean just visiting. I mean actively caring for the family member. Helping them to the bathroom, helping them dress and eat and clean themselves. Helping them do basics. Entertaining them, distracting them, comforting them. Things we used to be able to do when our patients weren't actively trying to die at all times.

*technically, we have been in a nursing shortage since WWII. But a lot of factors, COVID-19 specifically and a shortage of student slots in RN-level nursing schools, have made things particularly bad in recent years.

It's cold shock.

When your skin first hits very cold water you enter a temporary state called cold shock. This is not shock in the medical sense, nor is it the same as hypothermia. It's just a situation where you gasp uncontrollably, and heart rate and blood pressure go way, way up as a response to the skin suddenly getting very cold. It ends within a couple of minutes, but while it's happening, it greatly increases the oxygen demand of the heart muscle.

That means, if there are any blockages (clots, plaque) in the arteries supplying the heart muscle with blood, the arteries can't supply the necessary oxygen, and the heart muscle begins to die- a heart attack.