Author

About the Author
I am an experienced trauma nurse who has seen a lot of super tragic and gnarly things. On the flip side, I’ve have seen and done a lot of amazing things in my 20 years of nursing as well. I’ve saved lives for a living and I have had the privilege and the honor of holding patients hands as they take their last breath. I have seen SO many patients and their loved ones in their most fragile moments. I am proud of my profession, and for the fact that I have fought so valiantly to be here. Sometimes nurses get burnt out, but I have been blessed to be at the bedside all of my career. I have earned multiple degrees and certifications in nursing. I am the nurse you want at your bedside when you’re critically injured and dying. I put my blood, sweat and tears into being clinically astute & relevant. This blog is to help new nurses, nursing students, paramedics, experienced nurses, or whomever comes across my blogs path and think it is intriguing, educational or inspiring to them. In this career, we are all here to share and help one another grow. I believe in building others up, so they can reach the next level, whatever their goal may be. Carpe Diem & ENJOY!

A Day in the Life

• @emergency__doctor Checkout my feature ‘A Day in the Life’ by @aoafordos !

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A DAY IN THE LIFE:

Max Lazarus, DO, PGY 2 (@emergency_doctor)

Emergency medicine resident at a Level 1 Trauma Center in New York and graduate of @nyitcomdo

I had a somewhat ‘non traditional’ path to medicine. I worked as a personal trainer full time throughout college while I majored in exercise physiology. My career as a trainer made me realize I wanted to help people, and heal them with more than just exercise so I decided to become a physician.

I was specifically attracted to the holistic education and emphasis on the human body from my time learning about health, wellness and exercise.

After finishing college, I was fortunate to be selected to do a summer internship called ‘Project Healthcare’ in the Emergency Department at Bellevue Hospital. The program was started by Dr. Lewis Goldfrank, a pioneer in emergency medicine and toxicology.

I spent the summer after college working 5-6 days a week there and fell in love with emergency medicine. I realized I wanted to be on the front lines of medicine helping the most destitute and acutely ill patients at anytime. Emergency medicine is thrilling to me because you are the doctor that’s ready for anything at anytime. #doctorsthatdo #emergencymedicine #pgy2 #osteopathicmedicine #baferd #jaferd

BCEN #instacrew #mywhy

www.instagram.com/p/B0PJ9orBPdl/

A long time ago, I was thrust into the preceptor role when we didn’t even have a preceptor “class”. Someone just said, “you like to teach, why don’t you take one of the new nurses and train her?” Of course, I agreed. That nurse that I taught has now been a certified flight RN #cfrn for over 15 years. 18 years ago, I decided to get my CEN #cen and that was my 1st certification exam. Today, I have taught numerous clinical rotations, paramedic interns, nursing students, residents, emergency nurses, trauma nurses and I am grateful that my certifications help to pave the way by showing my continued dedication to being a lifelong learner and nursing excellence. •

Follow BCEN certifications or anyone in the BCEN #instacrew (all members tagged in my pic) for more info about what being a certified RN means or how to prepare, sit for a certification exam 😃💯 #bcen #cen #tcrn #cpen #cfrn #ctrn #bcenmywhy #nurseeducator #traumamama #runswithscissors #showmeyourshears #emergencytraumamama

Lucas

www.instagram.com/p/B0TRCJYhGmZ/

• @the_resuscitationist .

AUTOMATIVE CPR MACHINES: to include “lucas” “autopulse” etc.

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BOTTOM LINE: these do NOT increase rates of survival and out of hospital discharge neurointact. .

POLARIZING statement I know… but this isn’t just an emotional based opinion. Multiple studies over the years (I can send them to you or a quick search) shows no increased survival when compared to manual (hands on chest) CPR. There’s added concern for the delay in compressions during placement.

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HOWEVER: there is added benefit for small pre-hospital crews that the use of these machine does keep crews more safe and “free’s up hands” to prevent task saturation. In the ER setting, I typically wont take the time to place one. They also cover the chest and make any needed chest procedures difficult (pericardiocentesis, chest tubes, central lines, needle decompressions etc)

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NOTE: cost roughly $15k per unit. If you’re system does not have these, do not think your CPR is inferior.

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MY MAIN POINT: quality CPR principles include early chest compressions and limited interruptions. Peds has a few subtleties, but keys below -Intubate while compressions take place. – hard and fast (100-120 bmp) -ribs will likely crack. This is normal.

-place patient on hard surface

– don’t hyperventilate. Even bystander compressions only without rescue breaths is acceptable – keep compressions after shocks given

– coronary perfusion pressure (CPP) is greatly impacted from above principles.

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QUALITY CPR SAVES LIVES.

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#cpr #heartattack #acls #bls #ems #paramedic #anesthesia #medicine #emergency #er #emergencymedicine #arrest #compressions #chest #pulse #medicine #medical #research #science #rn #medic #paramedic #nurse #crna #doctor #doc #discuss #hospital #education #teach #learn #help

Advanced Strangulation Training

Strangulation has been identified as one of the most lethal forms of domestic violence and sexual assault: unconsciousness may occur within seconds and death within minutes. When domestic violence perpetrators choke (strangle) their victims, not only is this felonious assault, but it may be an attempted homicide.


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Strangulation is an ultimate form of power and control where the batterer can demonstrate control over the victim’s next breath: it may have devastating psychological effects or a potentially fatal outcome.


Do you ever wonder what happens to the kids and teens that witness DV every year in America? Camp HOPE America offers camps sessions around the nation for kids who have witnessed domestic violence in the home and/or been negatively impacted by DV. This organization offers year-round camping and mentoring program for both children and teens. The focus of the camps are ingrained in creating collaborative, trauma-informed, and hope-centered pathways for trauma-exposed kids to believe in themselves, in others, and in their dreams.


#lastwarningshot #allianceforhopeinternational#caseygwinn #gaelstrack #drbillsmock#camphopeamerica #camphope #hopehealscamp#havehopetogivehope #strangulation #allianceforhope#domesticviolence #camphopeamerica#emergencytraumamama #runswithtraumashears

The Emergency Department Neuro Exam – Three YouTube Videos

The Emergency Department Neuro Exam – Three YouTube Videos

https://www.tomwademd.net/the-emergency-department-neuro-exam-three-youtube-videos/
— Read on www.tomwademd.net/the-emergency-department-neuro-exam-three-youtube-videos/

Strangulation of Adult & Pediatric Patients

As a trauma nurse that is cross-trained with a master of forensic science degree, I spend a lot of time thinking about recognition & assessment of strangulation patients. •

Strangulation and Domestic Violence

Strangulation has been identified as one of the most lethal forms of domestic violence. It is one of the best predictors for subsequent homicide. Prior strangulation increases the odds of strangulation homicide by more than seven times. For perpetrators, strangulation is the ultimate form of power and control. However, because there are often no visible injuries, patients, physicians, and law enforcement often minimize the possible health consequences of reported strangulation.

Pathophysiology

The vasculature of the neck is relatively unprotected and vulnerable to injury and vascular occlusion. The application of 4.4 pounds of pressure to the jugular veins causes venous outflow obstruction from the brain and thus stagnant hypoxia. Eleven pounds of pressure to the carotid arteries can cause loss of consciousness in approximately 10 seconds. Compression of the trachea requires significantly more force: 33 pounds of pressure for occlusion and 35 pounds to fracture tracheal cartilage.

Strangulation can be fatal in as little as four to five minutes. Mechanisms in addition to hypoxia due to vascular occlusion have been proposed. Pressure on the carotid body may cause bradycardia and subsequent cardiac arrest. Delayed mortality may be caused by carotid artery dissection, aspiration, postobstructive pulmonary edema, acute respiratory distress syndrome, or tracheal injury.

📓: ACEP Now, Heather V. Rozzi, MD, FACEP; and Ralph Riviello, MD, MS/April 2019