You Got To Know When To Hold 'Em.....

Holy cow!

I never saw this in Microbiology!

Just a bunch of stressed out student nurses trying to cram in it into one summer session going five days a week for five hours a day.

Mr. Graham Positive here was nowhere in sight.

Then again, I took Micro so long ago that if he was in my class he'd be wearing Angel Flight pants, a silk shirt open to the lower sternum showing (hopefully) chest hair and gold chains, as he walked to his desk in platform shoes and feathered hair a la Barry Gibb.

I think I need a cold shower.

hhhhhhhhhhhhhhhhhh

Ah, it isn't often that I feel a "rant" coming on but there is something that I feel very strongly about.

Maybe it makes me a heartless nurse.

Perhaps it makes me a bad mother.

The issue?

I cannot stand it when conscious sedation is ordered for children who have a laceration.

I am old-school. I believe in wrapping them like a mummy, placing them in a papoose and holding them during the suturing. It's faster, the pain stops after the lidocaine injections and the child is then up and ready to go immediately.

For the uninitiated, "conscious sedation" is a term used when a patient needs an especially painful procedure done. An IV is placed and they are given medications that (1) reduce the pain (2) sedate the patient and (3) cause amnesia so the patient doesn't remember what the procedure was like when they wake up.

During the procedure the patient is placed on a cardiac monitor, oxygen, a respiratory therapist is present in case there are airway problems, reversal agents are kept at the bedside in case of emergency, and the patient has the IV as previously mentioned.

It is a wonderful way to get patients of any age through procedures like reducing shoulder dislocations or fractures or hip prosthesis dislocations.

It also ties up one nurse with one patient for however long it takes that patient to recover. The patient is never left alone. The drugs are short acting, but recovery can take as long as one hour for some patients, depending on how much medication they were given and how fast they metabolize it. Vital signs are taken every five minutes during the procedure and then every 10-15 minutes after until the patient is awake, able to tolerate clear fluids, have vital signs near pre-procedure levels and can ambulate.

Is this really necessary for a child with a one-half inch laceration on his forehead?

Ah, I hear the chorus now....

From the parents: "But it is so traumatic on my poor child to hold them down!"

They'll get over it. I not only remember getting stitched at the age of three I still have the scar!

It does not "scar"you psychologically for life. Getting stitches is a part of life. Are we raising a generation of wimps for whom a boo-boo is a life altering trauma?

From the ER docs: "It's hard to hit a moving target!"

Then your nurse doesn't know how to hold. I developed the (not-patented) chest hold many, many years ago where the child couldn't move his head if he tried. Let's just say that it involved removal of my scrub jacket and namebadge, leaning over the gurney, placing my chest on one side of the head and using my arm to surround the top of the child's head and holding it against my chest.

Works every time.

ddd

Just a couple of my personal beliefs.

• Every person getting conscious sedation, including kids, gets an IV whether or not the doc believes it is warranted. Emergency situations are rare, but that patient is my responsibility, too, and my derriere is on the line if we aren't prepared for them.

• If conscious sedation is ordered, I feel it is the doctor's responsibility to explain to the parents exactly what that entails, including oxygen, monitoring, IV medications, etc. Just telling the parents that the patient will sleep through the procedure is not enough. They shouldn't have to hear that from the nurse who is having them sign that they have received informed consent.

End of rant.

Now, to end on a positive note:

Emergency room physicians are second only to plastic surgeons when it comes to stitching lacerations on patients of any age. I've seen some beautiful repair work by ER doctors in my time.