Month: February 2012

Author Beware: Hallmark’s Christmas Magic

/ Jordyn Redwood / Leave a comment
There’s nothing more charming for me than a Hallmark Christmas movie. Several I loved this past Christmas season– particularly Trading Christmas written by Debbie Macomber. Hilarious if you’re a writer.
Some I didn’t like as much– and you guessed it– had to do with a medical reason.
Christmas Magic was a Hallmark movie where a young PR exec was involved in serious car accident.
Spoiler alert!
Most of the movie, you’re led to believe that she has died and is doing some angel work before going to heaven. At the end of the movie– you learn she has been in a comatose state and the climatic scene is where the man and daughter she was trying to help, come to her side at the hospital, to sing her back to life before her father “pulls the plug.”
My first issue: You should actually look injured if you’ve been in such a devastating car accident that you’ve been lying in a hospital bed for the better part of a week. In her “death” scene, her hair is clean and styled. Nary a scratch on her pretty face. Exactly what was her injury? Supposedly brain trauma. Well, she should at least have a bruise on her head.
My second issue: Pulling the plug generally denotes that you are on a ventilator. Discontinuing the ventilator– pulling the plug– means a patient’s breathing is no longer being assisted, they then cannot oxygenate their body, and the heart will stop beating when it doesn’t have oxygen.
In this scene, she was on a heart monitor (which is merely a monitoring device) and an IV bag of fluids hung at her bedside. She was not on a ventilator. Therefore, no “plug to pull”.
To denote discontinuing “life support” the nurse in the movie turned off the IV solution where then the heart began to slow down. Okay, you will die if you are in a comatose state from dehydration (think Terri Shiavo’s case) but it will not happen in a few minutes. It will take days.
But, this patient was able to comply and nearly died in a few short minutes.

Next season, Hallmark Channel, hire me as a consultant. You might be surprised at how inexpensive I am!

Micheal Rivers: Altered Mental Status

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I’m pleased to host guest blogger Michael Rivers today as he discusses the EMS perspective on altered mental status.

Welcome, Micheal!

EMS handles thousands of calls every year especially in the larger cities like Chicago. There is one kind of emergency call that can take the life of a Paramedic or EMT very quickly, or leave him or her with serious injuries. These calls are either for domestic or institutionalized people with altered mental status.

These calls are handled differently from other calls even involving shooting because the medical personnel have no idea what they can be walking into. Although he is there to help, the sight of the uniform alone can cause a very violent reaction from the patient. The ambulance personnel must not only be wary and insure the safety of the scene, but he has to be inventive when handling his patient.
Depending on the scene you never want the patient to hear your siren or see the flashing lights of the ambulance. It frightens them and they automatically become defensive. If you are running code 3(emergency) stop the siren and the lights a block or more before you arrive on the scene. If at all possible gather all the information on your patient and turn this to your advantage. These are some very good examples that work. This knowledge was gained through experience.
The patient was a 320 pound female confined to a psych facility for homicide. She was known to go through fits of rage even when under the influence of her medication. Arriving on the scene she was found in the nurse’s station sitting in a chair brooding. An armed security guard from the Sheriff’s department stood close by her. Due to the experience of the EMT’s, one stayed at the entrance while the attending EMT walked by the patient basically ignoring her while visually accessing her as he passed by. This assessment tells a great deal about who he is dealing with.
With a better knowledge of the problem and a few personal facts you begin to communicate with your patient. They want to be heard. Listen to them and find a way to get them on the stretcher without a fight. You may have to become an accomplished actor, but you have to convince them you are genuinely concerned and you are their friend, their guardian. In this case the attending EMT was able to get the vitals and convince her to get on the stretcher on her own when in the beginning she refused to be touched. If they had tried to force her, there would have been someone taking a lot of body damage. She was strapped x4 thinking it was for her safety.
Knowing the patient was not diabetic and was allowed sweets was a plus. With a simple cookie and the promise she would not be harmed, (history of physical abuse) she co-operated fully. She was even able to display sympathy for the EMT when he said he would get in trouble if she did not let him take her to the hospital. The call went smoothly and the patient was able to receive treatment without causing further harm to her.
These EMTs were very experienced. Experience cannot always let you see the unexpected coming. They specialized in the Altered Mental Status calls and knew exactly what to look for. Yet, Ambulance 04 was retired one year later after nearly being destroyed as the driver was attacked by a street person from inside the ambulance with altered mental status. This was an incident where the driver’s window was down to answer a man’s question. The street person dove through the window attempting to kill the EMT. At the time they had another patient inside the ambulance also with altered mental status.
This is a perfect example of the symptoms of altered mental status not being displayed by a person you are speaking with. If you are an EMT or Paramedic you already know the question; “Is the scene safe?”
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Micheal, born in 1953, is an American author. He served his country as a United States Marine during Vietnam. Born in North Carolina, he lived in the Chicago area in the past and furthered his education there and served the community as an Emergency Medical Technician. Micheal returned to the mountains of North Carolina where he resides with his wife and his Boxer he fondly calls Dee Dee. You can learn more about Micheal at http://michealrivers.com/.

Florence Nightingale Diagnosis Henry VIII: Part 3/3

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This has been an amazing series by JoAnn Spears. I’ve enjoyed having her and I hope you learned something new about medicine during Henry VIII’s time.

Baby blues
Nursing Diagnosis:  Sexuality Pattern, Ineffective
Nursing Diagnosis:  Role Performance, Ineffective
In Tudor times, one of the main imperatives on a king was to father sons. Henry’s inability to achieve this goal was the impetus behind the Reformation in England, and has been made much of in fact and fiction. The fact is, though, that his full complement of male children was two legitimate sons, and one illegitimate son. One of the legitimate boys died in infancy and the other, Edward VI, died in his teens. The illegitimate Henry Fitzroy died shortly after he was married, at the age of seventeen. Henry also fathered two healthy girls, Mary I and Elizabeth I. He was in his mid-forties when he sired his last child.
Rhesus or Kell issues, in which incongruent parental blood types can cause a stillbirth or compromised infant, have been suggested as causes of the many miscarriages suffered by Henry’s first two wives. However, his first healthy daughter was born subsequent to his first wife having a succession of pregnancies, which is quite the opposite trajectory to that usually seen with such incompatibilities.
Syphilis, which, untreated, can lead to mental health problems in both parents and offspring, is an embedded but unlikely part of Tudor medical lore. Henry’s impulsive and violent propensities were not described by contemporaries in a way associated with the dementia and deterioration typical of tertiary syphilis. Also, none of Henry’s surviving children exhibited symptoms of congenital syphilis.
Henry’s first three wives each conceived quickly after marriage and, in the case of the first two, conceived multiple times. None of his subsequent three wives conceived. Henry’s symptoms of substantial weight gain and compromised circulation became noteworthy around the period between Henry’s third and fourth marriages. Erectile dysfunction is another potential side effect of both diabetes and poor circulation, and would account for a lot of the personal history of Henry and his last three wives.
Exit strategy
Nursing Diagnosis:  Mobility: Bed, Impaired
Nursing Diagnosis:  Risk for Compromised Human Dignity
Henry VIII’s last years were anything but majestic. The handsome, charming, 6’2” blond athlete of earlier days was a bloated, irritable, sickly being who was largely confined to bed and chair. A mechanical hoist was required to get the king onto a horse once he donned his outsized armor. The purulence of his leg ulcers caused a nauseating stench. His very last days, in which he was confined to his bedchamber, were spent hammering out a succession plan for the progeny he and his sisters would leave behind.
Henry was in his mid-fifties when he died. During the era he lived in, his would not have been considered an advanced age, but a death at that age was certainly not considered untimely. The actual cause of his death is unknown. An embolus to the heart or lung has been suggested. However, either of these would probably have killed Henry quite quickly, and there were days’ worth of succession planning and priestly officiating before the death. Stroke has also been suggested, but the tenor of the deathbed activity around him is not entirely congruent with the suddenness of a cerebrovascular event. Given the circumstances, the eventual succumbing of a once-healthy body to years of chronic disease seems as likely an explanation as any of Henry’s death.
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.  
 Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.

Florence Nightingale Diagnosis Henry VIII: Part 2/3

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Today, JoAnn Spears continues her nursing evaluation of Henry VIII.
The King’s pains.
Nursing Diagnosis:  Tissue Perfusion, Ineffective, Peripheral
Nursing Diagnosis:  Pain, Chronic
Nursing Diagnosis:  Skin Integrity, Impaired
Henry VIII and his bandaged, suppurating, painful legs are the stuff of Tudor legend, as is “the gout”. Gout was common in Henry’s time, when diets were high in triggering, purine-rich foodstuffs such as beer, ale, and organ meats. Gout does cause excruciating pain in the lower extremities, but it tends to be episodic and associated with inflammation, rather than chronic ulceration. If Henry did have gout, it may have been the least of his problems.
Poor peripheral circulation seems a more likely explanation of Henry’s lower extremity woes. The weight and immobility that were part of his life after the age of about forty could certainly have caused or contributed to this condition. The weight gain may in turn have been either the cause or the effect of type 2 diabetes. This is the type of diabetes which is acquired later in life. To continue a sad spiral, diabetes also contributes to lower extremity problems such as easily damaged skin, neuropathic pain, and ulcers that will not heal and become chronically infected.
Size Matters.
Nursing Diagnosis:  Nutrition, Imbalanced: More than Body Requirements
Diabetes is a disorder of glucose metabolism, and type 2 diabetes is associated with excess food intake. Henry’s much vaunted gluttony and his weight in middle age—estimated by some to be as much as five hundred pounds—argue strongly in favor of this diagnosis, but not exclusively.
Hypothyroidism is also associated with weight gain and mental irritability such as Henry displayed. This condition is, though, more commonly seen in women than in men.
Tudor portraiture makes a strong argument for Cushing Syndrome as the cause of Henry’s obesity. Pituitary tumors which disrupt normal cortisol activity are a frequent cause of this disease. Portraits of Henry in later life feature the typical moon face of Cushing’s Syndrome and the characteristic distribution of excess fat deposited in the core rather than the extremities. Ironically, Cushing’s Syndrome can also cause or exacerbate mental status changes and diabetic processes, as well as erectile dysfunction
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JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.
 Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.