Here is a run-down of the total number of hospital admissions and ICU admissions in Australia with H1N1 (2009) so far this month.
Quite a steep increase in workload on our public hospital systems over the last 48 hrs.
It is yet to be seen if this is just a spike or the beginning of a surge.

Source of data: Australian Government Department of Health and Ageing.

Two of the things we can probably strive to improve in most emergency departments is our service delivery to the aged care, and to those with mental health issues.

One excellent publication that gives practical guidance in the initial clinical assessment and management of mental health presentations is now available for free download as a pdf file.
Mental Health for Emergency Departments 2009;  has been developed by the New South Wales Department of Health following an extensive consultation process, and is the result of collaboration between mental health and emergency department clinicians.

It has been structured to cover many key issues relevant to the ED nurse, including:

• Issues that apply to all stages of the mental health patient’s initial care contact.
• Clinical issues that apply to particular stages of care:
  – Triage of potential mental health presentations
  – Initial emergency assessment
  – Ongoing care
  – Discharge planning
• Key specific management issues:
  – Management of patients under mental health legislation and agreements
  – Management of severe behavioural disturbance.
• Practical assistance :
  – Assessment, screening tools and resource documents.
  – Psychiatric terminology.

As a freely available download, this book makes an excellent addition to your professional reference library at home or at work. Check it out.

“A good nurse will seek to improve the length of their career.
A great nurse will seek to improve the breadth of it.
But an uber-nurse will seek to explore the depth of it.”

Ahhh, nurses shoes. The place where our professional rubber meets the road (See: How to handle your toxic nursing shoes ).
And after a typical boilover shift in the Emergency Department, it is not uncommon to flop through the front door only to find that you have brought a little  work home with you.

Like the song says;  she may have diamonds on the soles of her shoes, but we mostly just have gobs of sticky icky stuff.

About a month ago there was an email doing the rounds of our hospital. It contained some amazing photos of a group of dogs and a Polar Bear. I suspected that the brief story that accompanied the slides was bogus, and that the animals were from some zoo, or had been domesticated¹.
Well it turns out the story was in fact quite true….

German photographer Norbert Rosing and Hunter/Trapper Brian Ladoon were out taking some sunset photographs of his Huskies near the shore of Canada’s Hudson bay mid-November 1992.
Without warning they were interrupted by a 1200 pound Polar Bear which was moving in quickly on one of the dogs named Hudson. 
Polar Bears in the area had not eaten in over four months as  the Hudson bay had yet to freeze over, preventing them from hunting their usual diet of seal.
As Hudson was chained to a stake, Norbert, fully expected that he was about to witness the dog’s death.

What happened next was quite remarkable:

The bear closed in. Did Hudson howl in terror and try to flee? On the contrary. He wagged his tail, grinned, and actually bowed to the bear, as if in invitation. The bear responded with enthusiastic body language and nonaggressive facial signals. These two normally antagonistic species were speaking the same language: “Let’s play!”
The romp was on. For several minutes dog and bear wrestled and cavorted. Once the bear completely wrapped himself around the dog like a friendly white cloud. Bear and dog then embraced, as if in sheer abandon. Overheated by his smaller playmate’s shenanigans, the bear lay down and called for a time-out.
Every evening for more than a week the bear returned to play with one of the dogs. Finally the ice formed, and he set off for his winter habitat.

This behavior has been witnessed repeatedly in Churchill but has not been reported elsewhere in the Arctic. Throughout the region, polar bears occasionally kill and eat sled dogs.
Why should the Churchill bears behave so differently? Although he has not seen the phenomenon, biologist Ian Stirling of the Canadian Wildlife Service says that the fall fasting of these Hudson Bay bears slows their metabolism so much that “they can almost be hibernating on their feet.” Perhaps that saved the dog’s life. But why would the bear play rather than attack? This is an open question, and it fascinates me.

:: Stuart L Brown; Animals At Play, 1994 issue of National Geographic ::

You can see all the amazing photos for yourself, along with commentary by Stuart Brown: Animals At Play.

1. a domesticated Polar Bear? Yeah, right.  But Donald, he just looks so cute and cuddly…cant we have one pleeease?

A snake-bite colon punctures the end of the song.

In musical notation, this is called a repeat sign. It directs the musician to return to the beginning of the phrase or section and play it through again. To repeat it over.

But it is never a true repeat, because you can never play the same piece of music twice. Although the musician returns over notation that is exactly the same, the flow and form of the music is always moving onward. Really, there are no repetitions.

As nurses we must always be careful of repeats. 
It is easy to fall into the trap of treating patients that return over and over with similar symptoms as exactly the same each presentation. Or to treat a particular condition or diagnoses as repeating itself identically amongst different patients. 
To do so is to risk missing the onward flow and form within our patients individual lives.

Our nursing work calls for endless repetition. Drawing blood. Giving medications. Taking ECG’s. Writing notes. Day after day. Year after year. We think we know what we are doing. Going back over the same section again and again.
But really, you can never take blood from the same patient twice.

It is very important we stay on the notes as they sound. Aware of the guiding directions of the greater notation, we temper the instruments of our knowledge and skills to attend to the patients condition.
But always, staying on the sound, staying with the sound, listening closely as it unfolds.

A HUGE increase in the number of people presenting to New South Wales hospitals with flu-like symptoms has forced the State Government to make hundreds of extra beds available….
…To cope with a 17-fold increase in people with flu symptoms - swine or seasonal - compared to the same period last year, 550 extra beds would be made available, NSW Health Minister John Della Bosca said.

NSW Health’s Chief Medical Officer, Kerry Chant, said the problem was only going to get worse.
“The numbers for our Sydney southwest region are the highest,” Dr Chant said.

“As time goes on, the disease will progressively spread around through the rest of metropolitan Sydney, and will also then progressively spread to our rural and regional areas….
….Dr Chant said it was not possible to say what percentage of the population could be affected by the influenza A(H1N1) virus, but she indicated it could be as high as 40 per cent.
“We would estimate the clinical attack rate is going to be something like 20 to 40 per cent,” she said.
“Because it’s a new virus the population doesn’t have any degree of immunity to it.

1. most public hospitals push for their staff to have the flu-vax each year to minimize sickness amongst staff. This year those staff will have no immunity to the circulating H1N1 virus.

Here is a quick and simple tip that is guaranteed to bring a few moments of sheer joy to even the most heinous of shifts.

Carry a fresh spare pair of quality socks in your locker or work-bag. For those times when your shift is sucking the big one.
Excuse yourself for a few minutes and find a quiet spot to peel off those hot, ripe, smelly, sticky socks that have gotten you thus far through the shift.
The sheer bliss of changing into a fresh pair of socks has to be experienced to be believed.
Even if you wear stockings….peel them off and get your emergency socks on.

Combined with a splash of water to the face and a brush of your teeth and you will find yourself ready to face whatever the rest of the evening can throw at you.

New from cutting edge chaps at impactednurse labs: UberPee.
Most hospitalized males feel pretty uncomfortable having to pee into a plastic bottle.  It just feels all so un-natural. Especially with those clear plastic ones that put your frothy pee on public display as the nurse carries it out to the pan-room. Just plain embarrassing.
Not-so with the UberPee.
With this beautifully hand-crafted bone porcelain bottle, your patients will instantly appreciate the workmanship and attention to detail.

From the very first reassuring sound of urine splashing against ceramics, to the empowering option of leaving the seat up when they have finished, to the comforting collateral splatter on the lid….your patients will feel so very much at home.

We have been testing plenty of people for H1N1 influenza lately. Flocked swabs swizzled deep into the patients sneezing, snotty nostrils.
Hang on a cotton picking minute, flocked swabs…..what exactly do you do to a swab to flock it?  
And why would we want to get flocked anyway?

In the design world, flocking is used to produce a decorative or functional finish to a surface. Fine particles are applied to an adhesive on the surface to be flocked altering its surface properties.
The process is used on everything from designer goods such as t-shirts and wallpaper, to high-tech military applications. In photography, flocking is used to reduce the reflectivity of surfaces such as lens hoods.

Flocking may have been around since at least 1000 BC when the Chinese would bond natural fibers to fabrics with the use of a resin glue.
Today the effect is achieved  via the application of a high voltage electrostatic field to the flocking fibers which causes them to penetrate end-on into the adhesive base.

[ left: wound swab. right: flocked swab ]

In the medical world, our traditional swab-sticks have a tip of wound fibers that tend to entangle and trap any specimen being swabbed. 
The problem is that when the sample is placed into a transport medium it’s matted surface tends to hang onto the goods.

The tip of a flocked swab on the other hand, is formed with perpendicular nylon fibers. The capillary action between these fibers produces a small hydraulic hold on the specimen which is held at the surface of the swab and released more easily into the transport medium (this release is known as elution).

So, the reasoning goes, that by obtaining a better sample, you are more likely to have a greater effect on diagnostic sensitivity.
Now you know.