Quiet Nights The last two nights at work have been relatively quiet. No bad traumas and nothing at all after about 2 in the morning both nights.Hopefully tonight will also be quiet. I am borrowing my dad's truck after work tomorrow so we can use it to move stuff to the new house. Hopefully we will be down to just the major furniture pieces by next Saturday.

House Prep We have spent a few hours each day this week over at the new house getting things ready. The owners did a lousy job cleaning after they moved out so we have had lots to do. I have used a carpet cleaner on the bed rooms upstairs and am putting new contact paper in all the drawers and cabinets. We replaced the shower heads and the toilet seats (the old ones were pretty gross). The one bedrooms walls were so dirty that after cleaning what she could Thumper painted the room today. We won't be moving our furniture for another 8 days so there is still time to get things in order. We are eager to move in but at least this way we don't have to kill ourselves trying to clean everything in 1 or 2 days. Fortunately we have all the things that was wrong with the house well documented so when we move out we should get all of our deposit back.

Long Night I realized that I had not blogged in a while but with the pending move we have been very busy. We have started moving boxes of stuff over to the new house and will continue to do so this week. We have less than two weeks left until the "big moving day" when we will rent a truck and move all the major furniture. I had a very busy night at work last night. It started with a five year old boy whose cousin had knocked him off a chair breaking his arm. The problem was that the break had caused him to lose circulation to his hand. Fortunately once the surgeons set his arm back in proper position and placed a couple of wires to hold it there his circulation returned. Next I did a case of a 55 year old women who looked about 85. She had emergency surgery last week and at the time they were unable to close her abdominal incision because of massive swelling. As I rolled the women to the ICU the first of four trama cases came up from the OR. A young women who was obviously intoxicated had been in a car wreck. She ended up having injuries to her small intestine and a laceration to her liver. My last case of the night was a seventeen year old boy who had been in a car wreck with his family. He also had bowel injuries. I was relieved by the day shift before this case was finished. Hopefully tonight will be a little quieter.

We Got It!!! The property manager called this morning and we got the rental house we wanted. We signed all the paperwork today and will get the keys next week. I guess this means we are really moving. Max will not be thrilled!!

House Hunting Thumper and I have been living in an apartment for the last year. We had not lived in an apartment for many years and hopefully will not live in one again for a long time. Now don't get me wrong this is not a bad apartment but it is a little small especially with no garage for storage. Our upstairs neighbors are mostly quiet though the occasional vacuum cleaner running at 7 in the morning is annoying. We decided that since our lease is running out next month we would look for a house to rent. We have looked at several so far and a few of them were not bad, but not great. This afternoon we have an appointment to see another one. The house is only about 4 years old and looks wonderful on the outside. It is on a cul de sac (spelled right?) which means less street traffic. Hopefully it will be as nice on the inside. I am not looking forward to moving again but our son has arranged for some of his friends to help on the big moving day. They will only cost me pizza and beer. Anyways I or Thumper will blog how things go.

Sad Case I started out last night by taking over for the evening nurse anesthetist to finish a kidney transplant case. When I took over it was mostly finished already. I woke the man up 45 minutes later and he seemed to be doing fine. Things were quiet after that until about 4 in the morning. A 19 year old man had been in a bad car accident. His left leg was broken but the real concern was his head. His skull was fractured on the left side and was compressing in on his brain. He already had a breathing tube in when he arrived so it was a simple matter to get him in the room and off to sleep. Right from the start I had problems. He had good breath sounds on both sides of his chest but his oxygenation was low. He was getting enough oxygen into his lungs but it was not transfering to his blood like it should. His pulse ox which is a measure of oxygenation should have read between 98 and 100. His never got any higher than 94 and sometimes drifted down into the 80's. It is possible that he had developed at fat embolism from his broken leg but there is no way to tell in the OR. The surgeons opened his skull and removed several bone fragments leaving a hole in his skull the size of a quarter. Unfortunately the area of his brain that was damaged was near his speech center. It won't be known till later whether or not this young man will be able to speak normally. I finished the case about 6 in the morning and soon was on my way home. Two more nights to go.

Like a relief pitcher One of my jobs when I get to work on the night shift is to relieve the Evening shift nurse anesthetists if they are doing a case when it is time for them to get off work. We have two evening shift people on week nights. One gets off at eleven and the other at midnight. Shortly before eleven I took over the case of a seven year old boy who had fallen and broken his left arm. The case was mostly finished and I woke the boy up at eleven thirty. I next took over the other evening shift CRNA's case which involved a 19 year old man with multiple gunshot wounds to the chest and abdomen. Fortunately he was very stable and his case was finished by one in the morning. Nothing else came in after that.

AAA When I say AAA I am not refering to the auto club. In the OR AAA stands for Abdominal Aortic Aneurysm. The Aorta is the largest artery in the body and can easily be as big as a garden hose. An aneurysm is when an area of artery wall weakens and balloons out to 2 or 3 times normal size or more. If that aneurysm pops open or ruptures it can in some cases mean death within minutes. Last night we got the warning that a patient with a ruptured AAA was on his way by helicopter from another hospital, It was going to take 30 minutes for him to arrive. We wondered if the man would even be alive when he got to us. Sometimes when the aorta ruptures lower down in the abdomen the patients own body cavity fills to capacity but then there is no more room for further bleeding. The patients body applys direct pressure to the rupture which slows the bleeding and can give you a little time to get them to an OR. When the 72 year old man arrived he was still concious and able to respond to our quick questions as we rushed him into the OR. We started giving him blood and other fluids as fast as we could before the surgeons made their incision. When the surgeons make their incision it releases the pressure that has been stopping the bleeding and the patients blood pressure will drop critically until they can get down to the aorta and clamp it shut. This patients pressure dropped down to about 60/20 for about a minute but came back up after the clamp was applied. Three hours and many units of blood products later the surgeons had finished their repair and we took the man to the ICU. I checked up on him this morning before I came home. He had good pulses in both of his feet and was starting to wake up. Barring other complications he should do fine.

Why you Should not run from a K9 Cop Had a fairly quiet night last night. I started out finishing a case on a lady who had bleeding in her abdomen from a prior surgery. The case was routine and they were done with her in less than an hour. About 2 in the morning a patient was brought up from the ER accompanied by police officers. He was out of prison on parole but was still taking and selling drugs. When approached by the police he tried to run. He could not outrun the police German Sheppard that ran him down and when he fought, bit him on the leg. He was brought to the OR to wash out the large bite on his leg. He was high on drugs and a little belligerent which of course means I quickly sedated him in the hall and was quickly off to sleep. One of the nice things about my job is I don't have tho put up with mean or belligerent patients for very long. They go to sleep fast and they don't wake up until after I have left them in the recovery room. It turns out he was carrying a pistol when he was arrested and a sawed off shotgun was found in his house. According to the police officer who stayed in the room during the case he will probably go back to prison for 10-15 years only now he will have a large scar on his calf from the dog bite. That was it for the night but I have two more to go.