Archive for May, 2009

Twitter follower-quette

May 26, 2009 at 8:16 pm · Filed under twitter

I’ve been getting a ton of follower notices for Twitter. Many are spam (block) or medical companies/nurse recruiters (OK, but I’m not following you back), but lots are also pretty interesting nurses. My Twitter group has therefore gotten pretty big, and I decided I need criteria for unfollowing people or deciding whether to follow them to begin with. Here’s NNR’s list of cardinal Twitter sins (meaning ways to get unfollowed or never followed):

  • Tweet about your follower stats. No one cares. I don’t even know why YOU do.
  • Tweet what you are listening to on blip.fm every few minutes so that I suddenly have 50 tweets, all from you, all indicating that you like Barry Manilow. Ixnay.
  • Include more than two hash tags with every tweet. If I have to wade through your tags to get to your content (if any), screw it.
  • Indicate that you are now, or have ever been, a Bush/war supporter.
  • Use Twitter only to push out updates to your blog.
  • Tweet each meal you eat and chore you do. WTF is this: reality Twitter?
  • Never produce an original tweet so your entire repertoire is composed of, eg, @some_eejit Me too!
  • Exclusively tweet about the amazingly intelligent things your toddler does (especially conversations involving contents and consistency of diapers; adult diapers in nursing discussions are, however, perfectly legit).

Conversely, I’ll instantly and devotedly follow you if you

  • Are funny
  • Are irreverent, funny, and agree with me
  • Appropriately use phrases such as “what the bloody feck” and coin delightful terms such as “twunt”
  • Appreciate good body function stories (nurses, I’m talking to you)
  • Recommend cool applications, Web sites, books, or movies
  • Keep me updated on what is actually happening in the world so that I can avoid the farcical “media”

These are obviously just general rules, most of which are, like all good rules, made to be broken. I usually enjoy the odd snapshot or vignette about toddler antics thrown in with other tweets, and obviously Twitter is made for conversation. Some people just go waaaaay overboard. Like, “Poop coming out now.” Too much information. And seriously: if you’re following me and 5,493 other people and have no updates, why should I follow you? Wait! It’s so I can boost my follower stats, which I will NOT be tweeting!

UPDATE 5/28/09: Just noticed Twittercism has a similar list, some of which I agree with. This “if you don’t follow me back, I’m taking my toys and going home” trend, though, I see no point in. I follow people because they’re funny or whatever. I usually never even KNOW if they follow me back. This goes into the category of my not understanding, at all, the obsession with follower stats. Let us lighten up. And just as a reminder, people you’re not following can still converse with you with @mentions, so what’s the big effin’ deal other than an ego thing?

Comments (9)

Heart blocks cheat sheet

May 21, 2009 at 11:40 am · Filed under Nursing

I just read Student RN Tiffany’s woes regarding heart blocks and want to bless the blogosphere with my distilled knowledge on this subject, having pondered the differences at some length so I don’t look totally stupid at work.

  • First-degree blocks are easy: if the P-R interval is longer than 0.20 seconds, it’s a first-degree AV block. Period. End of story. That’s longer than one large box on the EKG paper.
  • There are two types of second-degree blocks, which is stupid because why didn’t they just make first-, second-, third-, and fourth-degree blocks? But I digress. Both involve dropped beats. You can tell them apart by whether the P-R interval is consistent. A type II second-degree block has consistent P-R intervals, but a type I (Wenkebach) block has longer and longer P-R intervals until the impulse just doesn’t quite reach the ventricles and the QRS is dropped. So the P-R interval is normal (therefore not a first-degree block) in a type II block—it’s just not always followed by a QRS complex—but progressively longer in Wenkebach.
  • Third-degree (complete) heart blocks can be spotted in the wild pretty easily if you suspect them when you see a verrrrry slooooow ventricular rate. The ventricles have no access to the perky SA node and are left to their own devices to contract at 20 to 40 beats per minute. The atria, however, march along to their usual drummer at the normal sinus rate. To confirm your suspicions, march out the P waves (don’t be fooled by P waves hiding inside the QRS complexes) to see if they’re regular.

EKG classes and books tend to make this more difficult than it needs to be. Anything else, oh wise readers?

Comments (9)

ACLS: check

May 14, 2009 at 5:56 pm · Filed under Nursing

I went through ACLS training yesterday and today and emerged certified (with 100% on my written exam, to boot!). I will feel MUCH more comfortable working on my unit with this certification. When I left my last shift, one of my patients was in increasing runs of v-tach. I’d been calling his cardiologist fairly regularly all night (who didn’t hang up on me, weirdly) and had just hung an amidodarone drip, but the V-tach was up to runs of 30. The charge nurse was helping me out because I had three other patients and was forced to ask for a bailout, and I was really suspicious that my patient would require an “unelective” cardioversion in short order, which I was then unqualified to perform. So I left him at shift change with pads on and a crash cart outside the room. I left at a fast clip, happy to escape. I shouldn’t have had patients like that without ACLS training/certification, so I’m extremely happy to have it.

That night was pretty cray-zee all around. My patients all went downhill in some fashion and necessitated multiple physician pages, and none of them hung up on me. That made it a red-letter day. For some reason, they usually hang up on me, generally after biting my head off. These were all a tolerant bunch—pretty nice dudes, although one did say, “What exactly do you think I can DO at 2:00 in the morning?” (Me: “That’s why I’m calling. I’m out of ideas.”)

But again, nights like that night are showing me how very much I’m progressing in a short time. I would not have been able to handle that shift in any way a few months ago. I had to ask for help, but I think any nurse would have. Four deteriorating critical care patients = not a load anyone can reasonably handle. And my asking for help was controlled; I wasn’t panicking and running around without any idea what to do. I was able to do it like, “Can you please do x, y, and z?” rather than “Help! I have no idea where to start or what to do!”

Comments (1)