Friday, January 28, 2011

The Face Behind the Mask: Part 3/5

We're continuing our five part Friday January/February series with certified nurse anesthetist Kimberly Zweygardt. By the way, happy Nurse Anesthetists Week Kim!

So far, we’ve met the characters in the OR and discussed the setting. Today, let’s talk about things that could go wrong including anesthesia complications.

Andartur/Photobucket
We’ve all read about wrong patient or wrong operation or surgeons operating on the opposite leg, hip, etc. Safegaurds, like the time out, are designed to prevent this, but what if it increases plot tension?
 Also, the OR is its own little world—only staff and patients allowed, but there was a case where someone impersonated a doctor. What did the nurse say when she found out he wasn’t a real surgeon? “I couldn’t tell. He was wearing a mask!” In a large teaching hospital there are students of all types and the OR gets much more crowded. It would be possible for someone to sneak in with mayhem on their mind, although safegaurds like doors to the dressing rooms with keypad entries have become common.
The OR is a very busy place and patient care comes first. As the case ends and the patient wakes up, there is lots of hub bub.My concern is if my patient is pain free and breathing before taking them to the PACU (Post Anesthesia Care Unit), not about the drugs which locked up unless being used. While I’m gone, the room is “turned over” (cleaned and readied for the next case). Nurses, scrub technicians and housekeeping are in and out. In some OR’s an anesthesia tech cleans and restocks the anesthesia supplies, changing the mask and breathing circuit on the anesthesia machine so that when I return, all I have to do is draw up drugs for the next patient.
Due to the nature of the OR, the anesthesia cart is unlocked so that the tech can restock drugs and supplies. What would happen if someone had murder on their mind?
Drug companies sometimes use the same labels for different drugs. For example, Drug A is in a 2cc vial and slows down the heart. The label is maroon and the vial has a maroon cap. It is clearly labeled as Drug A. Drug B also is a 2 cc vial with a maroon label and has a maroon cap but Drug B increases the blood pressure. What happens if the pharmacist sends the wrong drug because he recognized the colored label and grabbed it? Or if both drugs are in the anesthesia cart, but one vial gets put in the wrong drawer along with vials that look identical? Or the patients blood pressure is dangerously low and in my hurry, I grab the wrong drug and slow down the heart causing the blood pressure to plummet even lower? What if it wasn’t an accident?
For your comfort, practitioners are know about “look alike” drug vials and take special precautions to prevent errors. Don’t be afraid if having surgery, but what fun would that be for our characters? Remember this blog post is about getting the medical details right, not making our characters happy!

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Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

Friday, January 21, 2011

The Face Behind the Mask: Part 2/5

We're continuing our five part Friday series with certified nurse anesthetist Kimberly Zweygardt.

Last post we discussed who is in the OR. Today let’s talk about the OR setting then discuss the anesthetic.
The OR is a cold, sterile, hard surface, brightly lit environment that is all about the task instead of comfort. Cabinets hold supplies, the operating room bed is called a table, Mayo stands hold instruments for immediate use during the operation and stainless steel wheeled tables hold extra instruments and supplies. IV poles,  wheeled chairs/stools and the anesthesia machine and anesthesia cart complete the setting. 
ejburkhardt/Photobucket

When a patient comes in, the staff does a “time out.” The circulating nurse, the surgeon and anesthetist all say aloud that it is the correct patient and procedure. It sounds like this, “This is Mrs. Harriet Smith and she’s having cataract surgery on her left eye.”  Once done, the staff swings into action, the circulator “prepping” the surgical site (washing it off with a solution to kill the germs) while the scrub nurse prepares the instruments after “gowning and gloving” (putting on sterile gown and gloves). Meanwhile, the surgeon “scrubs” meaning washing his hands at the sink outside the room. When he is done, he’ll enter the room to get gowned and gloved. Before all this is happens, I’ve started my care of the patient.
I meet the patient before this to fill out a health history specific to anesthesia. Are they NPO (Have they had anything to eat or drink after midnight)? Do they have allergies? Have they ever had an anesthetic and if so, any complications? Has anyone in their family ever had complications with anesthesia? Then I ask about medications and other health problems  so I can choose the best anesthetic. But an even bigger job is reassuring them that I am there to take care of them.
When they come to the OR, I attach monitors—EKG heart monitor, blood pressure cuff, and pulse oximetry (a small monitor that fits on the finger to measure the oxygen levels in the blood). Once the monitors are on, I give medicines for the  “induction” of anesthesia. As the patient goes to sleep, they are breathing oxygen through a face mask. Drugs include the induction agent (most likely Propofol), narcotics (Fentanyl most common), an amnestic (Versed which provides amnesia), plus a muscle relaxant (Anectine)that paralyzes the muscles.  When asleep, the breathing tube is placed using a laryngoscope that allows me to visualize the vocal chords. Then the anesthetic gas is turned on.
I am with the patient through the whole operation, watching monitors, giving medications and making adjustments.  At the end, I reverse the muscle relaxants, turn off the anesthetic gas, and begin the “emergence” process waking the patient up.
Now, that’s the norm but we’re writer’s where normal is boring! Next post I’ll let you in on all the things that can go wrong!

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Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com

Friday, January 14, 2011

The Face Behind the Mask: Part 1/5

Redwood's Medical Edge is happy to host certified nurse anesthetist Kimberly Zweygardt for the next five Fridays. She will be blogging about how to make those OR scenes realistic.



If you have a profession besides writing, doesn’t it bug you when someone doesn’t get it right? It may be something small, but you wonder, “Why didn’t they do some research?”  With the Internet, it is easier than ever to find information, but if it is a hidden profession like my own, there might not be much info for you to glean. Today I want to share with you, The Face Behind the Mask or The Life and Times of a Certified Registered Nurse Anesthetist (CRNA). The operating room is my world, so let’s begin there.
A CRNA is an advanced practice nurse that specializes in anesthesia. CRNA’s were the first anesthesia specialists beginning in the late 1800’s. Anesthesiologists are MDs that specialize in anesthesia (it became a medical specialty after WWII), unless of course you are in great Britain where everyone is an Anaesthetist (Ah-neest’-the-tist’). Confusing, yes? Just remember, the work is the same, but the title is different. For some reason, the term  Anesthesiologist is more widely known (because it is easier to pronounce?), but since CRNAs give over 60% of the anesthesia in the US, if you write a surgery scene, you might want to consider using a CRNA as the caregiver, especially if it is a rural setting. Over 90% of the anesthesia in rural America is provided by a CRNA.
The OR is its own world. Someone has to do the operation, so there are general surgeons, trauma surgeons, orthopedic surgeons (bone), neurosurgeons (brain and nerves), cardiovascular surgeons (heart and major vessels), as well as OB/Gyn (women’s health), ENT (ear, nose and throat) and ophthalmologists (eye surgeon). If it is a large teaching hospital, there might be a medical student or surgery resident assisting the surgeon.
 A scrub nurse or surgical technician is there who hands the instruments to the doctor as well as a circulating nurse—a RN who records what happens during the operation as well as obtains any supplies needed in the room. For example, if the doctor needs more suture, the circulating nurse would open it so it remains sterile and hand it to the scrub nurse who is also sterile.
Two of man’s greatest fears are being out of control and the fear of the unknown. The OR setting speaks to both. What great plot scenarios and drama we can create by going through the double doors that lead to surgery!  Next time we’ll talk about interesting scenarios and complications concerning surgery and anesthesia. Happy plotting!

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Kimberly Zweygardt is a Christ follower, wife, mother, writer, blogger, dramatist, worship leader, Certified Registered Nurse Anesthetist, a fused glass artist and a taker of naps. Her writings have been featured in Rural Roads Magazine, The Rocking Chair Reader, and Chicken Soup for the Soul Healthy Living Series on Heart Disease. She is the author of Stories From the Well and Ashes to Beauty, The Real Cinderella Story and was featured in Stories of Remarkable Women of Faith. She lives in Northwest Kansas with her husband where their nest is empty but their lives are full. For more information: www.kimzweygardt.com


Friday, January 7, 2011

Disaster Status: Part 3/3

Another Real-Life Incident

I was on-shift the night an industrial hazardous waste plant burst into flames. I obviously have all the inside information, but it won’t be released to the public, so I’m sorry to say I can’t share most of it with you. What I can say – inside the facility, stored toxic material ignited. The fire quickly grew to a plume of smoke then the entire facility erupted into a fireball with several rapid fire explosions. This swift and extreme domino of events occurred simply because the burning toxic chemicals were stored right next to oxygen cylinders, and oxygen feeds fire. You guessed it, properly stored O2 is essential. 

   

The reverse 911 system was activated – recorded messages called all nearby residents, warning them to evacuate. View the photos included here – it was an intense explosion and the burning toxic chemicals created a massive haz-mat situation. The chemicals involved in that explosion react negatively when mixed with water, so we were forced to allow the fire to burn itself out. Two days post the onset of the incident, a foam application extinguished the remaining flames.



Even though this makes for boring fiction, emergency agencies that night proved pre-planning and inter-agency training and execution results in excellent emergency incident response outcome. My crew along with many other emergency crews, successfully worked the potentially deadly incident – no loss of life and only minor exposure issues occurred. But think of the endless possible dramas that could’ve happened.

Thank you in advance for reading and for your participation and comments. If you have any questions, please do not hesitate to ask. Photos are courtesy of Apex Fire Department.



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After majoring in communications and enjoying a successful career as a travel agent, Dianna Torscher Benson left the travel industry to write novels and earn her EMS degree. A EMT and Haz-Mat Ops in Wake County, NC, Dianna loves the adrenaline rush of responding to medical emergencies and helping people in need, often in their darkest time in life. Her suspense novels about characters who are ordinary people thrown into tremendous circumstances, provide readers with a similar kind of rush. Married to her best friend, Leo, she met her husband when they walked down the aisle as a bridesmaid and groomsmen at a wedding when she was eleven and he was thirteen. They live in North Carolina with their three children. Visit her website at http://www.diannatbenson.com/ 


Wednesday, January 5, 2011

Disaster Status: Part 2/3

A Real-life Haz-Mat Incident

January 6, 2005 in Graniteville, South Carolina in Aiken County, a railroad engineer left his train for the night to sleep at a hotel in town. Before leaving his train, he failed to properly reline the railroad switch for mainline operations; meaning, he simply forgot to change the rails on the track. Changing the rails would’ve closed off the track where his train was parked, successfully forcing an incoming train to veer-off onto another track and pass the parked train.

In the middle of the night, an incoming train – planning to pass the town – collided with that parked train, which contained chlorine gas, sodium hydroxide, and cresol. The collision derailed both locomotives and many freight cars. The parked-train’s tank car – containing ninety tons of chlorine – ruptured, releasing sixty tons of the gas, creating a haz-mat spill, including polluting a creek.

scott007/Photobucket


A true haz-mat team – trained, experienced, and equipped for such a catastrophic event – is not located in small-town Graniteville. Only a few of Graniteville’s emergency crews are trained in haz-mat, and their training, expertise, and equipment is insufficient for an incident of this magnitude.

Inside the Avondale Mills plant near the crash site, a man in respiratory distress called 911. From a dispatcher’s viewpoint, this situation is heart-wrenching Even if rescue crews could’ve safely entered the area to extricate the man, it would’ve been pointless due to his immediate exposure to chlorine. He was suffering bronchial chlorine burns, and he died a painful death while on the phone with the 911-dispatcher. For haz-mat training purposes, I listened to that chilling 911-Call. Overwhelmed in every way, that dispatcher could only listen as this man gasped his last breaths. Understandably, she had no words of comfort to offer him. That gave me passion to become a 911-dispatcher once I’m too old to run 911-Calls on an ambulance. When that man asked the dispatcher – “Please, don’t hang up; I don’t want to be alone.” I would’ve spoken with him about his family and his passions in life in order to get him as relaxed as possible. I would’ve talked about God and offered to pray with him. Often when people suspect their death is imminent, they suddenly forget all about being atheist, agnostic, stumbling in their faith, or whatever else, and reach for God.

Due to this haz-mat incident, nine people died, 250 were treated for chlorine exposure, and 5,400 residents within a mile radius of the crash site were forced to evacuate for nearly two weeks while haz-mat teams and clean-up crews decontaminated the area.  

Think of the fictional characterization possibilities within this tragedy:

1) Plagued by guilt, the train engineer is pushed over the edge by predisposition to mental illness, and becomes a murderous psychotic (an example of a villain in one of my books). What similar characters could you develop? To be honest, though, my heart goes out to that train engineer. My greatest fear in life is making an unintentional mistake as an EMT, resulting in a patient’s death.  

2) The 911-dispatcher: For fictional purposes, let’s suppose it was this dispatcher’s first day alone (no longer training) on the job that horrible night in early 2005, and she resigned, making her first day also her last. Think about the baggage she would carry for years to come. In addition, what if she was already in a severe financial bind and now being jobless she’s in dire straits? She’d make a likable and fascinating main character.  

3) Me, the future 911-dispatcher – what if a character had aspirations to be an amazing dispatcher but fails miserably? What if he/she is unable to handle the stress of the work and is then lost in life on where to head career-wise? Another idea for a terrific main character.

Monday, January 3, 2011

Disaster Status: Part 1/3

We're going to start the New Year off with a bang. Nothing can complicate a story more than a disaster hitting the town in your novel. What would a realistic response look like from the EMS community? There's no one better to talk about disasters than an EMS professional. Dianna's back this month with a three part series on disaster response.

Worst Possible Haz-Mat Situations



In a hazardous-material situation, a small town can easily and rapidly become overwhelmed and thus unable to efficiently handle the crisis at hand due to their limited resources. Below is a list of some additional factors beyond “the town is small” that would heighten the chaos, and for writers, would create solid fictional conflict.

Scenario: Traveling at high speeds, two tanker trucks collide; both roll-over. One truck is an atmospheric pressure tank; the other is a cryogenic liquid tank.

donW23/Photobucket

Additional possible factors….

The accident occurs:
1)      Near a school during school hours
2)      Near a stadium filled with spectators and athletes/performers
3)      Near a power plant
4)      Near a hazardous waste facility
5)      Near the town’s landfill (landfills contain countless haz-mats)
6)      Near the town’s water treatment plant
7)      Near the town’s only EMS station
8)      Near the town’s only hospital
9)      Near the town’s only fire department
10)  Near the town’s only police department
11)  During rush hour traffic
12)  During a storm
13)  At 3am
14)  The closest haz-mat team is four hours away

In all of the ten “near” cases above, assume those buildings/areas are contaminated by hazardous material spills from both trucks. Haz-mats are often airborne (so air vapors), which are the most deadly simply because air vapors are invisible – they travel quickly, through most any material (including ventilation systems), and without warning; plus they’re next to impossible to contain. Sometimes an unusual cloud or smell is detected, but obviously that warning comes concurrent of the smell and/or cloud discovery, so those individuals in or near the hot zone are already exposed. Keeping safe distance from the hot zone is the only way to eliminate exposure.

Minimum safe distances depend on the chemicals of the hazardous materials present, but an example of an initial minimum safe distance is: 1,000 feet downwind, 500 feet upwind, 330 feet complete radius. Avoid downwind areas entirely and stay upwind. Clearly, continuous monitoring of wind changes is vital.   

What additional scenarios and additional factors can you think of?