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A Mega Code Blue

A patient codes not just one but two patients simultaneously in a cardio-pulmonary arrest. A multitude of actions were set in motion. Someone called an I-Care Staff to prompt a crash team in every unit of our hospital for an Emergency Code Blue through a paging system. It so happened that we had only 1 crash cart in the unit and that i need to get 1 more at a nearby unit as fast i could. When the nurses, doctors, IM interns, therapists, med techs at the bedside know each other well, it’s almost like a dance, everyone moving fairly gracefully around each other and the equipment flooding into the rooms of each patient.

Someone watches the monitors, someone makes sure there’s a patent line and starts one if necessary.  Others give meds, record events, defibrillate, bag the patient, do CPR.  Someone is sent out to call the attending physicians.

During the code, I was the runner; a jack-of-all trade.  I didn’t have a specific job because at that time i was waiting for a call at the O.R. unit to facilitate 1 patient for a scheduled tracheostomy; while waiting, I was just running to get supplies as needed.  After I’d run to get suction tubing, more paper to record on, this, that and the other thing, I was just watching and waiting to see if anyone needed anything else until an oderly staff came in which i left the unit for a few minutes to facilitate transfer of 1 patient to the OR.  Although what was happening was very sad, I was admiring the dance - a chacha-tango or twister moves as we funly termed it.  Everyone there that day knew each other very well and it was especially graceful.  

Would you believe it?  After over 1 year and a half of being an ICU nurse, I had never before been  witnessed a mega code just like that. The busiest unit i ever thought in the hospital that day.

Once the dance is well established, once we are in the middle of doing everything, someone always throws out the suggestion, almost as though it were an afterthought – “someone needs to go call the family screaming outside the unit.”

Calling the family is often more stressful after an hour of reviving the patient that no longer responding.The patient was sick, but as far as I know wasn’t expected to die anytime soon. An older man suffering from a global MI suddenly manifesting ventricular tachycardia thus need an immediate defibrillation. So I told 1 family member that their dad had taken a turn for the worse, that he stopped breathing, the nurses and doctors were trying to help him.

On the other room, a pulmonologist arrived and declared a younger patient, suffering from a chronic liver disease, dead after several attempts of reviving him.

Unfortunately, the two patient did not survived after all medical and nursing interventions combined were made.


I'm back again!

I've been trying and failing to make myself sit down and blog for 10 months now and well before that it was like I was pretty much off to the land of dead blogs.To those of you who check in frequently to see where i am and what I have been up to, I apologize.  I decided to take a long break from the journal.   

I basically went on unannounced hiatus – unannounced since I kept on planning to post but got too busy and stuff with work, life, etc.  It is time to catch you all up on what I been blogging. I’ll be back posting regularly-ish again.

So...after a long hiatus i am back and this blog is coming off hiatus; Feel free to stop by more often and say hi!




Being an icu nurse for nearly 10 months now is not enough for me to master with different toxic cases in the unit mostly cardiac and pulmonary in origin. Proper handling of some of these dilicate cases should be dealt with a good knowledge on Basic Life Support and Advance Cardiovascular Life Support.

Last March 13, i attended 1-day lecture-demo on BLS and just recently a 2-day ACLS @ DDH organized by the Philippine Heart Association - Southern Mindanao Chapter. ECG tracings are not new to me since i already handled cardiac and central monitors inside an ICU setting. Cardiopulmonary resuscitations (CPR), ambubagging, defibrillation etc. were always a scenario and yet am still  hesitant to take a great stride to revive the patients. However, after i attended these trainings, ICU is not that scary after all if only i have a good knowledge and skills. Good assessment plus with good knowledge in reading ECG tracings, we might prevent someone to progress into CP arrest.

In behalf of my ICU colleagues, with many thanks to the facilitators and to Dr. M. Maglana.


Do Not Re-Use Mineral Water Bottles

Many are unaware of the poisoning caused by re-using plastic bottles. Some of you may be in the habit of using and re-using your disposable mineral water bottles keeping them in your car or at work. Not a good idea!

In a nutshell, the plastic (called polyethelene terephthalate or PET) used in these bottles contains a potentially carcinogenic element (sometimes called diethylhydroxylamine or DEHA). The bottles are safe for one-time use only; if you must keep them longer, it should be or no more than a few days, week maximum, and keep them away from heat as well. Repeated washing and rinsing can cause the plastic to break down and the carcinogens (cancer-causing chemical agents) can leak into the water that you are drinking. Better to invest in water bottles that are really meant for multiple uses.

This is not something we should be scrimping on. Those of you with family-do please advise them, especially children. Prevention is better than cure.

How to Avoid: Check on the bottom of the bottle there is a triangle sign and there will be a number on it. If the number is higher than of equal to 5 - then this bottle is safe to use. Whatever number under 5 will release the chemical. For most bottle water, the number is 1.

Did you know chemical released by plastic water bottles can cause cancer? It is not the water that's affecting you but the chemical releases from the bottle.

Source: ADZ Unli.
I often heard these Alert Phases raised from time to time over televisions, newspapers and blogs but i didn't knew what it means until such time i read a blog about it.

Swine Influenza or simply Swine Flu is currently the newest influenza virus that awakens the global attention nowadays. According to some sources, Swine flu is only common to pigs and rare to humans. The strains of virus between human and pigs are distinct. However, the origin of this new strain of influenza called Influenza A virus subtype H1N1 is unknown.

The current statistics of SIV cases as of today reached 251 lab confirmed cases, 2,700+ suspected cases and 9 deaths already with the highest cases found in Mexico City. World Health Organization raised Pandemic Alert to Phase 5. What is this mean?

WHO uses a 6-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans.  The following Pandemic Influenza Phases are:

Phases 1 - 3  = Predominatly animal infections; few human infection

Phase      4     = Sustained human to human transmission

Phases 5 -6   PANDEMIC is imminent; Widespread human infection

Post Peak  = Possibility of Recurrent Events

Post Pandemic = Disease activity at seasonal level

Swine Flu is transmitted through contact spread either direct, indirect or droplet transmission.  so, hand hygiene is highly recommended. Most people will not have immunity to this virus (no vaccine yet; vaccine might be available June 2009), and as it continues to spread, more cases, more hospitalizations and more deaths are expected in the coming days and weeks.

Swine Flu virus  is resistant to older flu medicines but it remains sensitive to Tamiflu (Oseltamivir) and to Relenza (Zanamivir).  Davao City don't have these sufficient supply and the only precautionary measures that our hospitals are preparing were the isolation techniques and contact precautions.

SIV Precautions:

1. Stay home if you’re sick.
2. Avoid close contact with people who are sick.
3. Wash your hands often.
4. Avoid touching your eyes, nose, and mouth.
5. Cover your mouth or nose with a tissue when coughing or sneezing.
6. Wear a mask
7.Wipe down all door knobs and other surfaces with an antiseptic solution such as Lysol especially if you have people in your home with compromised immune systems. Keep a bottle of Purell hand sanitizer by your most used door…so people can wipe their hands before entering your home.
 8. Lastly, refrain from travelling abroad nowadays specially in the countries with high cases of SIV infection.

Signs & Symptoms of SIV:

Ordinary flu symptoms: fever, runny nose sore throat, lethargy, lack of appetite, coughing, diarrhea, nausea and vomiting.

Swine Influenza A Virus subtype H1N1 strain

Ebola Reston Virus

It was reported recently on television and daily newspapers that Philippine livestocks especially pigs were infected with Ebola Reston Virus. Lyndon Lee-Suy, a health department disease control manager, said in a telephone interview that studies show the virus is a "low level" pathogen. Humans can get the virus, but it does not cause illness. It means its safe to eat pork this holiday seasons provided that it will properly handled and thoroughly cooked. 

Ebola Reston virus also referred to as Asian filovirus, Reston virus, or Ebola Reston (EBO-R) is named not after a location in Africa; rather, it identifies a strain of the virus that managed to break out in the town of  Reston, Virginia. This virus was first diagnosed in crab-eating Cynomolgus Macaques (Macaca fascicularis), not humans. Hazleton Research Products' (HRP) Reston Primate Quarantine Unit in Reston, Virginia usually imported 16,000 wild monkeys annually from the tropics, destined for medical research. In October 1989, a shipment of 100 crab-eating monkeys arrived from Ferlite Farms in Calamba City, Laguna; two had already died upon arrival. The monkeys used for breeding come from Zamboanga and Iligan City. Supposedly, Ferlite quarantines the monkeys 30 days prior to shipping.

Several human workers at the facility were infected with Ebola Reston; strangely, none of them died. It was not until after the event that researchers could conclusively state that the virus for some mysterious reason had no effect on humans, while the reaction in infected monkeys was similar to the symptoms in humans in previous outbreaks. Many other important questions about Ebola Reston have not yet been answered. For instance: How did Ebola end up in a primate host from the Philippines? At the time, there was a civil war going on in the area where Ferlite Farms had captured its monkeys; this prevented investigators from tracking the disease outside of the U.S. (Later serologic studies in the Philippines, and elsewhere in Southeast Asia, suggest that the virus may be a prevalent cause of infection in macaques.) More important, though, is the debate about whether Ebola Reston, unlike its predecessors, was airborne. The monkeys that became ill were separated by cages, and were contained in a number of separate, sealed rooms, yet nowhere in the building were the animals safe from the disease.

The three other subtypes of Ebola virus are Zaïre, Sudan, Côte d’Ivoire virus. These 3 strains have been identified as causing deadly hemorrhagic fever in humans, according to the World Health Organization (WHO). Ebola haemorrhagic fever (EHF) is a febrile haemorrhagic illness which causes death in 50-90% of all clinically ill cases. Only Ebola Reston subtype, found in our country (Philippines), has only caused asymptomatic illness, meaning that those who contract the disease do not experience clinical illness. 

  The Ebola Reston Virus                                                       The Crab-eating Macaque

Congratulations Manny Pacquiao

I dol talaga kita Manny... Congatz! sana invite mo naman ako sa party mo with coach. hehehehe!


Am back from being on Blog Hiatus!

So it’s been a few months since my last blog post, and even longer since a proper one. So, i bet you’re all wondering what has happened? This is definitely a long overdued blog post, yet life has just been so busy lately, i literally could not find the time to make a quick blog post.

Now that I have announced that, it has been some time since I have blogged on a regular basis (breaking all the blogger rules, I know) but I felt I had lost focus for this web site.  I have been blogging for anything, but, for some reason, so it isn't like I am not blogging but this site seemed to have lost something.  I won't pretend to know what that was but I lost it.  The fire was gone.  Sure, I could pump out stuff like most blogs:

  • "Wow, this is funny."
  • "Hey, look what I found on Pulsecircle..."
  • "Look, this picture is interesting.  Go check it out!"

But that didn't satisfy me at all.  I just would sit in front of the keyboard when my "blogging hour" hit and nothing would come.  False starts and frustration took over and I decided it was time to take a break.  (You'll notice that bloggers do this kind of thing from time to time.)  Actually, it wasn't that I decided to take the break but my body told me to  I guess I feel like my thoughts and my fingers lost a connection.  They were disconnected.  Each time I sat down to compose anything blog related, it was like my fingers were telling me to stop or refused to function.  I wish I had something more profound to say about it but, normally, it is something I have struggled with for some time.  A typical comment I would use is: "What's the point?"  Then, without much fanfare, I disappeared and left this site to linger.   Sounds very dramatic, doesn't it.

I tried some ideas - reformatting, making some plans to do other things: but I keep coming back to the blog.  But, they were typical attempts at reviving a blog and didn't really make me want to write.

Then, I missed my livejournal blogging.  I didn't realize it on the day but this would hit me as something I should have done.  For the last couple of months, I have been on trainings and documenting some things about it.  It is something I enjoy doing and it is important to me.  But, I missed it this year and within a couple of days, I felt like I had let myself down.  It was a surprise but a welcome one.

So, there you go.  My tale of woe (or boredom).  I'm back.


Oathtaking Ceremony of New Nurses

It was almost 3 months or 81 days to be exact of stressful and anxiety-provoking experiences before the Professional Regulation Commission (PRC) finally decided to release the much awaited exam result of this land - The December 1 & 2, 2007 Nurse Licensure Exam. result. About 28,900 board takers or 43.42% survived the unique, tagalized & mind-boggling NLE. I jolted in surprise &  couldn't stop my tears running on my cheeks as i saw my name in the list of NLE passers on the Inquirer website last February 21, 2008. I couldn't believed myself i belong to these survivors and now here i am - a full-fledge Philippine Registered Nurse. Lucky Me! hehehe!

Last wednesday, about 3,000 new nurses from Davao City and nearby regions gathered at the CAP auditorium for an oathtaking ceremony. Due to a large number of oathtakers, PRC decided to split the populations into morning and afternoon sessions. Parents & expectators were not allowed to enter the hall in this solemn ceremony, of course PRC would not want all of us to fall down during the event due to our huge numbers. Inorder for our loveones to witness our memorable oath, PRC provided a wide screen outside the building. While we were taking our oath inside shivering for a cold temperature, our parents took an agony of waiting under the intense heat of the sun outside. =(

The oathtaking was attended by Hon. Perla G. Po, one of the member of the Board of Nursing. She was adept in Psychiatric Nursing and definitely was her forte of expertise. She jokingly said during her speech that we should not blame her if we got low in Test V (more of Psychiatric Nursing) because the exam was designed and contributed by all of them - Board of Nursing. If we were to blame her then blame the whole Board of Nursing, she added that we couldn't do that already because we successfully passed the hurdles of NLE. Furthermore, she said that we have a responsibility to safeguard our Philippine Nursing and maintain its integrity by adhering to the laws, regulations and the standards of Nursing Practice not only here but also in overseas countries where safe nursing practice has been stricly implemented. She encouraged us to acquire more learnings and more experiences related to nursing practice before we worked abroad for us to have more confidence of the nursing jobs. Her talked runs for about an hour before she finally led us with an Oath of Professionals. The Florence Nightingale's Pledge & Nurses' Prayer were led by the 2 NLE topnotchers present on the afternoon session. Finally, we inducted by the PNA Board Governor here in Region 11 to be the new members of the PHILIPPINE NURSES ASSOCIATION (PNA). The oathtaking ceremony ended at about 3:45 p.m. 



NLE December 2007 result: When?

Today marks the 2nd month since we took the NLE 2007, until now, we are still hopeful that the PRC people will release the much anticipated NLE results anytime today. Rumors spreads like a wildfire through text, e-mails and blog comments as to when the exact time and date the PRC will post the result but no one ever knew when these results will be posted. 

This exam result is prolonging our agony, hightened our fears and anxieties. We want to move on and start to apply what we had learn from college but we can't just easily do that without a license. I know PRC people are doing there bests to make it sure that there will be no more issues this time in nursing exams but being silent as to when the exact result will be released makes us crazy each day. I hope and pray PRC will gives us good news so that our prolonged agony will be reciprocated. May God grant me a passing rate. =)