urgent list

10

Orphan season has well and truly arrived and more patients are arriving every day!

With so many new arrivals, we are quickly running out of some much-needed supplies. Our Amazon Wishlist is constantly being updated and if anyone wants to help our new arrivals out we are in urgent need of the following:
- Cimicat milk to feed baby bunnies
- Thin paintbrushes to feed orphaned birds
- Teats (both regular and miracle nipples)
- Biolapis and Promodulate
- Colostrum for particularly new babies
- Rehydration support for sick patients

Our Wishlist can be found at the link below. If you can help out with anything then we (both people and patients!) will be extremely grateful!

https://www.amazon.co.uk/registry/wishlist/3MQX8VLJAMUXN

Thank you :)

Living the Nightlife: Tips for surviving night shifts.


I’m not talking about clinical skills; if you’ve gotten this far, you can do it. My tips about the techicalities of night shifts can be found in my Tips for New Junior Doctors post. Nope, it’s just hard to get used to night shifts at all. I’ve spent quite a bit of time chatting to various colleagues, and gathered a few things that seem to work for me, so this is a lost of suggestions which might help for those struggling to ease into the world of working nights. Not mandatory, by any means. I don’t really feel it’s a complete list, but I do feel like putting it out into the aether. If you have any tips, feel free to add to the list :)

In the lead-up to nights:

  • Sort out your life admin. On-calls don’t leave much time for other things.
  • Try to go to bed a bit later than normal. This is easier if you have a weekend or a day off before you start.
  • Let yourself sleep in late in the leadup to nights. The aim is to shift your body clock closer to when you will be on nights, so that you will feel less of a shock when everything flips.
  • Tell your friends and family you will be on nights. Anyone likely to text/call/whatsapp you during the day. Not to brag or whinge, but so they know that they shouldn’t disturb you, or sulk if you don’t answer!
  • Schedule any deliveries for the days before your nights, or only for times you know you don’t plan to sleep on your nights block. There is nothing worse than being woken up by a ring at the door halfway through your sleep. If you wake up it is harder to snooze off again.
  • Plan your ‘packed lunch’. Yup, 12 hour shifts are long, you WILL be hungry. Your doctors’ mess may not be well-stocked. The hot food and vending machines at your hospital may also be broken; always plan in advance; I spent my first night shift snacking on huge piles of shortbread because the machines were broken and there was nothing else in the Mess. Never again.

On the day:

  • Get as much sleep as humanly possible.
  • It may be easier to sleep in until late, then get up and go about your day before your evening shift sets in.
  • Or, some people prefer to get up at a relatively normal time, and take a nap in the afternoon preceding the night shift. There is no right answer.
  • Eat a good ‘breakfast’ before your shift starts. I usually eat ‘dinner’ in the morning (before bed), then ‘breakfast’ when I wake up (before work) then halfway through the shift when it is less busy (2-4am) I have ‘lunch’.
  • I feel it helps to set out the day pretty similarly to normal days, because it feels less jarring. Trying to eat at reasonably regular intervals also helps avoid that hypoglycaemic feeling of despair and not being able to cope. And the hangry rage.
  • I also pack snacks because long days are exhausting.
  • Don’t forget plenty of loose sheets of paper and your clip board, request forms etc.

The shift itself:

  • You will get a pile of jobs as soon as you start. The aim is usually to band to gether as a team to clear them as soon as possible.
  • Make sure that the person who handed over those jobs gave you all the right infromation.
  • Make two jobs lists: urgent jobs, and the ones that you ‘can do if you find a spare moment’
  • If you are lucky, it will become more peaceful around 2-3am.
  • If you are moderately busy, you will catch a breather around 4-5am as people stop wandering around or going to A+E.
  • You need to eat. If it hasn’t petered out by 2-3am, talk to your counterparts to plan breaks and cover each other.
  • You don’t need to have no jobs or patients on the list to eat or got to the toilet. If there are no urgent ward jobs, you can eat quickly.
  • If the patients waiting to be seen on the acute take have been triaged as low risk, are clinically stable, and have not been waiting long, having a cup of tea and a quick sandwich is not harmful. They will be monitored by your nurse colleagues. Just let your senior know so they can crack on with seeing patients.
  • You cannot look after patients to your best ability if you are exhausted, hungry, dehydrated or bursting to go to the toilet.
  • You never know when 30 people will turn up to A&E at once, or when 5 patients will fall on the wards in rapid succession. Take it easy when you can.
  • If it’s not bad on your take, help your ward equivalent.
  • If it’s not bad on the wards, check the A+E list for referrals and help your colleague clear patients.
  • Update the list whenever you have time.
  • If you don’t have time to eat but are feeling completely exhausted, a hot drink or some juice, or even a cup of water can work absolute miracles.
  • caffeine in reasonable moderation is your friend.

After the shift:

  • Do not drink caffeinated drinks after your shift.
  • …Unless you have a long drive ahead and need it for your safety.
  • Don’t drive long distances after night shifts. If possible, d not drive or cycle at all: you will be hugely exhausted and sleepy so are at particular risk of accidents.
  • Eat your ‘dinner’ when you get home, not long before ‘bedtime’. The postprandial effect may even help you drift off more easily.
  • No matter how awake you feel, go to bed, just as if it was night time.
  • Don’t get out of bed, even if you don’t feel sleepy.
  • If you wake up, don’t sweat it. It may be harder to get to sleep, but you can keep trying. Just stay in bed, don’t play on your phone or computer and you are much more likely to drift off.
  • Read about good sleep hygeine.
  • Don’t play on your phone; that will only kee you up.
  • Blackour curtains or a sleep mask are an absolute must.
  • Close your windows.
  • Put a note on your bedroom door/fridge/etc to let your flatmates know that you are working nights.
  • Explain to them that being noisy is the equivalent of you banging pots and pans around in the middle of the night for them.
  • Silence your whatsapp/text/ringtone. Everything that is not your alarm clock should be switched off.
  • Give yourself a good 7-8 hours of sleep. I always try to sleep more hours on nights than I do normally, by being stricter with myself. It actually means I barely feel sleepy on nights at all!
  • When you wake up, leave a good amount of time to eat and get to work.
  • Night shifts are 12=13 hours long usually. Even with sleep accounted for, if you don’t live too far away from work you still get a couple of hours to eat/watch TV/catch up with someone close/chill. Try to de-stress in that time.

After nights:

  • You get days off! YAY
  • But getting your body clock back to normal will be brutal.
  • Personally, I recommend not sleeping through the day that follows your last night shift, if you can. This will leave you more sleepy when it is night time, and hopefully make it easier for you to go back to normal sleeping patterns.
  • If you must nap during the day, keep it short and set an alarm so that you don’t end up sleeping the entire day and lying awake all night.
  • Despite your best efforts, you’ll probably find that you feel more sleepy during the next few days, and find it harder to sleep at night. That’s common, and your body will eventually settle back.
  • Practise sleep hygeine as best as you can, to settle into a normal pattern quickeer.
  • URGENT: Here is a list of Representatives, who are STILL undecided on what their vote will be for the TRUMP CARE BILL. It looks like they are going to try to bring this to a vote on Thursday, and it's really close. The good news is Rep. Upton is now a no, so we're at that threshold, BUT DESPERATELY NEED TO KEEP THE CALLS COMING INTO THE CAPITOL SWITCHBOARD 202-225-3121.
  • Undecided or unclear
  • AK-1 Don Young
  • CA-21 David Valadao
  • CA-25 Steve Knight
  • CA-49 Darrell Issa
  • CO-6 Mike Coffman
  • FL-18 Brian Mast
  • FL-25 Mario Diaz-Balart
  • FL-26 Carlos Curbelo
  • IA-4 Steve King
  • IL-6 Peter Roskam
  • IL-16 Adam Kinzinger
  • IN-5 Susan W. Brooks
  • KS-3 Kevin Yoder
  • ME-2 Bruce Poliquin
  • MI-3 Justin Amash
  • MN-3 Erik Paulsen
  • NJ-11 Rodney Frelinghuysen
  • NY-19 John J. Faso
  • NY-21 Elise Stefanik
  • OH-10 Michael R. Turner
  • PA-4 Scott Perry
  • VA-1 Rob Wittman
  • WV-1 David B. McKinley
At the whims of Demons

ALRIGHTY So you guys wanted to see what would happen to poor Henry after what went down in the first fic you can read here 

Gonna put a slight warning here about some body horror and various dark themes ect. After all this is a horror game

Keep reading

A family can be 2 traumatised soldiers and their 30 kids (5)

1, 2, 3, 4 

Read on AO3 


Part 5 

“You’re not serious?”

“We have to,” Jyn insisted. “I’ve got Vance and Rivi sucking face whenever I turn my back, and a slightly traumatised Azha asking me what an erection was. We literally have to give them the talk.”

Jyn was not looking forward to it in the slightest, but someone had to be there for these kids before there were accidentally even more of them to take care of. It wasn’t something that had been on the most urgent of lists in her head, but now it was becoming more and more apparent that it was needed. She wondered whether it was ironic of her to be bringing up the subject now of all times, lying in bed with Cassian, naked and feeling a very, very good kind of exhausted.

“Poor Azha. What did you tell her?”

“The bare basics for now. She was more than a little horrified,” Jyn snorted. “Look, really I just need to know what our policy on this is going to be. What did they tell you when you were in the youth class?”

Cassian scoffed a little. “When I was twelve, our commanding officer would fall asleep in the corner. I learned about sex from the holonet.”

“Yowch,” Jyn winced.

“You?”

Keep reading

100 Ways to Say ‘I hate you’ Masterpage

(inspired by @ihavehimontheropes‘s 100 Ways series) 

Pairing: Bucky x Reader

Summary: Loosely connected drabble series where you and Bucky banter, tease and annoy each other until it comes to an end.

MASTERLIST 

Keep reading

RESPECTING YOURSELF

I asked you guys to send me any problems you’re having that are relationship-related and almost every single person who messaged me had the same issue:
None of you are demanding the respect you deserve!!! So many of you said you like somebody who doesn’t know you exist, or you like somebody who treats you like everyone else, or you like somebody who only talks to you when it’s “convenient”. My heart actually aches for all of you, because you guys all deserve SO much better. You all deserve to be treated like precious diamonds but you allow people to treat you like the gum under their shoe!!! I have compiled a list of URGENT things I need you all to know, here it is:

1. If someone doesn’t like you back, stop talking to them. I beg of you, please stop talking to them. If someone wants to talk to you, I promise THEY WILL.

2. Stop texting first if they never text you first!! Relationships (romantic & platonic) are supposed to be equal. It never should be one person starting every conversation while the recipient of these text messages just casually has the time of their life while stringing the other person along lol. Starting conversations is not bad, but you should NEVER find yourself putting in all the effort while they literally do nothing.

3. My brother taught me this one, and it’s kind of an evaluation process. If you really like someone, and put in tons of energy towards them, but you aren’t sure if they’re worth it, do this:
- Think of said person’s good qualities, just off the top of your head. If you have one quality for every finger on your right hand, that just shows that this person is a regular human being because these first 5 qualities will probably be something along the lines of: funny, nice, good looking, smart, and has good taste in music (or something, idk). The reason these first 5 aren’t that important is because these are shallow things that just popped into your head; things you didn’t really have to think about. If you can’t even think of 5 good qualities, this person is a definite no-no, and as my brother says, “a means to an end, and the beginning of a heartbreak.”
- Now, if they passed the right hand test, try your left hand. Try to think of actual character traits this time, rather than typical things like what you came up with for the first hand. If you don’t know if this person is loyal, trustworthy, supportive, etc. then you probably haven’t known them long enough to be this obsessed with them.
- If they have five MORE qualities for every finger on your left hand (unless ur missing a finger or have an extra one or something, it’ll be 5 lol), then they are pretty good. Not the best, but this person is above average, and probably worth half the energy you put into them (rather than worth none of the energy you put in, like the person who has less than 5 good qualities lol)

The more good character traits you can think of, the better this person is for you. You may find after this test, that someone who you thought was so “special” is really just like everyone else.
Just cause someone is “nice”, doesn’t mean that they’re worth putting all your energy into.

4. If you find yourself constantly coming up with different ways to get someone to like you, they are NOT worth your time. Similar to what I said before, if somebody likes you, you won’t have to change yourself or put in sooo muuuuuch effoooort into getting them to even talk to you. Stop hanging onto smiles, stop freaking out when someone says hi to you, stop chasing someone who doesn’t give you the time of day!! When I don’t really know someone but I find myself really liking them, I like to try to think of them as one of my acquaintances who I don’t have feelings for. Would I freak out and replay it 100 times if someone who I met once smiled at me? No!!! That is something EVERYONE does. Humans smile at each other, humans talk to each other, humans naturally like each other! I used to freak out if the guy who I liked (but didn’t know I existed) would even LOOK at me, but when i think about it, i realize how ridiculous that is!! If you have to practically force someone to like you, they are NOT worth it.

5. If someone likes somebody else, or is hesitating between you & somebody else, LET THEM GO. If someone has to choose between you & another person, you don’t want them to choose you! Let them choose someone else!! Clearly this person isn’t right for you, because if they were, they wouldn’t be thinking about anyone else! It’s time to move on. You deserve so much more than you realize. You deserve someone who will actually give you their time, someone who will let you know if they like you, someone who WONT ignore you or string you along! You do not deserve back & forth. You do not deserve confusion & pain. You do not deserve to want someone who doesn’t want you. You have to remember that there are SO many people in this world who would ACTUALLY give you what you deserve. Moving on sounds difficult, but if you constantly remind yourself why you’re moving on, it really isn’t that hard. Express yourself, embrace your personality, find who you are, don’t let another person slow you down or keep you from being you. Take the time in between liking people to really search for yourself and the self love that IS evident deep down. If you look hard enough, I promise you will find what you’re looking for, and I promise you will realize your worth. It changed my life when I realized that I deserve better. It made me stronger and it made me happier. Please open your mind up to the possibility of finding somebody else who actually treats you right, and I promise that your self esteem will thank you. It isn’t good for you to let someone ignore you, and treat you the wrong way. It just isn’t good. If you want to be happy with yourself, and happy in your relationships, the first step is demanding the respect you deserve by moving on from people who will never be able to give you what you need.
Chief complaint: Tingling sensations in ears and rectum x 2 years.
— 

Initial reaction to seeing this on the Urgent Care registration list:

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Then upon taking a history and learning that the patient is on phenytoin, and he hasn’t checked his drug level in years (phenytoin, like most anticonvulsants, can cause paresthesias if levels are too high):

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And later the phenytoin level is twice above therapeutic:

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ON TONIGHTS EUTH LIST
TO BE DESTROYED - 10/01/14
Brooklyn Center - New York

Ruff ruff, my name is Lola. My Animal ID # is A1014670.
I am a spayed female tricolor pit bull mix. The shelter thinks I am about 3 years old.

I came in the shelter as an owner surrender on 09/20/2014 from NY 11413, owner surrender reason stated was “No Time”. 

You can call (212) 788-4000 for automated instructions.