btp is a teacher now

A patient mentioned he might have too many blankets on. I told him no problem just kick one off. I then remembered he had both legs amputated.

OH MY GOD
This is horrible and hilarious and I am just almost falling off of my chair.
I can't breathe.

My mum was reading over my shoulder and we both pretty much had the same reaction.

We're all going to hell, yay :D

Oh Boy. Hi Plaid's mom! Your daughter is a great artist. Go buy her something fancy.

I've really been neglecting this. In large part because of other projects which I have also had difficulty in completing. But that's the same story I've told a thousand times.

Anyway I am officially attempting to transition out of this job. I mean, I've been trying to do that for months now, but I am officially in the home stretch. My last full-time day was yesterday, now I'm PRN (scheduled to go only once a week). The rest of my time (theoretically) will be spent trying to acquire and prepare for a job teaching highschoolers things about science. It should be a very pleasant change (and one I am highly anxious about).

But my last day was not really a great one. Especially because it reminded me too much of the official Worst Day as a PCA. (hint: Worst Days are when people die.)

This 80 something year old lady came in saturday night. She was complaining of weakness and had been admitted for kidney failure. From a vitals perspective everything was okay, except she had fractured her shoulder recently.

Oh and her blood pressure was like 80/30.

BLOOD PRESSURE LESSON:

Show Content

SpoilerI tend to give people this speel when they seem worried about their BP. It can be scary for them. I come in and hook a machine up and it squeezes their arm and then some number pops up on the screen and it means they are either good or bad and they have no idea why so I tell them:

The top number is highest pressure in your bloodstream, when your heart is pushing blood into your arteries. The bottom number is the lowest pressure, when your heart relaxes.

The best number is 120/80, but you can be in a range around that and still be okay, like 160/90 is alright or 90/60 is okay but both are still high/low compared to where you should be.

When it gets too high, say 200/100 then you have way too much pressure pushing on your veins and it can start to damage them and break things off. High is bad over a long period, but we can manage it through medication.

When it's low, that can be bad right away. See blood pressure is determined by two things: The amount of blood in your body and how big your vessels (veins/arteries) are. If you're dehydrated, that means there isn't a lot of blood in there to fill your vessels and the pressure is low. If something is causing your vessels to open up, then there's more space your blood needs to fill and your pressure goes down.

Generally, when BP is low (in the 80's/ in the 40's) is when you start to worry an ask about blood transfusions, etc.

So that's low.

We put an IV line in her quickly and started pumping her with fluids. If you up the saline in her blood it will up the total blood volume and her pressure will go up to good levels.

Good job team, work is done. See you in the morning.

Morning, 12 hours later:

I come back in and bring my vitals machine. I greet the lady and reminder who I am, that I was here yesterday, and that I just want to check her blood pressure.

She s....oh hey my cute girlfriend just walked in guess I'll pick this up later...

DAMN YOU BOB AND YOUR GIRLFRIENDLY CLIFFHANGEEEEEERS

Sorry for the girlfriendly cliffhanger. I suppose it wasn't much of a cliffhanger, more of a guy who rented a movie but twenty minutes in has to get off to talk on the phone and just makes everyone sit there.

I suppose the proper thing to do would have been save what I had typed into a text file and finish it up later, but that just didn't occur to me when I heard the door knocking.

Anyway I checked the lady's vitals and they were doing a little better, but still low, like 95/45. But what made me uneasy was that when she said "good morning" to me there was a little gargle in her voice.

Note: I learned later, this means she sounds "wet". Imagine that there is glass of water, and you are drinking this glass of water, and in the middle of drinking this glass of water, you try to tell someone something that it comes out all bubbly.

Now put that glass of water inside your lungs.

Of course, what do I know? I'm just the butt-maid. But I check her oxygen saturation and it comes out at 84%.

LESSON ON OXYGEN SATURATION:

Show Content

SpoilerThis is something I wasn't really aware of until I got my EMT certification. but basically there is a really easy way to measure how well your blood is oxygenated.

See when blood is well oxygenated, it turns bright red. When it is not, it's more of a dark red. Well through the magic of a little variation on spectrophotometry, you can hook a little thing onto your finger and it will measure exactly how red your blood is, which equates to how much oxygen you have.

Generally you want from 95-100%, 90% or above is okay but you might need to figure out why. Below 90%, and you need to do something to bring it up.

Okay so that's low now.

I go tell the nurse and grab the nasal cannula (little tubes that you wear like a necklace and delivers oxygen through your nose), and I put her on 2 Liters/min of oxygen (a standard starting dose).

Well her number goes up slightly, but right at 90% so I boost it to 3L/m and go talk to the nurse about it.



So, at this point, both myself and her nurse have an idea of what is happening to this lady, though some of the mechanics of it still elude me.

Here's the deal:

Lady comes in dehydrated - so we give her an IV to bring her blood pressure up.

FOR SOME REASON...

...that fluid isn't staying in her bloodstream. It's leaking into her lungs. This is making it harder for her to breathe. After 12 hours of continuous IV usage, that fluid is continuing to accumulate. She is slowly drowning inside of her own body.

So take off the IV?

NO YOU CAN'T. Her blood pressure is still low, we have to keep the IV on to manage the blood pressure. If she drops down to say 40/10 then there isn't anything we can do for her. With a low oxygen saturation, at least we can give her more oxygen.

So we call the doctor and keep the IV running. (also, we don't technically have the authority to remove the IV against the dr's orders. (we should have removed the IV)).

THREE HOURS LATER.

I check her again. Her oxygen saturation has gotten worse, it's back in the 80's again and we can't seem to get it back up past 90%.

WHAT THIS MEANS: The amount of fluid in her lungs has increased SUBSTANTIALLY in the last 180 minutes. She really is starting to drown.


From my standpoint though...I don't really know this for certain. The nurse has called her doctor and while I know that her oxygen stat is down, it's not sending off any major flags for me.

But I know that the dr. has seen her and written an order to have her move to an intermediate care unit. Somewhere they can give stronger medicines that our floor isn't allowed to give.

I figure that we'll get her downstairs, they'll give her medicine to manage her blood pressure, and then take her off the IV and start trying to get that fluid out of there.

Apparently, that was not what happened. Apparently, an hour after we transferred her and moved her into her new bed, and passed report onto the other nurses, she started coughing up a sickly green fluid, the same fluid that had built up and filled her lungs. And she died.


It really wasn't a good day for me. Even though I wasn't there for her passing, I knew what it looked like. I had seen it happen a while back with another patient of mine. It was why her "wet" breathing worried me in the first place.


Before she passed, while she was still on our floor and getting a little worse, I came into her room and explained in a simple way what was happening to her, and why we needed to move her to another floor. I did it in a way that hid my own concerns, my own worries that I weren't certain were substantiated or not.

"Your blood pressure is running low, so we're going to give you some fluid to help build it back up. Right now it's like a waterballoon that isn't filled all the way. We'll come back and check it to make sure it's working."

"Your oxygen levels are a little low. I think it might be related to why you've been coughing and gurgling a little while you breathe. It's nothing too serious, we'll just give you a little extra oxygen to keep it stable."

"Your oxygen and blood pressure are still low, so we're going to move you to another floor. It's over in another building and they can give you some medicine to help your blood pressure that we can't here. The nice thing about over there is that your nurse will only have a couple of patients, so they can pay a lot more attention to you."

"This is your new room. They'll take good care of you here and get your breathing back on track. They'll be monitoring your blood pressure, oxygen and heart rate on this machine right here."

"You'll be okay. I'm praying for you."


I said that last line at a moment when she was already in the new room. The other nurses had left briefly to gather whatever materials or reports they needed and I stood by her side, holding her hand. Earlier she had mentioned how her doctor was a christian, and how that was a huge comfort to her. I wanted to let her know I shared in that, to comfort her more. Something was nagging me to pray with her then, at that moment. But I pushed it aside and ignored it.

That was probably my biggest regret. Not that it would have changed what happened, but that it would have brought her more comfort.

Working at the hospital, you realize that the prayer of choice isn't that a certain patient would get better (though that is what you hope for) but that they would have an easy transition, wherever they go.

---
This is the part where I toss in the tidbits that didn't come up naturally in what I just wrote. Like how, after we moved the patient the nurse showed me that, the only order the doctor wrote (aside from having the patient moved), was a DNR order (Do Not Resuscitate). The nurse was frustrated because "if she's dnr, why did we move her in the first place."

I was mad because "what the hell? That's the order you wrote?" I don't know the whole story or the doctor's perspective, but there have been many times a patient's well being has been seemingly ignored because they're "DNR". It almost seemed that the doctor had simply written that order because he figured she wouldn't make it and didn't want there to be a hassle. But, again, I don't know the whole story, and my secret indignation didn't seem to be shared.

Of course, probably the worst thing I've heard relating to DNR patients was something said to by a speaker at my hospital orientation over a year ago. The person speaking was in charge of a committee designed to oversee "Variances" aka, things that go wrong. She was talking about the various things that warrant a Variance report and then interjected in a callous way that underlied her annoyance:

"And don't fill out a Variance Report for a DNR patient who dies. That's what's supposed to happen."

wow. When a phrase sticks without because of how uncaring it sounds, that's a pretty big clue that there is something wrong there.

The second thing is that, even now, I don't understand the mechanics of what happened to her. She didn't have any known heart disease. She did have acute kidney failure so her fluid wasn't going to be voided out. And I can understand why it would seep into her lungs (and abdomen - it was very distended - though we didn't notice until we transferred her), if her BP was HIGH, but it was LOW. Generally that would mean that fluid would travel AWAY from tissue and back into the bloodstream. It could have been something with her capillaries, but that's rare, it could have been a heart condition, but she hadn't been diagnosed. Really there are several odd things it could have been. And while I don't really /need/ to know it would help if I ever saw this again. again.

Guys it is official.

The thread title even says so.

I am officially in charge of the science learnings of some 150-odd suburbanite children.

I now have a grown up job

that does not involve scooping poop.



OF COURSE THIS DOES NOT MEAN I KNOW WHAT I AM DOING.

I need suggestions for things to do with these kids. Review games, laboratories, presentation tips, simply cool ideas, etc. (FYI I am teaching them the physics.)

Chances are, if you suggest something here, I will very seriously look for a way to incorporate it, and will probably document doing so in some fashion here.

Think of this as an adventure game, but instead of making suggestions for comic characters, you are making suggestions for the lives of quite a few human beings.

>_

enter them in a grand battle

holy sick!

um, i guess it depends on what level of physics

spin around in a swivel chair holding a ball and release the ball to demonstrate newton's first law

Ask the kids, have them come up with the answers. Make them have to connect their intuition directly to the theory, and to come up with hypotheses based on the current theories covered in class.

include a thing on what science is: trying to understand the observable world by making testable hypotheses and proving them wrong

What kind of physics? Freak out in front of them about standardizing notation. Be intense. Make yourself memorable. Throw shoes to punctuate important facts. Make stupid jokes.

Like one thing my high school physics teacher did that was really cool was, before every single demonstration in class, he made us write down what we would think would happen, and defend it using the theory currently developed in class. As an extension of this, whenever we did any physics problem involving math, we had to start directly from the theory. As in, start with the equations

xfinal = xinitial +vinitial * t + 1/2 at^2
F = ma

and then manipulating them to get
xfinal = xinitial +vinitial * t +1/2 F/m t^2

rather than starting at the second thing. These things made us sure we were actually doing science, as in, actually testing against theory.

also, if it's at an appropriate level, don't hide the math. some people find material easier to understand if they see how it's derived, and/or if they can derive it themselves.

enter them in a grand battle

Hmmm...I'm not sure I can force my students to fight to the death in an alternate dimension...however I may be able to introduce GB themes subtly in my lessons/review questions. I will keep you updated.

Also I was provided with a swivel chair...

Now, this is regular physics, some kids at this point haven't even passed algebra - though some are currently taking calculus...its a very mixed level classroom. So far my goal has been to prepare them in such a way that they will do well on the exams, but that is mainly because I've been struggling to keep my head above water. It is difficult to innovate or inspire when you're not sure what you'll even do tomorrow.

Of course my hope is to get past that point, and really engage students in the material. I like the idea of having the students work to derive the new material themselves. These last few days have mainly been me throwing equations at them...also hacky balls.

Also we're currently in 1 dimensional analysis right now. Aka, displacement, velocity, acceleration and the like.

Blocks. Blocks and spheres and so on. Get them to stand up and move back and forth on a line. Show discrete and instantaneous states.

Oh definitely do the spinny chair trick. Arms out to slow your velocity, arms in to speed it up again. Goes great provided nobody falls out and breaks something.

Buggered if I remember the scientific principle behind this, but I'm a biologist not a science teacher.

Ok. That's like, hard.

I think to be fair, the tests need to be more about the concepts than running the math, but I couldn't tell you how to do that. I'd recommend something about making kids work together, but I know that's like the number one thing I hated to do a lot of the time as a top student.

Maybe try to incorporate the "jigsaw": Divide the class into groups of two or three students. Have each group name an "A", a "B", etc. All the students of the same letter go for 20 minutes to one station that explains one part of a concept (make it clear which involves more math). Then, the groups meet back together and explain the different parts, and work together on problems that involve all of the stations.

This sounds maybe hard to write, but it tries to avoid having one person do all the work.

---

There are all sorts of things to do with a spinny chair.

You can demonstrate F=ma by putting one kid on the chair and pushing them, and then putting two kids on the chair and pushing them.

You can say that the spinny chair is an approximation of a frictionless system!

Okay I am for sure am going to do the spinny chair - at least when we get to circular motion.

I will keep a wastebasket handy for vomit-prone students.


At the moment I am putting together questions for a review game over acceleration and the like.

i.e.: Draw a velocity-time graph for a base jumper whose parachute does not open.

No one has mentioned Bill Nye yet. Someone should do that. (It should be you. To your students. In video form.)

Also, small, clear plastic containers with different weights of junk in them duct taped shut and dropped off of some sort of roof can be used to demonstrate that weight and acceleration due to gravity. (I encourage basically any teaching that involves throwing and rooves.)

(Also, who the heck came up with "roofs" and why have they not been shot yet.)

do story time
my teacher did story time it was great
but uh
i don't remember any of the stories

make up your own stories that demonstrate physics concepts it will be great

how much physics demonstration equipment do you have
do you have that static electricity generator with the belt and the big metal sphere (what is it called???) have them line up in a chain and shock themselves with a metal doorpost

Oh definitely do the spinny chair trick. Arms out to slow your velocity, arms in to speed it up again. Goes great provided nobody falls out and breaks something.

Buggered if I remember the scientific principle behind this, but I'm a biologist not a science teacher.

Moment of inertia + conservation of angular momentum.

When you pull your arms in, you decrease your rotational inertia and you're "easier" to spin, so your rotational speed goes up to keep the angular momentum constant.

Edit: Bob if you share what curriculum you are supposed to cover I am sure I can come up with all sorts of demos and shiz. Do you have any budget for materials or would it have to come out of your own pocket?

Crowstone's talking about a Van de Graff Generator.

So my high school physics teacher was the impeccably organized type who probably sorts his undergarments by color, and also had a set of pretty useful handouts for each lesson that he uploaded online without fail. They more or less described the entire lesson.

Being the crazy nugget that I am, I downloaded just about all of them. I don't know if this violates teacher bushido or something, but I can donate his lesson plans to you for your perusal/inspiration. They're divided by unit too.

Protip: Teachers are 100% pro-theft. I would adore you if you would share some of those lessons with me.

I don't know if there is a budget for labratory supplies, but I would certainly be willing to invest some of my own capitol into my students. The current curriculum calls for 1-dimensional motion analysis to wrap up next Thursday, and that Friday would be an awesome day to do some sort of demo to get the kids excited about Forces.

Also I don't know if we have a van de graff generator. I hope we do, but I don't recall seeing one when I had my brief tour of the supply room.

I could share the lab about gravity and acceleration and etc in a bit if you want. It's tying paperclips to a string and dropping them on a metal pie tin, and seeing what pattern of spacing along the string results in equal time intervals of pie tin crashes.

Choo choo
64 megabytes of lesson plans incoming.
https://www.dropbox.com/s/o12k8n4nz0d4m4...uments.zip

Hmm. I find it pretty hard to get excited about forces by themselves.

You could try and reproduce one of those setups that are counterintuitively on equilibrium. Maybe even show it in motivation poster form to earn Cool Teacher Cred.

On the other hand if you had a lightmill at hand then that would just be great.

trebuchets totes need to happen. Just gotta wait for pumkin chunkin to start up again. I did manage to do a neat demo in class about inertia (this one actually) Twice my students knocked water everywhere, but it got the point across.

Also, without fail, all six classes became very excited when I informed them that the coeffecient of friction is pronounced "mew", like the pokemon.