October 9, 2018

Shear Madness!: Top Trauma Shear Comparison

Are you tired of the same old trauma shear?  We have tried many over the years and we cannot explain how frustrating it is to do one day of cutting and the blades are dull.  This is most common with the cheap/ economical shears you can find around.  These are the ones that you toss in the trash easily and don’t really care as much losing.  Most of the lower end shears are from China and or Taiwan.  They use the cheapest plastics and the cheapest metals.  This is why we tend to get dull blades fast and or bending.  We have made our own Trauma shear due to the lack of quality steel and coatings in the industry. Most and almost all use J2 420/ 3 Cr13 steel like the XShear and disposable shear. They use low-grade consumer steel that is very inexpensive to make. Don’t believe the hype of 3mm J2 420 steel as it still is the same as household scissors. Thus we give you the ER LIFE ONE SHEAR™ a Extreme Heavy Duty Steel™ Trauma Shear!

The market now has a few upgraded and high-end options.  These are very sharp, durable, functional, and will last.  Some of the top brands Like Leatherman and X-Shear even have warranties on craftsmanship.  Try to get a warranty from China direct.   Good Luck…

#1 Extreme Heavy Duty Steel™ Trauma Shear ER LIFE ONE SHEAR™

The ONE SHEAR™ is a revolutionary shear that uses simplicity and sophisticated materials. Quite possibly the Apple of trauma shears. Our Extreme Heavy Duty Steel™ Trauma shears were conceived in 2018 based on the idea that wholesale prices were very high for the products others were selling. We found out that J2 Shears even in the $40 range we could produce for $5 through our partners in manufacturing. This was due to the low-grade steel being 420 J2/ 3Cr13 and the titanium coatings which were inexpensive and offered almost no protection. We then did a market analysis and thought of how we could make a great quality product at an affordable rate. This would give access to the public and Healthcare professionals to quality goods that they thought they were buying with the competitors. We took the best from the knife industry and the trauma shear industry and the ER LIFE ONE SHEAR™ was created.

Luckily we had contacts in manufacturing of the world’s most sold surgical supplies. We employed a team of engineers that inspected Kevins exact specs and concept drawings. He broke down everything to exact measurements and insured what the engineers made reflected that.

Key Materials Used:

Extreme Heavy Duty Steel™

  • This steel is almost the highest end steel money can buy and light years ahead of J2 420/ 3Cr13 our competitors use.
  • Known for great blade retention
  • Great wear resistance
  • High Rockwell hardness avg. 58-61
  • One of the high corrosion-resistant metals in the world
  • Found in knives in the $200-500 Price range

Runner Up

Leatherman® Raptor®

This is an amazing product.  Leatherman® has really thought hard on how to create a custom multi-tool, Trauma Shear.  This shear has been seen all around local Emergency Rooms and with EMS.  Recently is has a great following in the tactical realm as well.  Leatherman® is known for its great craftsmanship and a 25-year warranty.  This is the best in the market hands down and they will own up to it.  This company has been around for years and continues to put out great tools.  

I have a personal friend that uses the shears every day as a tech.  These shears held up for years.  Eventually after cutting plaster for casting one too many times; the shears got gummed up from the fiberglass material.  A quick email and send the shears off and BOOM!  He got refurbished and or new shears back.  If anything breaks they standby their products.  Really a great company. The Achilles heel of the Raptor® is that the ring cutter is easily fractured while in-use. We have seen it break even on the first use of cutting rings in practice.

Features of Leatherman’s® Raptor®

  • 420HC Stainless Steel Utility Grade
  • Folding mechanism
  • Strap Cutter
  • Ring Cutter
  • Ruler (5cm)  Great for EKG strips too
  • Oxygen Tank Wrench
  • Carbide Glass Breaker
  • Lanyard Loop
  • Holster
  • Pocket Clip
  • 25-year Warranty

Cons:

  • Price Point is steep on of the highest in the market $69.99+
  • Carbide Glass breaker will wear your pants or scrubs down 
  • Possibly too many unnecessary features for most hospital-based employees
  • Limited colors of handles
  • Ring cutter breaks easily
  • No non-slip coating on handles
  • No coating and highly corrosive steel
  • Not easily cleanable due to the folding mechanism
  • Unable to field strip due to torq bolt center
  • Not left-handed cutting friendly

3rd Pick

XSHEAR

This is a great shear.  It has a simple form with just straight cutting performance.  No bells and whistles just sharp and a 5-year warranty.  We spoke with the Owner Wes and he was so kind as to send us a pair to review.  We have used these extensively and found it superior to other economical traditional shears.  A fair point at $35-$40.  You can almost buy two pairs compared to buying the Leatherman shears.  These shear were very promising in the hospital setting.  We put them to the test in our local ER and found them to cut through almost anything.  Except that cell phone that was in the front pocket….  We cut shoes off , belts, bras, necklaces, and almost did a circumcision.  Thick 420 J2 blades in uncoated and coated in Titanium finishes.  

Features of XSHEAR

  • 3mm thick Hardened J2 420 Utility Low-grade stainless steel blades
  • Sharp edge
  • Black titanium economical coating on certain models
  • Blunt tip design
  • Curved design to cut away from the patient
  • Curved design helps keep blade away from the patient
  • The curved design appears to help pull the fabric into the center cut path, but pulls the cut slightly to left if right handed.
  • Soft inner touch handles for non-slip
  • Heavy-duty center bolt for adjusting if needed via torq key (if you have one)
  • Easily found on the web
  • 90-day No-hassle Money Back Guarantee
  • 5 Year Warranty

Cons:

  • No o2 wrench for medics
  • Price is slightly higher than cheaper economical shears
  • The black finish has dust when first removing from the package.  Time will tell on abrasion testing and cleaning wipes.
  • Titanium coating is an inexpensive coating for the cost of the shear
  • Titanium coating offers little offerings other than black color
  • Soft-touch inner handle coating is not 100% seamless with handle.  Appears to be molded and possibly tear down the road.
  • The metal being J2 420 used appears to be the same as household shears and disposable trauma shears just thicker.
  • No holster with shear included
  • Center bolt required torq key; not friendly for infield strip/ cleaning
  • Not an ambidextrous shear
  • The curved pattern makes sort of jagged cuts
  • Edges of the steel wear quickly due to the inexpensive Ti coating and utility steel used.

October 5, 2018

Most Amazing Winter Travel Nursing Locations in the USA!

Winter time is a great time to get away.  If you are in a inclement area; sometimes traveling is the best option.  Or maybe you are just looking to change up the scenery with a little bit more cash flow.  Here are some of the top destinations and why.

TOP STATES TRAVELED

  • Florida
  • Arizona
  • Texas
  • California
  • Colorado
  • Oregon
  • New Jersey
  • New York
  • Connecticut
  • Massachusets

Where to Travel & Why.

Tampa, FL

Warm Year round Climate

Near Major Hospital Systems

Exciting Downtown Night Life

Busch Gardens, closet to Disney, Universal, and other theme parks 

Arts & Many Craft Breweries 

Phoenix, Arizona

Warm Weather during the day & Cooler at night

Canyons & Hikers dream

Many Hospital Systems including Mayo Clinic & Children’s Hospitals

Sports Teams & exciting events

Close to other Southern states

Sacramento, California

Warm Weather Most of the year

Close to Lake Tahoe

Close to San Francisco 

Great Night Life

Great Pay scale

Hiking & Biking

Colorado

Beautiful scenery

Skiing dream

Outdoors dream

Many Mountains to explore

Great Hospital systems

Laid back atmosphere

Many Art Festivals year round

Boston, Massachusetts

Sports Team Power House

Great Bay side views

Great Night life

Major Hospital systems

Water views are amazing

Close By NJ and NYC

October 2, 2018

Making The Most Money In Nursing.

Racking In The Cash

One of the most common questions we are asked is how much money can I make being a New Nurse?

  • Currently, Indeed.com states $32 hr is the average for the USA (unknown experience level on this amount)
  • South Florida $24-$28 hr 
  • Typical yearly  $50k – $65k is a fair estimate for a New Grad RN

The Next question is, do Nurses make more money depending on the department they work in?

  • The answer is Yes and No.  In some states, Nurses are paid more due to the acuity.  Currently in South Florida Nurses are paid the same rate regardless, especially as a new nurse.
  • Now some hospitals will pay more for a BSN or other high levels of education as a Tier system.  Although most hospitals do not pay more as a base only as an incentive program you have to apply for and do more at the hospital.
  • The Majority of pay is based on years of experience, past specialty knowledge, and or education.

Highest Paid Nursing Positions

#1 Certified Registered Nurse Anesthetist

Making between $105K and $130K annually, these nurses work in both inpatient, outpatient, and emergency facilities alongside dentists, anesthesiologists, and surgeons. It is the nurse who typically prepares the patient and mixes and administers anesthesia. You would be well advised to seek a degree program that offers job-placement, as this market is among the more competitive.

trends-crna

#2 Nurse Researcher

A research nurse can expect to earn a salary between $75,000 and $95,000 per year. Nurse researchers work in universities, medical labs, or any number of industries and nonprofits concerned with healthcare. Strong writing skills are a must in this profession, which requires grant proposals, medical journal contributions, and presentations.

trends-nurseresearcher

#3 Mental Health Nurse Practitioner

In this field, you will work closely with the patients and their families and caretakers. You may find employment at a mental health facility, a correctional center, or you can launch an independent practice. With an average salary ranging between $70,000 and $90,000, work experience as an RN will increase your earnings potential. There are dozens of specializations, should you feel compelled to work exclusively with substance abuse patients, young people, or the elderly.

trends-mhnr

Sponsored School

Featured Programs:

Capella University – RN-to-BSN Completion and RN-to-BSN/MSN Combined Option, Post Master’s DNP and BSN-to-DNP

#4 Certified Nurse Midwife

Paying a median salary of $75,000, this field was one exclusive to women. However, more male nurses are exploring careers in midwifery. Midwives work alongside OB/GYN physicians, assisting with the full range of women’s health services, and advising under unusual circumstances, such as irregular pregnancy and illness. Suggestion: Try the online Georgetown University Master of Science in Nursing – Nurse-Midwifery/Women’s Health Nurse Practitioner(Online).

trends-cnm

#5 Pediatric Nurse

Working with children is a rewarding profession, and pediatric nurses can expect to earn a salary near $67,000. Pediatric nurses may find employment at a variety of facilities, from the ICU to the school system to small practices. Those who work with young patients need to be excellent at communicating with patients as well as their caregivers. 

trends-pn

#6 Orthopedic Nurse

An orthopedic nurse can expect to provide care for a broad swath of patients facing mobility issues due to disease, disorder, or injury. Duties include assisting with surgery, physical therapy, and rehabilitation, and creating a prevention and wellness regimen. Orthopedic nurses generally work in hospital wards, emergency rooms, or outpatient clinics, although there are career opportunities in specialized offices as well. Experienced staff nurses with critical care training can earn up to $120,000 per year. 

trends-on

#7 Nurse Practitioner

A general nurse practitioner is a terrific entry-level position, with a starting salary of around $78K. NPS has nearly endless options regarding the place of employment and are particularly in demand in critical care and mid-sized family practices. A nurse practitioner will need to interact closely with patients, analyzing medical history, symptoms, treatment, and prevention.

trends-np

#8 Clinical Nurse Specialist

To become a CSN, you will need at least a master’s degree in a specialized field of nursing, whether that’s by patient age or gender, disease, or type of care. This field requires a heavy load of researching. Demand is high for CSNs across disciplines, and you can expect to earn a salary as high as $104,000. 

trends-cns

#9 Geriatric Nurse

Nurses who work in gerontology tend to earn about $75,000 a year, but NP certification and skills like being multilingual can bump your earnings potential into six figures. With the aging population in the U.S., geriatric nurses are in high demand and have a range of responsibilities, including monitoring mental health, medication, and preventative care. Geriatric nurses will also need to be skilled in communicating with the families and caretakers of elderly patients. Suggestion: Try the online Georgetown University  Master of Science in Nursing – Adult-Gerontology ACNP/ CNS (Online).

trends-gn

#10 Neonatal Nurse

A very rewarding field of nursing that is highly in demand, this newer specialization consists of caring for newborn babies up to 28 days old. Nurseries for healthy babies seem to be getting phased out, but emergency care for premature babies and newborns with minor illnesses are growing. Neonatal nurses will administer oxygen, medication, and some more basic procedures. Working in the NICU will require extensive knowledge in critical infant care.

trends-nicu
Nursingjournal.org & Indeed.com

Working Over Time!

Do you work 4 days every week or 5 days for one week & 3 days the next?

Working 4 days; you get 3 days regular time up to 40 hrs plus 8 hrs overtime. Over a month’s time, you will have 32 hrs of overtime.  This also makes you feel like you are at work every day each week VS having some days off.  It eventually drags the week out.

Working 5 days you get 20 hrs of overtime. Then the next week you rest and then repeat.  This would yield 40 hours of overtime a month.   This makes you hustle one week and rest the other.  Overall I felt as if it was more relaxing on the off weeks and my pockets were heavier.

Pro-Tip

As a New Grad work at a place that is willing to train you for around two years; especially critical care.  Then jump ship; unless you are able to advance within the facility along with pay.  Most hospitals will put you on yearly raises, but at entering the marketplace at the bottom it will take you FOREVER to get to the market value.  If you leave you now have experience and can negotiate at a high rate.  This typically is $5 more an hour with other sign-on bonuses.  

Also after two years of experience, you may be able to work per diem somewhere else for $30-40 hr and or Agency/ in a pool of nurses for $40-50 hr. 

September 28, 2018

Chainsaw Massacre: Oops I Did It Again…

Have you every worked Trauma?  If not  Trauma patients tend to walk in to even the lowest acuity Emergency Rooms (ER).  From shootings, painful accidents, drownings, and many other low-frequency high acuity scenarios these patients will show up when you least expect them.  Although these could be a high frequency occurance at Level 1 trauma Centers.

Recently at a local hospital; there was a patient that suffered a chainsaw injury.  Now, this can be life-threatening for sure as it has high RPMs and made for cutting hard objects like trees.  It wouldn’t be hard for a chainsaw to easily cut off a limb, cut down to artery or muscle, and even decapitate someone.

This patient came in via personal vehicle.  The patient was found lying in the back seat covered in blood holding his neck.  This patient was accompanied by three other individuals that were workers.  Due to a mild language barrier, it was difficult to find out quickly what happened. The first thought is did he cut deep and any arterial vessels involved and or spine?  The patient was assisted out of the car with multiple personnel controlling C Spine.  A makeshift pressure bandage was applied with a C-Collar and the patient was placed on the arriving stretcher.  Once the patient made it to the back of the ER where the Trauma bay was he was greeted by an army of staff.  The staff was interested due to all the blood and the Charge Nurse informing the Doctor on that the patient had a chainsaw to the neck injury.  This type of injury had not been seen at that ER and obviously fascinated the staff.

The patient was placed in a room and immediately the nurses did what they do best…  They cut the patients clothes off with ER LIFE® ONE SHEAR™s heavy duty trauma shears to assess the patient better and began to hook the patient up to the monitor and start IVs.  Once the wound was assessed by the MD and blood was sent off to the lab; the patient was off to Radiology.  The patient had many CTs done and an Angiogram to check for bleeding due to the injury.  The patient was lucky and missed all major vessel and organs.  This turned out to be a flesh wound that was dirty and needed clean out and closure in the Operating Room.

Later that day the story came out of how the accident went down.  The patient stated that he was on his knees trying to cut a large log when the chainsaw jammed.  After Jamming; he tried to pry it out.  He then attempted to back it up and restart.  His friend behind him helped pull and restarted the saw.  Little did they know that the blade was partially broken.  When the patient tried to start it the chainsaw had so much torque he lost control and the chain snapped at high tension.  The patient lost control due to the torque and hit his neck and the remaining chain hit his friend in the bicep.  The friend also went to the OR due to arterial bleed and muscle involvement.  The patient said all he remembered was a lough snap and his neck was cut.

Findings:

  • Alert and Oriented
  • The left side of the neck had a visual opening of skin showing trachea and neck muscles
  • Dark Blood (the good kind)
  • No arterial blood/ bright ejection or pulsation noted.
  • PT had sensation and was able to talk
  • GCS 15

Testing was done:

  •  2 large bore IV inserted
  • Lab test was done including the type and screen for possible transfusion
  • Fluids started IVF
  • Serial CT exams are done
  • Neck area cleaned and covered to help maintain from infections.
  • OR surgeon called and Patient prepped for OR immediately

Outcome:

  • The patient did well
  • The patient had neck cleaned out and closed in the OR
  • Abx treatment course administered per surgeon and admitting provider
  • The patient was discharged home and did well

Prevention:

  1. Properly oiled chainsaw blades
  2. When the chainsaw torque kicked and didn’t seem to move the patient should have been more cautious
  3. The patient was not using a chain upper guard rail protector
  4. Maintenance all equipment frequently
  5. Wear protective goggles
  6. Wear properly fitting clothing (no loose-fitting garments as they can get stuck in saws mechanisms)

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September 26, 2018

Oops… The Wrong Hole: Forgot the Pull String

Alright, guys,  we have all seen it.  That patient comes into triage and says I got something stuck.  The triage Nurse reply is usually stuck where?  Followed by the patient whisper….. in my butthole.  This usually requires great hidden laughter and professionalism by the Nurse.  Only the most skilled can pull this one off.

What happens when a person puts a foreign body in their rectum?

  • The item becomes hard to retrieve
  • Embarrassment sets in
  • Abdominal pain
  • Peristalsis which causes contracting of muscles and the item goes further up the colon.  Eventually needing surgical removal.

How do you prevent this?

  1. Don’t put anything in your rectum
  2. Only use rectal approved devices with the appropriate attachments and or strapons
  3. Tie a string on it.  Come on, if you can’t put a string to pull to get it out then at least put a handle on it.

Diagnostics

  • Xray Imaging
  • Digital palpation
  • Other US/ CT may help but are not the most typical

Items Commonly Misplaced and lost

  • Vibrators/ Dildos
  • Buttplugs
  • Toothbrushes
  • Golfballs
  • Toys
  • Lightbulb
  • Various vegetables
  • Utensils
  • Squirt Bottles
  • etc.