Saturday, 29 September 2007

One For the Emergency Nurses

This is a fantastic article. Well written and funny too. I have never done A&E myself but I have a few friends and relatives that do. It sounds pretty hellish even on a good day.

http://ezinearticles.com/?Registered-Nuts---A-Night-in-the-Life-of-an-ER-Nurse&id=145069

I've ceased with the pre-shift ritual of meditating in my parked truck along with a soothing piece of music. No more prayers to God en route to work asking for more patience, more humanity, more understanding. I have accepted the fact that it will be no different than any other night in the Emergency Department, no matter if I blare Yanni's rancid piano etudes or make a promise to God to pass out my own body parts to the discharged patients as they leave. Nothing will change. I use to look forward to making a difference in someone’s life, helping a poor soul whose body has given out. Those moments are few and far between now. Instead, I resign myself to the fact that the next 12 hours will be spent pasting a fake smile on a tired body, going through the motions of caring, repeating ready-made lines of false concern and giving out medical advice that fall on deaf ears. I use to feel important in my role as Charge Nurse at a major ER of an inner-city charity hospital. Now, as I sit in my truck at 6:45 in the evening, gangster rap blaring, I send out a quick impromptu message to God..... "Please God, allow me the opportunity to be gainfully employed 12 hours from now."

7:02 PM-

I receive a quick report of the clingons and leftovers who haven't made it out of the department by change of shift and to no surprise to myself and the night crew, a few names are all too familiar and the reports of their latest "illness" easily recitable from memory. The usual apologies from the day crew for not getting them out before we arrived go unnoticed. A shrill screech from one of the psych beds startles no one. We all just look up from within the "safe" confines of the nursing station, confirm that our overweight security force is camped out beside the room, shake our heads briefly and go on about our business. We go through the ritual of taking our own baseline vital signs, popping a few Xanax and removing sharp objects from our pockets. Patient safety is important and we wouldn't want to accidentally stab one of them repeatedly in the chest.

7:17 PM-

My primary job aside from direct patient care is triage. Initial interview, vital signs, brief medical history, current medical problem, current medications, height, weight etc etc. My first of 35 or so fits the typical profile of this or any other ER in the country. 40 year old, female, morbidly obese, diabetic, hypertensive, multiple psych meds, very little English, less common sense, no means to pay. She complains of the usual nausea, vomiting, diarrhea and generalized abdominal pain. She's already spent thousands of dollars of other people’s money last week for the same complaint. She didn't fill her scripts, didn't follow up with her Gastroenterologist as requested and by no means was this 300 + lb, truffle hunting leech going to alter her diet one iota in order to prevent another attack of diverticulitis. Her idea of a "Clear Liquid Diet" was a bucket of chicken and bowl of menudo an hour prior to her arrival. So here she is, totally oblivious as to why she is still sick. Non-compliant with her meds, non-compliant with the discharge instructions, follow up or diet instructions, which included a bland, low-fat, liquid diet for a few days until she was able to tolerate semi-solid/or solid food.

She bitches profusely when she is not brought straight back and put into a bed, instead she is sent back out to the waiting area for a lengthy wait. We are full and busy with the truly "emergent" patients but she can't seem to fathom this. She barrels through the exit door, into the waiting area calling me every name in the book (in Spanish) and swearing to never come back again. "PENDEJO!", she mutters. Oh, she'll be back.

"NEXT"!

7:31 PM-

My 3rd patient is a 23-year-old mother of 3, the oldest being 10. She has somehow mistaken our "EMERGENCY DEPARTMENT" for a pediatric clinic and wants her brood "checked out" because they feel "hot." No temperature ever taken at home, no Tylenol or Motrin given before the decision was made to spend $1500.00 of other people's money and to waste our time babysitting 3 snot-nosed, unkempt ankle-biters who are no more sicker than the man in the moon. I usher them one at a time onto a scale for weights and am not surprised that each is twice the size they should be at their particular ages. One, I have to pry finger foods and a "Big Gulp" from their obstinate little mitts prior to the weight so as not to inadvertently add 5 lbs to his already triple digit reading. The electronic scale beeps incessantly and reads, "ONE AT A TIME, PLEASE."(Ok, not really) With all their vitals being normal they are ushered out into the waiting area where they eagerly pounce on the furniture and run around like the defensive line for the Attention Deficits.

I am verbally attacked by my obese belly pain lady, who has "been waiting for hours" (uh, how about 20 minutes). I instantly notice the "positive Cheetos sign" on her fingers and around her lips and remind her that the sickest are seen first and to have a seat. She tosses me a "Pincha Pendejo" and rumbles back to her seat. I sneak in a quick call to God asking that he makes sure she looks before she plops back down in her chair(s). I can hear the intercom announcer now, "CODE BLUE TRAUMA, ER WAITING ROOM." I mentally picture the scenario of the code team spending the next hour removing baby Julio from the rectum of a 300-lb verbally abusive Hispanic woman. "NEXT"!!

9:21 PM-

I've survived the dinner crowd with my job intact and make my way back to the treatment area to assist the rest of my team in the treatment of the patients who were lucky enough to make it back ahead of the non-emergent riff-raff. I make my way to the EMS radio station when I hear....."Unit 842 code 2 patient report"....we have a 102 year old nursing home patient,....found unresponsive on the floor....no IV....she's now awake, combative, confused, covered in stool, incontinent of urine, blah, blah, blah..." The report from the nursing home prior to her EMS transport reveals that this patient had a tendency to "dig out stool from her rectum when constipated." "Oh, that's just friggin lovely"

9:25 PM-

The waiting room intercom a buzz......"I beeen waiting for 10 hours, you pendejo...you piece of...." Click!

9:33 PM

Our lovely elderly finger painter arrives, covered in poop from head to toe. EMS personnel smirk as they wheel her by, updating us as to any changes en route. Nope, no changes, except that now she's given up the fight and is again unresponsive and her breathing more shallow. In an instant her breathing stops and is immediately rushed to trauma 1 where CPR is initiated. "CODE BLUE ER-1, CODE BLUE ER-1."

9:57 PM-

"Time of death, 9:55" is belted out by the code team leader. "She never stood a chance." "It was her time." "She had a long and good life." Blah Blah Blah Blah. She had a horrendous death. Born covered in amniotic fluid, but certainly a proud moment for her parents one can be sure. She died, however, covered in shit, piss and bedsores. The nursing home where she spent her remaining days in agony and perpetual loneliness should be burned to the ground. No family, no attention, nowhere near as prominent and proud as she once was. Left to waste while the understaffed workers at Our Lady of the Perpetual Petri Dish took their extended breaks and pillaged through her personal belongings. A courtesy call to the nursing home is placed telling them that Mrs. Mullins will not be coming back and has been transferred to the ECU (Eternal Care Unit). I hear, "Whew, thank God.....CLICK."

10:22 PM-

Our usually bevy of drug-seeking, bipolar, depressed, suicidal, Xanax, Vicodin, Demerol hounds arrive as scheduled with multiple and varied complaints of, migraine headaches, chronic back pain, stress, anxiety, fibromyalgia, blah, blah, blah....! They are easy to spot, almost always familiar, with the same ole' story. Most we know on a first name basis. They are all, coincidentally, allergic to the same medications; Tylenol, Motrin, Vistaril, Toradol, Aspirin or any other non narcotic or harmless placebo we've attempted to quell their "pain" with in the past. The only thing that works is "Demerol" and they must have a large supply of Vicodin in the form of a prescription when they leave. (Vicodin has Tylenol in it but apparently doesn't cause a severe allergic reaction when mixed with euphoria,....go figure!)

Security is usually called, for to tell them "no drugs tonight" is just asking for a fight. $1000.00 later of other peoples money and they usually leave with their buzz on and their script for Vicodin. But usually not before asking for a "shot for the road" or additional scripts for anxiety (preferably Xanax) or sleep aids. 30 pills are often the number of pills given, depending on the frequency of the prescribed dose. This usually last a few days for the typical drug seeker and then they'll usually return with more "pain" and a hungry monkey.

In the age when Doctors are sued for both under treating pain OR for prescribing too many narcotics and "getting them addicted", we medical personal are caught up in the proverbial "catch 22". More often than not I have been written up and on several occasions was at a point where my job was in jeopardy because I challenged their pathetic lies whenever these low-life drug addicts invaded our ER's. Now I just shut up, shake my head and pray for an overdose.

11:12 PM

Waiting Room intercom is ringing off the wall. "...how long will I.......can you tell me where I am on the list......Donde esta su Doctor.......I can't find my child........the dingo ate my baby.....PINCHE PEDEJO, I BEEN HEER FER TWO DAYS AND MY ASS FEELS LIKE SOMEONE POURED SALSA RIGHT UP MY..........click.

Midnight in the garden of good (for nothings) and the evil (doers)-

After a flurry of non emergent triages, (sore toe, "the shakes", anal abscess, foreign bodies in the nose, ears and stomach of a 2 year old, blah blah, blah) I call in an astute, well dressed, middle aged white male, who is walking quite gingerly and refusing to sit. Differential diagnoses race through my head, back pain, abdominal pain, rectal abscess,. or perhaps....no!....NO!......NOOOOOOOOOOO!

Yes!

The story goes (and it is a common one) that he and the Mrs. were "experimenting" in bed (against his wishes, no doubt) when a vibrator was jammed in his keester and is now painfully out of reach. Given the nature of the "injury" he is whisked back to a private room, placed on his side, lubed up like a 57 Chevy, and a valiant effort is made to retrieve the 12 inch "perpetrator with ribs" from his large bowel. All to no avail. At one point we had a hold of the foreign body (actually, it was made in the US) but the colon wouldn't let go of it's new found cylindrical friend. We tugged, twisted, yanked, pulled, all efforts proving futile. Finally the physician stopped, exhausted from the tug-o-war match, with the forceps, commonly used to removed big headed babies, protruding from the prominent lawyers butt, he made the decision to call in the surgical team. All efforts to remain professional, however, fell by the wayside when, during a moment of silence, a low buzz was detected in the room. Had the blood pressure cuff inflated? Were the incandescent lights buzzing? Was the TV on?

No, no and no. We looked at the forceps and noticed they were vibrating uncontrollably, instantly realizing at that point that this thing was STILL ON. A mad rush by the scant crew to the exit door of the private room was attempted as to not embarrass this local professional with our boisterous laughter. No dice.

We will all eventually be written up and apologies made for our "unprofessionalism and disregard for the patient’s privacy and mental well being". That's ok. We needed that to preserve our own mental well being. Still proving that laughter is still the best medicine.

1:02 AM

Ten triages later and its dinner time for this mentally worn crew. We retrieve our food, locate it to the middle of the nursing station and we eat. Not all at once, mind you but usually a bite at a time. Eat a French fry, go wipe an ass in ER-1, a bite of a Big Mac, go clean up cherry cool-aid flavored vomit in ER-4, a sip of Dr Pepper, then physically restrain a combative Scitzo-effective patient. By 2:15 we have polished off the last bite of a hardened burger, ate our last stale French fry and sucked down the last gulp of our watered-down soda. A soda that is now as warm as fresh urine and food that is as cold as Mrs. Mullins in ER13.

2:30 AM-

Ahhh, my favorite time during the entire shift is upon us. The "Last Call at the local bar crowd" (LCLBC) start to pour in to the front entrance, while EMS brings the ones who got the shit kicked out of them through the back ambulance entrance. "Santa Rosa, this is unit 842....we are coming code 2 trauma with a 19 year old male.....closed head injury....intoxicated...combative....soiled....bloody.....no insurance.....blah, blah,blah.

The same ole song and dance spews from this patients bloodied spout as he is wheeled into Trauma-2......"I was just minding my own business"......"I only had two beers"....."I don't do drugs"..... "Can I get something to eat?" "RAALLLLLLPHHH!" "Housekeeping to ER Trauma-2, Housekeeping...."

2:31 AM-

"Dear Lord, If ANYONE can make time travel possible, it's you, God." "Pleeeese, send me forward to 7 AM.

3:03 AM-

Patient waiting room intercom is screaming..........."CLICK"......."BANG, BANG, BANG".

3:15 AM-

I am ushered into the staff break room for a "time out" and reminded by the night supervisor that the cost of the intercom will be deducted from my paycheck.

4:18 AM-

Our portly female beast of a woman is finally ushered back to a room but not before mumbling under her breath as she brushes past me, "Pendejo"! A major "abdominal work-up" is ordered. 40 lab tests, urine tests, stool cultures, abdominal x-rays, Cat Scans, blah, blah, blah......She's placed in a gown that looks like curtains stolen from the Grand Ole Opry, and given the reminder "Opening to the back, please," tossed in for good measure. ("Lord, give me the strength to...........Oh forget it, never mind")

She's given a URINE cup as she bounces her way to the bathroom. She fills it with STOOL. "Housekeeping to ER, STAT."

Can't find a blood pressure cuff large enough so we must take a chance at an erroneous reading by placing it around her calf or forearm. The hydraulic bed grunts and groans with ever twitch and shift from this woman of substances. She continues to bitch and moan and will eventually file a complaint with (in) human resources, I am sure. Multiple attempts at IV access finally yields a vein that hasn't been choked off by the mass of arm fat and IV fluids are initiated. After a quick assessment by the ER physician she is off to radiology, with a little 120 lb tech pushing 600 lbs of patient and bed up to the 3rd floor for a series of $3000.00 radiologic exams. X-rays that were done just last week and that she has no intention or means to pay for. It would have been easier (and cheaper) had she driven to Sea World instead. Certainly more accommodating for a woman of her stature.

5:57 AM-

Multiple early morning stragglers are triaged and sent to wait. The foul odor of urine, poop, BO, booze, vomit, etc, permeates the air. "One Hour Left", I thought. We get all the results of the voluptuous Ms. Hinojosa's tests back and surprise, surprise...."Diverticulitis." Perhaps this time she will be compliant with her meds, compliant with her diet, compliant with her follow up, compliant with life. "Fat chance,"I thought. (Pun intended).

Her IV is removed and a half gallon of fat globules ooze from the harpoon hole. She is hoisted off the bed with the help of several departments within the hospital; half of who will call in sick tomorrow with severe back spasms. The battered stretcher which now resembles a low-rider after a major accident is towed to the back for repair. Ms Hinojosa is discharged but not before requesting a breakfast tray. Request denied.

Off she goes to the local "Taco Cabana" for a flurry of assorted breakfast tacos and a bowl of menudo. "She you in a few days, Ms Hinojosa."

"Pinche Pendejo!"

6:47 AM-

The dismal faces of the morning crew are evident as they reluctantly make there way in, some still in mid-prayer, the newer nurses with walkman's on, listening to ocean waves or cricket noises saturated with Muzac. A quick report is given to the mentally exhausted night crew and apologies made for the missing bed in ER 3 and the dead body in ER-12.

7:07 AM-

Each member of the night crew, each with a phone in hand, are awaiting the instant the clock strikes 7:08 where, with lightning speed, a flurry of buttons will be punched to clock out, ending another horrendous but typical night in the ER.

7:47 AM-

I pull up to my apartment and sit quietly in my truck. I recall the night’s events and wonder if I had made any critical errors in care or judgment. I mentally prepare for the answers to the complaints made the night before by this unique ER culture of ignorant, non-compliant, abusive, poor, helpless, drugged-up, psychotic, dregs of society.

I say a prayer for Mrs. Mullins and her family and curse all those who've abused the system in the last 12 hours, spending thousands upon thousands of dollars of other people’s money but contributing nothing to society what-so-ever. Once I deem that I will have a job come 6:45 that evening, I ease my tired body and shattered mind out of my vehicle, meander up to my apartment and into bed, hungry, frustrated, angry. Where I will fight the demons for an hour or so until I am able to fall asleep. I don't. I am woken by a dream whereby the ER staff are all patients in the waiting room on a busy night. I am called into the back where a 500-lb female nurse is ripping my clothes off with one hand and swinging a 6 foot rectal scope in the other like a pair of numchucks in a Bruce Lee movie. The alarm clock sounds and I immediately spring up and grab my ass, praying that a 6-foot proctoscope isn't dangling precariously from it. It's not. I breathe a sigh of relief and make my way to the shower and into another fateful night of chaos and mayhem.

6:43 PM-

I pull up to the ER, park my truck and sit. I clip on my name badge, giggle as I read our "Mission statement" tattooed on the back. "To extend the healing ministry of Christ," it reads, and I take a minute to ponder that statement. I smile, acknowledge it's powerful and profound meaning and bow my head to pray. "Lord, today, give me your divine power to accept my responsibilities within this ministry. I pray that..."

Just then a beat up delta 88 rolls by on two wheels, with a definite lean to one side. I watch as they take up two parking spaces in the "staff" lot and out pops Ms Hinojosa. I cringe. She leaves a trail of urped-up fajita and menudo through the patient parking lot, into the physicians parking area, towards the ER entrance. Anger churns inside me and I hang my head, looking down at my badge and the mission statement on the back. I try desperately to find the peace and pride I felt just 2 minutes earlier and I resume my prayer......"Lord,....I just.......If you could only find it in your heart to............OH FORGET IT!!!!!....... NEVER MIND."

Michael Brown is a Registered ER Nurse from Texas. He is currently taking no medications at this time.

Article Source: http://EzineArticles.com/?expert=Michael_Wayne_Brown

95 comments:

the A&E Charge Nurse said...

Never worked in A&E, eh.....it's never too late you know ;o)

Many of the problems identified by the ER nurse, such as inadequate self-management of chronic disease, childhood obseity, litigation, consumerism, etc, etc do not seem to have been resolved despite huge health expenditure in the States [16% of GPD I'm told].

Well it's often said that health trends in the US are soon followed in the UK - but aren't we closing down A&Es and opening a few gimmicky "polyclinics".

Gulp, maybe it'll be me looking for a job elsewhere.

Nurse Anne said...

Emergency departments in the USA ar pretty rough. A particular Emergency department may be a regional trauma centre with the medi chopper landing constantly bringing in trauma patients.

Same ED is also full of people with very minor problems who demand to be seen NOW. These people may not have insurance, and therefore are unable to see a GP to sort out routine stuff so they use the ED as a clinic. I have heard of people waiting ten hours to be seen over there. The waiting room is full of uninsured people who want bloody antibiotics for a cold, and repeat scripts for pain meds meanwhile the place is getting slammed with trauma cases and choppers are trying to land.

Our Night sister was telling me that we had a patient come in by ambulance for a hangnail once though here in the UK.

I thought the author was a bit mean to make all of those "fat jokes" about that patient and that made me cringe a bit but I can see how he is burned out.

Anonymous said...

GofEffecy

[url=http://healthplusrx.com/benefits-of-cod-liver-oil]benefits of cod liver oil[/url] Chovaloclilla

Anonymous said...

Buying [url=http://www.thomassabosaleukshop.co.uk]thomas sabo[/url] online can conserve you from the hassle of leaving your house to get a conventional buying spree. You will discover two ways to shop on the internet: by way of a store's official [url=http://www.monclersale4uk.com]moncler jackets[/url] or by means of a web based auction website. Buying at a website gives you a more substantial selection of types and sizes than the retailer. For instance, the turtleneck that you simply need within a size five is more likely to be in stock at the on the net retailer than at a common boutique retailer. It is possible to shop anytime which makes it advantageous for all those who've a busy schedule. You also save up on fuel and dollars, because you do not need to invest dollars on gas or fare.

The mark-up on diamonds is to become expected whenever you consider the reality that dealers must cover their own costs when also creating a profit. They have to deal with numerous different expenses and these end up coming out of your pocket at the finish on the day. For this reason alone [url=http://www.thomasfashionshop.com]thomas sabo sale[/url] makes sense to perform your shopping on the web after you are hunting for excellent excellent engagement rings at an excellent cost.

On the internet [url=http://www.topclarisonicmiasale.com]clarisonic mia sale[/url] do not have these expenses to believe about. The savings they appreciate can then be passed on to their customers. After you buy your diamond rings on-line, you are able to expect to appreciate savings of up to 20%, which is considerable.

[url=http://www.uggbootssaleonlineshop.com]ugg sale uk[/url] Assuming you've decided to purchase a ring, your next step is to decide how much you're prepared to spend. It really is always a fantastic idea to check out some local retailers to view how significantly they charge for the type of ring you need to purchase. This may enable you to make comparisons once you turn your attention to on the internet retailers.

Anonymous said...

Broncos Von Miller Jersey

You can solve this problem by "defragging" your hard drive Increase digestibility of food3

Charles Tillman Authentic Jersey

The priest should seek recourse to all available tools and techniques in his planning and decision-making Unlike humans, who use a variety of political processes to determine leadership and rank, dogs sort out their social order by dominance and powerWhen events happen the information is received through our sensory perception organs: eyes, ears, nose, and touch

Julius Peppers Elite Jersey

Anonymous said...

[b][url=http://www.louisvuittonhandbagsgo.com/]louis vuitton purses[/url][/b] Carrying out business with wholesale dropshippers supply an avenue for ease in addition to a better profit margin. After you are completely ready to cope with the very best dropshippers from SaleHoo you may well be warranted within your customers' fulfillment. Any time you customers are satisfied with the items and services which you and the dropshippers have extended to them, then they may surely be continuously scanning from the merchandise you might be advertising for the world-wide-web.

[b][url=http://www.onlinebagsstore.co.uk/]louis vuitton bags[/url][/b] In order for you your cheap motor vehicle subwoofer to produce loads of bass, you may generally have to have no less than 250 watts of continual energy handling from each and every sub. This will offer you a total of 500 watts of steady bass waves. This is certainly should be satisfy your requirements.

[b][url=http://www.lovelouisvuittonbags.co.uk/]louis vuitton purses[/url][/b] LV wholesale purses is generally appreciates just because Lv purses. Sawyer furthermore Sayid insured through their non permanent historical previous Quite a few years (then several a long time) up to now. Employed surrounding the overall physique, lots of these carriers depart guiding your arm relaxation 100 percent absolutely free; but are unquestionably a great deal a lot more stylish when compared with backpacks.

[b][url=http://www.louisvuittonwalletsmarket.com/]louis vuitton purses[/url][/b] Tag Heuer watches are created by a Swiss organization that makes a speciality of sports activities watches and chronographs. Right after finding this sort of results in the observe creating organization the corporate has moved on to generating other prime from the line products and solutions like eyewear, style components and so on. The company will now be owned by Louis Vuitton.

[b][url=http://www.louisvuittonvipstore.co.uk/]louis vuitton outlet[/url][/b] five)French Vanilla - Vanilla beans are considered to be the best flavor agents. A bean of vanilla can be used to flavor 10 cups of espresso. These beans are ground together with coffee beans. Following move is usually to stake out your tent. Check the floor and make sure it can be pulled out evenly. Should you have wrinkles from one particular corner towards the other it can be pulled far too tight while in the direction on the wrinkle.

Anonymous said...

Mu Yunfan smiled michael kors purses.
Which in the end is how ah Lisseur GHD.
well-behaved animals not seen like the wolf ugg boots uk.
also had a very bad time michael kors bags.

Anonymous said...

tRlx GHD Straightener
jSty wholesale nfl jerseys
mAlw ugg online
7tJeg ghd nz sale
9oQcq ghd hair straighteners uk

Anonymous said...

jOon ghd flat iron
lVkq cheap ugg boots
rTya michael kors purses
3yEwn GHD Hair Straightener
2vLcd burberry handbags
4rTsz bottes ugg pas cher
2mBnr ghd nz
3jWzh louis vuitton sale
9gDje michael kors sale
8xTjr cheap ghd
6cXjs ugg boots uk
2gYmq cheap nfl jerseys
3cUvj michael kors outlet
9xQtc ghd lisseur
2tKnc discount ugg boots

Anonymous said...

kYcm coach
fXnq ugg boots uk
fVtd michael kors outlet
6aNxm ugg uk
1uEly chi straightener
9zVfj michael kors outlet
8cZbq nfl football jerseys
2pTmq coach outlet
6wDgs north face jackets
7nEpx ugg australia
6vVgz buy ghd
1rNmm michael kors sale
9tXos cheap nfl jerseys
5rAbf ghd baratas
7vNsi ugg boots sale

Anonymous said...

xCca coach outlet
xZhq ugg uk
mMth michael kors
8fEae ugg uk
2pTmx chi hair straightener
4tBdb michael kors outlet
8gYdv cheap nfl jerseys
5dEbu coach outlet online
9aKsh north face outlet
7gVct botas ugg baratas
5lNzb ghd hair straighteners uk
9pEum michael kors
6fRqu nfl shop
2vTvw planchas ghd
2zYhk ugg boots usa

Anonymous said...

zJvh coach usa
hJif cUzx michael kors outlet
7xKhv cheap uggs
2sGue chi straighteners
1iIqd Michael Kors
1xEbs cheap nfl jerseys
2aNwm coach outlet online
6zUlo 9bGjl ugg baratas
0vFxo 7bVoh michael kors purses
8zYiy nike nfl jerseys
0pVtl plancha ghd
1sTlp ugg sale

Anonymous said...

It's in fact very complicated in this active life to listen news on TV, thus I simply use web for that reason, and obtain the newest information.

my site - louis vuitton bags on sale

Anonymous said...

It is appropriate time to make some plans for the longer term and it is time to be happy.
I've read this publish and if I may I want to counsel you few fascinating issues or tips. Perhaps you could write next articles relating to this article. I want to read even more issues approximately it!

Also visit my homepage :: Cheap Jerseys

Anonymous said...

You actually make it seem so easy with your presentation but I find this topic
to be actually something that I think I would never understand.
It seems too complex and very broad for me.

I am looking forward for your next post, I will try to get the hang of it!


Take a look at my website :: Air Max Femme

Anonymous said...

These are really impressive ideas in on the topic of blogging.
You have touched some nice factors here. Any way keep up
wrinting.

Visit my web site: Louis Vuitton Handbags

Anonymous said...

I enjoy looking through an article that will make men and women think.

Also, thanks for allowing for me to comment!


my web-site ... famous soccer players

Anonymous said...

Attractive section of content. I just stumbled upon your site and in
accession capital to assert that I get actually enjoyed account your blog posts.
Any way I'll be subscribing to your augment and even I achievement you access consistently fast.

Also visit my page; Cheap NFL Jerseys

Anonymous said...

I am actually thankful to the owner of this web page who has shared this enormous piece of writing at
at this place.

Look at my site ... Air Max

Anonymous said...

You could definitely see your expertise within the article you write.

The world hopes for even more passionate writers such as you
who are not afraid to mention how they believe. All the time go after your heart.


Feel free to surf to my web blog ... http://www.converseshopfr.com/

Anonymous said...

I’m not that much of a online reader to be honest but your blogs
really nice, keep it up! I'll go ahead and bookmark your site to come back down the road. Many thanks

My web-site :: Converse All Star

Anonymous said...

Does your blog have a contact page? I'm having problems locating it but, I'd like to
shoot you an e-mail. I've got some recommendations for your blog you might be interested in hearing. Either way, great website and I look forward to seeing it grow over time.

My web page Basket Air Jordan

Anonymous said...

magnificent post, very informative. I wonder why the other specialists of this sector
don't notice this. You must continue your writing. I am sure, you've a huge readers' base already!

Feel free to visit my site - NFL Cheap Jerseys

Anonymous said...

Anyone who is prepared to get a nicely-toned stomach can use this belt.


my website: Flex belt Discount

Anonymous said...

Hi, i feel that i saw you visited my site thus i got
here to return the favor?.I'm trying to to find issues to improve my website!I suppose its adequate to use a few of your concepts!!

Here is my website Air Max

Anonymous said...

I am sure this post has touched all the internet viewers, its really really
good article on building up new web site.

Visit my blog post Chaussure Nike Air Max

Anonymous said...

Excellent items from you, man. I've keep in mind your stuff prior to and you are just extremely fantastic. I really like what you've received right here, certainly like what you are
stating and the best way through which you are saying it.
You are making it entertaining and you continue to care for to keep it
wise. I can't wait to learn far more from you. This is really a tremendous website.

Also visit my site :: Abercrombie & Fitch

Anonymous said...

What's up, after reading this amazing post i am too cheerful to share my familiarity here with mates.

Feel free to surf to my website; Nike Air Max

Anonymous said...

Hello to every one, it's genuinely a fastidious for me to pay a visit this web site, it consists of valuable Information.

Also visit my website ... http://www.officielabercrombiebe.com

Anonymous said...

Hello, Neat post. There's a problem together with your website in web explorer, might check this? IE nonetheless is the market chief and a large component of people will omit your magnificent writing because of this problem.

Also visit my website Air Max 87

Anonymous said...

I am really thankful to the holder of this website who has shared this wonderful piece of
writing at at this time.

Also visit my blog iclic.com

Anonymous said...

Awesome post.

My blog - Air Jordan

Anonymous said...

Simply wish to say your article is as astonishing. The clarity to your put up is just cool and i can suppose you're an expert on this subject. Fine with your permission let me to take hold of your RSS feed to keep updated with imminent post. Thank you 1,000,000 and please continue the gratifying work.

my web page: Air Max Pas Cher

Anonymous said...

Thank you for sharing your thoughts. I truly appreciate your
efforts and I am waiting for your next post thank you once again.



Take a look at my webpage: Borse Gucci Ufficiale

Anonymous said...

Hi there, I would like to subscribe for this blog to take most up-to-date updates, thus where can i do it please
help.

Here is my web site :: Cheap Nike Air Max

Anonymous said...

You could certainly see your expertise within the article you write.
The world hopes for more passionate writers such as you who are not afraid
to say how they believe. All the time go after your heart.


Feel free to surf to my web page: ralph lauren sale

Anonymous said...

Amazing! Its in fact awesome article, I have got much clear idea about
from this piece of writing.

Here is my blog Michael Kors Canada

Anonymous said...

You really make it seem so easy with your presentation but
I find this topic to be really something which I think I would never understand.
It seems too complex and extremely broad for
me. I'm looking forward for your next post, I'll try
to get the hang of it!

My web page; wealthwayonline.com

Anonymous said...

Hi there to all, it's truly a pleasant for me to pay a quick visit this web site, it consists of priceless Information.

Here is my page - Cheap NFL Jerseys

Anonymous said...

Excellent article! We are linking to this great content on our site.
Keep up the great writing.

Also visit my web-site; Abercrombie Bruxelles

Anonymous said...

Hi there friends, its great paragraph about
cultureand fully explained, keep it up all the time.


my homepage; Visit Website

Anonymous said...

If you are going for best contents like I do, only visit
this web site everyday as it offers quality contents, thanks

Here is my blog; click for source

Anonymous said...

If you desire to improve your experience simply keep visiting this web page and be
updated with the most recent information posted here.


Review my web site Abercrombie France

Anonymous said...

I blog frequently and I genuinely appreciate your content.
The article has really peaked my interest.
I am going to book mark your site and keep checking for new
information about once per week. I subscribed to your RSS feed as well.


Feel free to surf to my website ... Louis Vuitton Bags

Anonymous said...

Really no matter if someone doesn't know then its up to other visitors that they will help, so here it takes place.

my web page: Louis Vuitton Outlet Online

Anonymous said...

Greetings! This is my first visit to your blog! We are a team of volunteers and starting a new initiative in a community in the same niche.
Your blog provided us useful information to work on. You have done a wonderful job!


my webpage Louis Vuitton Handbags Outlet

Anonymous said...

Heya i am for the first time here. I came across this board and I find
It truly useful & it helped me out much. I hope to give something back and
help others like you helped me.

My webpage: http://beta.truck.net

Anonymous said...

Hi there just wanted to give you a quick heads up and let you
know a few of the images aren't loading correctly. I'm
not sure why but I think its a linking issue. I've tried it in two different browsers and both show the same outcome.

Have a look at my web page link

Anonymous said...

Yes! Finally something about mall.

My website; Michael Kors

Anonymous said...

I love it when people get together and share views. Great website, stick with it!


Here is my page ... Montre Guess

Anonymous said...

If you are going for most excellent contents
like me, just pay a quick visit this web page daily
since it presents feature contents, thanks

my web blog ... Louis Vuitton Handbags

Anonymous said...

Appreciating the persistence you put into your site and
detailed information you provide. It's good to come across a blog every once in a while that isn't
the same old rehashed material. Wonderful read!
I've bookmarked your site and I'm including your RSS feeds to my Google account.



my website - Abercrombie & Fitch

Anonymous said...

Nice replies in return of this matter with firm arguments and explaining everything on the
topic of that.

Here is my web blog :: click for source

Anonymous said...

Thanks for finally writing about > "One For the Emergency Nurses" < Loved it!

Here is my blog - tedxyse.

com

Anonymous said...

Hello there! I know this is kinda off topic nevertheless I'd figured I'd ask.
Would you be interested in trading links or maybe guest
writing a blog post or vice-versa? My blog covers a lot of the same topics as yours and I feel we could greatly benefit from each other.
If you are interested feel free to send me an email. I look forward to hearing from you!
Superb blog by the way!

Here is my blog; Michael Kors Bags

Anonymous said...

Hi to all, it's genuinely a good for me to pay a visit this site, it contains important Information.

my blog Cheap Jerseys

Anonymous said...

Asking questions are actually good thing if you are not understanding anything
completely, except this paragraph presents nice
understanding even.

Feel free to surf to my blog post Cheap NFL Jerseys

Anonymous said...

It's actually a cool and helpful piece of information. I'm happy that you just shared this useful information
with us. Please keep us informed like this. Thank you for sharing.



Also visit my website - http://www.tedxyse.com/oakleysunglasses.html

Anonymous said...

Hello everyone, it's my first pay a visit at this website, and post is in fact fruitful in support of me, keep up posting such content.

Feel free to surf to my weblog; Evgeni Malkin Authentic Jersey

Anonymous said...

Appreciate the recommendation. Let me try it out.


Here is my website Nike Air Max

Anonymous said...

Hi there to all, how is the whole thing, I think every one is getting more from this website, and your views
are nice designed for new visitors.

My webpage - Sac Louis Vuitton Pas Cher

Anonymous said...

Write more, thats all I have to say. Literally, it seems as though you relied on the video to make your
point. You obviously know what youre talking about, why throw away your intelligence on just posting videos to your blog when you could be giving us something enlightening to read?



Here is my web-site; Solde Air Jordan

Anonymous said...

Hi to all, how is the whole thing, I think every one is getting more from this
website, and your views are nice for new users.



My web site ... Read More Here

Anonymous said...

Hello i am kavin, its my first time to commenting anyplace,
when i read this article i thought i could also make comment due to this brilliant piece of writing.


Feel free to surf to my website - Bonuses

Anonymous said...

I have read so many articles or reviews concerning the blogger
lovers except this piece of writing is actually a nice article, keep it up.



Review my webpage: Air Max

Anonymous said...

It's not my first time to visit this web page, i am browsing this web site dailly and take fastidious data from here all the time.

My web site; Chaussures De Football Pas Cher

Anonymous said...

Thanks for finally talking about > "One For the Emergency Nurses" < Liked it!

my homepage: nfl jerseys cheap

Anonymous said...

Write more, thats all I have to say. Literally, it seems as
though you relied on the video to make your point. You obviously know what youre talking about, why throw away
your intelligence on just posting videos to your site when you could
be giving us something enlightening to read?

Feel free to surf to my site; visit this link

Anonymous said...

Having read this I believed it was rather informative.

I appreciate you finding the time and energy to put this short article together.
I once again find myself spending a lot of time both reading and leaving comments.
But so what, it was still worthwhile!

Feel free to surf to my blog: Nike Free Sko

Anonymous said...

My spouse and I stumbled over here from a different web address and thought I might check things out.
I like what I see so now i am following you. Look forward to finding out
about your web page yet again.

Have a look at my blog post ... http://ngosummit.com/tory-burch-outlet.html

Anonymous said...

Howdy! Quick question that's totally off topic. Do you know how to make your site mobile friendly? My website looks weird when browsing from my apple iphone. I'm trying to
find a template or plugin that might be able to fix this issue.
If you have any suggestions, please share. Thank you!


Also visit my blog post - Read More Here ()

Anonymous said...

Pretty nice post. I just stumbled upon your weblog and wished to say that I've truly enjoyed surfing around your blog posts. In any case I will be subscribing to your rss feed and I hope you write again very soon!

my homepage; Going Here

Anonymous said...

Hi there to every one, it's genuinely a pleasant for me to visit this site, it consists of helpful Information.

my web site ... Learn More Here (www.columbiacycleworks.com)

Anonymous said...

I loved as much as you will receive carried out right here.

The sketch is attractive, your authored subject matter stylish.
nonetheless, you command get bought an shakiness over that you wish be
delivering the following. unwell unquestionably come more formerly again since exactly the
same nearly a lot often inside case you shield this hike.


My weblog; homepage

Anonymous said...

I all the time used to read piece of writing in news papers
but now as I am a user of internet so from now I am using net for articles, thanks to web.


My website get more info

Anonymous said...

Good blog post. I certainly appreciate this website.
Keep it up!

Also visit my page; Louis Vuitton Bags

Anonymous said...

I believe this is one of the such a lot important information for me.
And i am satisfied studying your article. But wanna observation on few
general issues, The website style is perfect, the articles is actually
nice : D. Excellent job, cheers

my site - Boutique Air Max

Anonymous said...

Hello There. I found your blog using msn. This is an extremely well written article.
I'll be sure to bookmark it and come back to read more of your useful info. Thanks for the post. I'll definitely return.


Here is my web site Nike Blazers for Women

Anonymous said...

When some one searches for his necessary thing, thus he/she wants to be available that
in detail, therefore that thing is maintained over here.


My web blog; Sac Louis Vuitton

Anonymous said...

It's very simple to find out any matter on web as compared to textbooks, as I found this article at this site.

Also visit my web-site; Louis Vuitton Pas Cher

Anonymous said...

I hardly leave responses, however I read a few of the remarks on "One For the Emergency Nurses".
I actually do have a few questions for you if you don't mind. Could it be only me or do a few of these responses appear like they are left by brain dead individuals? :-P And, if you are posting at other online social sites, I'd like to keep up with you.

Would you make a list of the complete urls of all your social
networking pages like your twitter feed, Facebook page or linkedin profile?


Also visit my homepage; Nike Air Jordan

Anonymous said...

I've learn some good stuff here. Definitely value bookmarking for revisiting. I surprise how so much effort you place to create one of these excellent informative website.

Feel free to surf to my webpage: related site

Anonymous said...

wonderful issues altogether, you simply gained a logo new reader.
What would you recommend about your submit that you simply made some days ago?
Any sure?

Also visit my blog ... Sac Louis Vuitton

Anonymous said...

Quality articles or reviews is the main to be a focus for the viewers to pay a visit
the website, that's what this website is providing.

Also visit my blog; Michael Kors (nysacpr.org)

Anonymous said...

Why people still make use of to read news papers when in this technological globe everything
is accessible on net?

Here is my blog Michael Kors Outlet

Anonymous said...

I loved as much as you'll receive carried out right here. The sketch is tasteful, your authored material stylish. nonetheless, you command get got an impatience over that you wish be delivering the following. unwell unquestionably come more formerly again as exactly the same nearly a lot often inside case you shield this hike.

Feel free to visit my website ... Air Max

Anonymous said...

I got this web page from my buddy who informed me about this site and now
this time I am visiting this website and reading very informative articles or reviews at this
place.

My blog post: Christian Louboutin (ngosummit.com)

Anonymous said...

When some one searches for his necessary thing, thus he/she desires to be available that in detail, therefore that
thing is maintained over here.

Feel free to surf to my blog Sac guess

Anonymous said...

Music For DJ House Techno Trance Hardstyle -
Music for Dance - Best Club Music
http://2013.0daymusic.org/
www.uploaded.lt
www.0daymusic.eu
www.0dayvinyls.org
www.filestube.eu
www.filestube.lt
www.mediafire.lt
www.oron.cz
www.oron.dk
www.oron.ee
www.oron.lt
www.oron.se
www.0daymusic.org

Anonymous said...

Have you ever considered writing an e-book or guest authoring
on other blogs? I have a blog based on the same information
you discuss and would really like to have you share some stories/information.
I know my viewers would value your work. If you are even remotely interested,
feel free to send me an e-mail.

Also visit my homepage Nike Air Max

Anonymous said...

This post is actually a fastidious one it helps new web viewers, who are wishing in favor of
blogging.

my blog; Air Max

oakleyses said...

oakley sunglasses, michael kors outlet, nike free, oakley sunglasses cheap, christian louboutin shoes, michael kors outlet, louis vuitton outlet, nike shoes, air max, kate spade outlet, polo ralph lauren outlet, true religion jeans, longchamp handbags, burberry outlet, louboutin outlet, gucci outlet, air max, michael kors outlet, longchamp outlet, louis vuitton outlet stores, oakley sunglasses, tory burch outlet, louboutin, longchamp handbags, coach purses, coach factory outlet, kate spade handbags, ray ban sunglasses, jordan shoes, louis vuitton, coach outlet, louis vuitton outlet, michael kors outlet, louboutin, ray ban sunglasses, michael kors outlet, chanel handbags, coach outlet store online, tiffany and co, burberry outlet, michael kors outlet, prada handbags, polo ralph lauren outlet, louis vuitton handbags, tiffany and co, prada outlet, true religion jeans

oakleyses said...

timberland, nike blazer, sac louis vuitton, sac louis vuitton, ray ban pas cher, hollister, louis vuitton, north face, new balance pas cher, sac guess, louis vuitton uk, louboutin, michael kors pas cher, vans pas cher, abercrombie and fitch, mulberry, ray ban sunglasses, longchamp, air max, converse pas cher, hollister, polo lacoste, true religion outlet, ralph lauren, michael kors, true religion outlet, nike roshe run, nike free, air max, michael kors, hogan outlet, polo ralph lauren, air jordan, air force, air max pas cher, sac burberry, nike tn, nike free pas cher, north face, oakley pas cher, sac longchamp, vanessa bruno, lululemon, nike air max, sac hermes

oakleyses said...

barbour, ugg pas cher, vans shoes, instyler, nfl jerseys, herve leger, wedding dresses, ugg boots, celine handbags, longchamp, marc jacobs, ghd, new balance shoes, lululemon outlet, soccer jerseys, beats by dre, ugg australia, chi flat iron, ferragamo shoes, ugg boots, mcm handbags, canada goose, birkin bag, bottega veneta, north face outlet, insanity workout, nike huarache, p90x, nike trainers, asics running shoes, canada goose outlet, mont blanc, uggs outlet, valentino shoes, nike roshe, giuseppe zanotti, canada goose jackets, abercrombie and fitch, north face jackets, nike roshe run, reebok outlet, rolex watches, mac cosmetics, jimmy choo outlet, babyliss pro, soccer shoes, hollister, ugg

oakleyses said...

converse, canada goose, hollister, rolex watches, ray ban, moncler, swarovski, air max, moncler outlet, moncler, gucci, pandora jewelry, pandora charms, moncler, thomas sabo, pandora charms, juicy couture outlet, karen millen, canada goose, wedding dresses, hollister clothing store, ugg, toms shoes, links of london, canada goose, louis vuitton, swarovski crystal, supra shoes, canada goose, parajumpers, moncler, montre homme, canada goose uk, lancel, vans, juicy couture outlet, moncler, oakley, iphone 6 cases, moncler, baseball bats, ralph lauren, hollister, converse shoes, timberland boots, louboutin, air max, coach outlet store online, ugg