Friday, March 28, 2008

Full Moon

My last 4 night stretch was insane. A little recap for your reading pleasure...

Night # 1: 95%er, see this post

Night #2: Freshly extubated patient goes into respiratory distress, with sustained tachycardia and hypertension, spiking fevers, and one nasty tunneling pressure ulcer from an unclosed section of autograft, and pooping gallons of poo. (oh the glory that is my job)

Night #3:
-Upon return from the hyperbaric chamber, a smoke inhalation admission (Pt A) from night #2 drops her BP to 60/30, her heart rate beats at 185, her troponin 0.7....can we say having a massive heart attack?
-While pt A is having her heart attack, the fellow sees a lab result from another new smoke inhalation patient and realizes that the patient needs to have a STAT arterial blood gas drawn...respiratory distress, here she comes!.
-A float nurse, taking care of pt C, decides that because he isn't familiar with burns and just wont do wound care...umm., that didn't fly with the us nurses. The above metnined nurse also revealed that he doesn't know how to use an A-line...uh, okay. maybe you should have told us that before you got report, now the assignment has to be changed at 2am.
-Then arrives incareratedpt E and his chain gang guards. No one can get blood from him...nurse Kelly to the rescue...guess I was feeling like a vampire, got it on the first stick.
-Pt F, thinks it's a good time to have runs of PVC's and then go into V-tach.
-About this time the central lab calls to inform Nurse M that patient E's blood sugar is 44. Did I mention that Nurse M is also taking care of patient F? So I venture in to give some D50, but what do you know?...the patient has pulled out her IV! Okay, IV dextrose out, oral glucose gel in! I

'm sure more was going on during this time but my head really couldn't do much more.

Night #4:
-Pt A has another cardiac episode.
-2 admissions from the ER...why do people let their kids play with matches?!?!?
-Mr. A's (not to be confused with Pt A) trach balloon popped thus severely diminishing the ability for the ventilator to deliver his oxygen. What to do?!? Yup, replace it STAT at the bedside. Oh yeah, that's right, there is ah hospital wide shortage on #8 trach sets...quick, run, to another room and see if they have an extra set. Found one! Thank God it's still in the box and plastic wrap, so much for isolation precautions. Uh, nothing a little bleach wipe can't fix!
-Back to pt A. She's maxed out on pressors, we are having to doppler her pulses every 30 minutes. Uh oh, we just lost the pulses in the right lower extremity. Call the on call fellow STAT. Oh wait, don't get excited, there just wasn't enough gel on the probe. Pulse is still there, weak-but there.
-On to pt E. Her NG tube is clogged. Can't auscultate it in the stomach, can't flush it. Out it comes. In goes a new one, we think. Nope, it's in her mouth. Try again. Nope, can't hear it in the stomach. Try it again. Nope, can't flush it. Enough! Text page the resident. His response: "No way, you're kidding, right? We couldn't get one in her the other night, she has some really funky nasopharygneal anatomy. Try it one more time, then let me know." Result? By some miracles of God, I got it in. All pt E had to do was tip her head back and continuously swallow....easier said than done.
-Did I mention that while all this was going on, our tube system (just like the ones at the drive up window at the bank) was down meaning we had to call escort to deliver all of our labs and/or send a nurse down to pharmacy to sign for meds and narcotics.

Again, I'm sure more was going on, but let's face it...we were already dealing with enough.

I wish I could say that I went home to bed, but I did not. Instead I hauled my tush across town to catch a 9:30 train to Philly to hang out with my favorite 2 and 4 year olds (R & J) for the week. Naps just weren't in the cards for R& J on Monday (who could blame them, Nurse Miss Kelly was in town!), so neither was a nap for me; however, when I finally crawled into bed at 8:45 pm after 32 hours of being awake, I was asleep in less than a minute, and it was pure bliss.

Back to work tonight. Wish me luck.

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