Wednesday, April 08, 2009

i've heard it all

No big surprise, our ICU census was full last night- all 20 beds occupied. Our step-down unit was only 3/4 full- 15 beds occupied. So when we got the EMS phone call at 3 am that we were getting three smoke inhalations, guess what?!?!, our three "stable" ICU patients (non vented/demented/etc) needed to head to the step-down unit.

Our prospcects were grim..
- two vneted patients over the age of 90
-two patients on CCVHD, also vented-duh!
-one fresh 30% degloving injury with history of dementia
-one 60% deglving injury, vented, in DIC
-new purpura syndrome admission with GI bleed
-fresh post op of STSG to bilateral legs on heparin gtt for a PE
-fresh extubation with signs of anoxic brain injury from initial carboxy hemoglobin > 50
-quadriplegic wound management patient with a 12% ejection fraction (systolic heart failure, ya think?!?!?)
-etc, etc,

And just who were the lucky three???

1. Thitry something year old man who refused to leave his room stating that it was Passover and that he had hired a cleaning service to come in and purify the room and it's air. Nope, under no circumstance would he leave his room to be sent to a "dirty and unholy hell hole" -direct quote.

2. Middle aged man with severe MR that likes to streak in the hallways and jump up and down naked when moaning and screaming when we do his burn care. Oh yeah, you can forget going near him with a needle for labs, let alone for IV placement...too bad he is going to the OR today for surgery.

3. Older woman with extensive history of ETOH, only 6 hours past the threshold for severe DT's. Did I mention she's obese and refuses to wear bipap so she essentially goes apnec every two minutes.

So glad that shift is over! Never a dull moment.

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