Saturday, December 05, 2009

In Which Jo Feels Like A Real CCU Nurse.

Yank the blood out. Put the blood back in. Hook up the machine that scrubs the blood and yank out more blood. Make sure it's going back where it belongs: you don't want the patient exsanguinating all over the bed! God, lungs sound like crap. And sats are crap, come to think of it. And the vent's yowling at me.

Fiddle with the vent. Call RT. The vent won't stop alarming; could you please come help me out? The marvelous, marvelous RT department at Sunnydale dispatches one of their folks. She fixes the problem in about two seconds, helps me turn the patient, suctions him, and disappears in a golden cloud, angels following. (Have I mentioned how much I love respiratory therapists? Their motto should be: Removing Asses From Slings, One RN At A Time.)

Patient is hypotensive. Drop rate on bloodscrubber. Still hypotensive. Reposition patient. No go. Up the pressors. Hmmmm....better, but still not great. Best call the doc while I'm dropping the sixteenth blood draw of the day off at the lab. How the hell do you end up with a stage IV ulcer *there*?

Doc has no freakin' clue what to do; tells me to figure it out. Uh...yeah. Okay. *deep breath* Drop rate further, up that other rate a little more, cut back on this one and raise that one just a titch. Voila! A MAP of 68, just where I want it! Wow. This pressor stuff really works.

Wups! Bed and scrubber are alarming at the same time. Check scrubber first. Reposition patient. Figure out that their access is wonkily positional; deal with that. Deal with bed. Deal with cooling blanket. Deal with IV pump that has suddenly blown a gasket. Draw more blood.

Change a couple of ew yick dressings. Meditate on the enormous *thing* coming out of my patient's head and be glad they're not awake to worry about it. Wonder why the notch has suddenly disappeared from my A-line tracing. Discover that that, too, is positional. CVP and MAP look good, CPP is right where it should be.



Up the rate on this drip, drop the rate on that one, change a bag on the scrubber, hang a new bag of stuff here and there. Check insulin drip. Check potassium drip. Check the anticoagulant infusion and the calcium infusion and that thing that's supposed to keep my patient calm. All good, all serene.

Don't kick that machine. It will make whooping noises for several minutes if you do that, and you won't be able to turn the alarm off. Wups!

CPP's okay, but MAP is dropping again. Am I more worried about kidneys or brain right now? Kidneys, actually (how odd, not to be worried about the brain). Cut back here, reposition there, up this, drop that. Patient suddenly isn't moving his right side. Well, that sucks rocks. Call doc. Too unstable to go for a CT; we can't do anything about that. Keep monitoring.

Right side comes back. So does bowel function (the patient's, not mine). Deal with that, change a dressing again, reposition. Make sure the wire coming out of the head isn't kinked. Pupils are still happy and reactive, right side seems okay, all good on the technical front. But those pressures still aren't where I want them. Fiddle some more.

Now patient drops *left* side. It's not ischemic, and I've never seen a bleed in an anticoagulated patient that simply resolves. In fifteen minutes, left side is back.

Docs rounding. Answer myriad questions, some of which are actually not covered by the paperwork they're holding. Get new orders. Change drips around. Change settings hither and yon. Make a couple of jokes with the pulmonologist. Glance out the window: when did it get dark? Grab lab results out of computer, ponder.

Charge rounds. Quick report, interrupted for bag-changing. Make sure all tubings are fresh. Make sure everything is clean, neat, stocked, and generally shipshape for oncoming shift.

Night relief arrives. *whew* Thank Frogs she's had this patient before. Head-to-toe together at the bedside, go over settings for one-two-three-four-five-six holy cow machines. Sign off. Remove self from computer.

Burger. Beer. Bed.


Alpine, R.N. said...

~claps~ you are officially my hero! That sounds WAY more than competent!

Homemaker Man said...

As someone about to start nursing school, I probably SHOULDN'T be reading this. But I can't help myself. That was awesome.

Penny Mitchell said...

You are every shade of wonderful that has ever existed.

Elizabeth said...

Sounds like you did an awesome job! Was this a 1:1 assignment?

bobbie said...

Get up tomorrow and do it all over again...

YAY for you!!!

CCSutton said...

How you do it, I don't know....

Anonymous said...

Really well done. You know, I hang more than two titrated drips, I begin to think it's time for the patient to go to the unit. Throw in an invasive monitor, and I'm a babbling idiot. You guys rock. Just don't let any of my colleagues in the ED know I told you so.

And yeah, RTs are saints, mostly because they deal with hork, which is mt least favourite body fluid.

Unknown said...

You go gurl. Feelin' all warm and fuzzy inside. You make me miss the critical's.

Carolyn said...

I'm a MICU girl. We don't do blood scrubbers. It's all pulmonary, pancreases (pancreae?), and GI bleeds with bad hearts at our shop. I'm good with the pressors.

What the Hell is a blood scrubber?

mike said...

My guess is blood scrubber=hemodialysis

JacquiBee said...

Jo your going great guns. Just when I think "I wonder if I'd like ICU" you write this and frighten the sox off me.

GingerJar said...

I just got to take care of my first balloon was scared silly, but all turned out all right. Recent policy change meant I had two patient's instead of just the I was sweating bullets.