Thursday, July 29, 2010

OMG OMG OMG

Just when I have almost lost faith in the ICU the day completely explodes and saves the internet from my personal life!

Yesterday was so slow, that someone called in sick, and we couldn't find anyone to come in. Still totally fine. Then the other student started puking - sent home. Mid-afternoon I was sent to Tim Horton's for treats. Totally fine - nothing happening, no crises.

Queue Today.

We started the day with 1 intubated adult and 1 intubated baby (32 weeks - so just tiny enough.)

First thing we get called to do a stat ABG on a patient we extubated yesterday. For the record I did not think she was with it enough to be extubated, but I don't get a say in things that happen. At 4 AM an RT was called because she wasn't looking great and they put her on BiPap. BiPap is great if your patient isn't obstructing. When we did the gas the pH was 6.9 and the CO2 was 110!! OMG, no one noticed this? Seriously. I wonder.

So there we go - intubation. Head count - 2 intubated adults. We also had to put an art line in, and my preceptor hadn't done one in quite a while, but we got the job done. We weaned to pressure support later in the day, and otherwise simply monitored this patient. Oh and I drew multiple gases off of the art line. Oh excitement. Oh the vamp.

We popped in on the baby to see if she would tolerate a switch to pressure support today, made the change and planned on extubating later in the day.

Our other intubated adult was a female with a neck mass that was compromising her airway. She was fully awake and not even restrained in any way. My preceptor the day before barged in and sxn'd her without even talking to her. She sxn'd her multiple times, and even instilled while the patient laid there patiently. Eventually after my preceptor loudly shouted to the nurse, "Can I get some sedation in here," the patient motioned to her clipboard and wrote a note saying, "Please leave me alone."
Anyway back to today. All of the ENT specialists (all 2 of them) are going on holidays so this patient was  airlifted to a bigger center today for closer monitoring by an ENT professional. Good choice. Cross this intubated patient off of our list.

Somehow this has taken all morning and I am just shoveling some salad into my mouth, when a code blue is called. As per custom, we all take off running down the hall. I lost all of the change from my pockets, but some nurse handed it into our office! So I have lost the change, and sprinted up a few flights of stairs, by the time we arrive I'm pretty much thinking they'll be coding me soon. The ICU staff turns to look at us and says, "Oh, we have this under control now." Great. No problem. However, we proceed to intubate (well assist anyway - for some reason the Docs really love doing their own intubations), and insert another artline. My preceptor is pretty freaking glad she had that practice one this morning since now a resident, the doc, the paramedics who have arrived to transport her to a cardiac center, and the transport RT are all staring at her. I totally am loving this whole time that I am being told to collect things, and run and grab things and I have no idea where any of this is. That really helps the idiot complex. Finally they take this patient away. We are back to one intubated patient!

We run over to the NICU to check on the baby.... and the NURSES have extubated. Well, whatever - this is just how they roll here.

After cleaning all of the dirty equipment (multiple vents, a bipap, and the baby vent) and doing all of the checkouts on them I think I had 30 minutes to sit down before shift change. Chaos, absolute chaos.

Semi Competent on the Drager Babylog


Mostly Competent on the Vamp Art-line System


Fully Competent  at consuming anything Tim Horton's.

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