Wednesday, October 27, 2010

Baby Day

Today somehow I was robbed of all the vents in ICU. Some guy is re-training in the ICU so they gave 2 vents to him. They gave me one vent and the one Nasal CPAP in the NICU (in this hospital whoever covers ICU also covers the NICU). At 7:15 AM we extubated the girl with the abscessed tonsil. At 11 AM the baby came off CPAP. Wow - a whole lot of inhalers for me to take care of.

We got called up to the floors to do a blood gas to assess for home oxygen - but by the time we got there the patient had been discharged? I guess they realized that he is already on home oxygen. Perfect.

And then we got called to dialysis to do an ABG and the poor little old man's PO2 was 40 mmHg. Yes 40. He was just sitting there talking to me plain as day.

Then because I was BORED. I ran all of the venous gases from the ER, and did some ECGs up on the floors.

I feel like I did nothing, but was busy all day.

Then the nursery exploded! I got to do 2 ECGs on newborns, 2 cap gases, attend 4 deliveries. What a day. Oh yes, all of the excitement started to happen at 5 pm. GAH.

And I feel like I was in a big hurry to give my pager away at the end of that shift. And now I am tired.

Tuesday, October 26, 2010

The ICU becomes routine.

I had the most interesting extubation today. This patient has obviously suffered extreme brain damage, even though his wife is certain he responds to her and knows what she is saying. Right. Well Mr. Flaily McFlailerson nearly bit through the tube before we had a chance to take it out. Then we barely had time to deflate the cuff before the guy practically self extubated. For the rest of the day he held his own but had to be sedated and restrained anyway. What a life this guy has ahead of him. He's a poster child for drug use gone wrong.

Then brain injury candidate #2 is breathing away at a rate of 50. All day. Because the doctor wants to do a neurological exam, so they have lifted the sedation. End result? CT Scan tomorrow morning and sedation and paralyzation for the rest of today Awesome. 82 year old vs stroke is my guess. Tomorrow will tell.

And of course... Shift change is coming in 10 minutes and we get called to the OR for a c-section. Awesome. Love the OR greens.

Wish I had something exciting to report.

I just was searching for a photo of the HT50 Transport vent which is the vent we use for internal transports and sometimes ground transports to different hospitals. I found this little web site of this kid who has congenital muscular dystrophy and her account of things in her life. Cute.
http://www.freewebs.com/girlnamedcait/trachsventsmore.htm

And last but not least...

Sunday, October 24, 2010

Exhausted!

I am done. Finally done my 4 day stretch. I have tomorrow off and then right back at it on Tuesday. This leaves tomorrow free for Grandparental Visitation. My favorite.

Anyway. I now completely excel at blood gases (knock on wood). I'm not sure when this happened, but somehow I have become good at this. I have all the steps down finally and have shaken my nervousness. So everyone at work thinks I am AWESOME. This may be a slight exaggeration, but I think that I am awesome. I walk to work now, it takes 8 minutes and the entire way there I tell myself that I am awesome and will do a great job today. It actually seems to be working even though it sounds ridiculous.

I've been giving the old lady on BiPap pep talks. Those, on the other hand, do not seem to be helping at all. I just pretend I am practicing for when my lifelong smoker of a mother is hospitalized and drowning in her own secretions all the while bitching about a life saving, albeit uncomfortable face mask. She was slightly less complainy today, or I just didn't check on her as often - I'm not too sure.

So someone disconnected themself from the ventilator today. This guy is so thrashy and he is on continuous propofol plus boluses and they can not knock that guy out. A nurse made his wife cry today by asking her to please not speak to or touch the patient. Truly. I agree.

I attended an awake intubation. Amazing and terrifying. Poor 21 year old girl with giant inflamed tonsil and a 5 mm airway. The anesthesiologist intubated over the bronchoscope. It went completely smoothly, which was shocking. My job consisted of running between the ICU and the OR for supplies (ET tube holder, bagger for transport). I try to be the most useful student that I can be in order to be loved - which is very important to me.  The pt was transported to the ICU, put on the vent on CPAP, since she was - you know - AWAKE. Later on, the doc on call - just your general run of the mill internist - put her out completely out and drained her abscessed tonsil by repeatedly poking it with an 19 gauge needle, and then pressing a suction catheter (yankauer) up against it. It was disgusting and awesome. Lord knows what will happen to her overnight.

I usually volunteer to run whatever venous gases that lab draws for us. Today all 3 of them were actually arterial. This is interesting because it is actually ILLEGAL for them to draw from an artery. And you know how much RTs love the fact that they are the arterial gas specialists. It was actually pretty entertaining watching the more senior RTs get all worked up and sending emails and calling people. Oh the rage. The rage.

The ICU really makes me love what I am doing now. It is better than the wards by about 300 million times. But I still like responding to ER calls. I'll really miss this hospital when I am done.

This is what my heart failure patient's x-ray looks like.  He should be palliative - not in the ICU.
(image from www.cardiophile.org)

Saturday, October 23, 2010

Sadness

You know how I said everyone was dying? Only one person died today.

The old lady on the BiPap is still kicking. Literally. Man is she cranky. She hates that mask with a vengeance. Then we tried a smaller size and she could open her mouth wide enough to breathe around the mask. I have never been more happy to see 6:45 roll around.

A family was waiting for one more family member to show up to say goodbye before they discontinued care. Unfortunately he showed up 5 minutes after his dad passed away on his own. That was sad. A lot of tears in the ICU today. I find it ironic that the ICU is neighbors with Labour and Delivery. Sometimes families waiting for a patient to die are just mingling in the hallway with families who are waiting for the arrival of a new baby. So weird. Anyway - I was super glad to hear that the family decided not to proceed with a full code. They said their goodbyes and that was that. I was with that patient when he was intubated. Before he was sedated he asked the doctors to do everything they could. Things change.

We did some routine stuff - conscious sedations, ECGs in psychiatry (always a treat). We ordered vietnamese food for lunch. All in all a pretty good Saturday.

Friday, October 22, 2010

Back at home.

Well on Thursday I started back at my home hospital. After 2 months of being a stranger in the hospital, without a security pass and without a clue about where I was going or who anyone was, it was quite the treat to be greeted with happiness and high fives upon my return. I felt like I had come home.

I'm in the ICU again, which is nice because previously I had more than my fill of time on the wards. This means that now I am mostly exempt from doing a billion ECGs every day. I get lots of practice with ventilators, and running blood gases. I enjoy it immensely because I feel like I am actually impacting someone's health. On the down side, everyone is dying.

Today I saw an RT put a non-rebreather mask on a flow meter that wasn't turned on. We figured it out when the sats hit the 40s. It reminded me of the time in the NICU when a little baby kept having brady after brady after brady. It turns out the oxygen tubing had been shut in the isolette door - effectively depriving him of any supplemental oxygen. Oops.

Also - I completely nailed 2 blood gases today, which was a boost for my confidence completely. I applied BiPap to a lady (who hated it and bitched about it the whole time). I don't know lady, what's worse - BiPap or Death.

I have a pile of days to go. Then a pile of days off. Hopefully the weekend goes smoothly!

Friday, October 15, 2010

So Basically

Here I am. Friday night and I am drunker than drunk and trying to write a paper on Transposition of the Great Vessels. This is what happens when your aorta and pulmonary artery are switched around and without surgery you are basically completely screwed.

I am done my last shift in the NICU. It wasn't too busy. The big change was that I was actually comfortable. I helped nurses lift 500 gram babies and I measured baby's heads for cpap toques like I was born to do that. I applied nasal prongs, and I stimulated a baby back from the brink of a serious brady. Man I loved those kids. This was a bit shocking considering I called in sick one day this week from a plain old case of apathy.
I assisted a mom in holding her 23 weeker infant for the VERY FIRST TIME. It was happy and depressing, as I can't help but think that this may be the only time she ever holds him alive -the prognosis is not good. We received a second Jet ventilator from Salt Lake this week in order to give this little on the same treatment that his twin is receiving.

We were a bit slow this day and spent part of the day looking up... placenta recipes. Yes that is right, some people actually eat their placenta. Gross. Well whatever - do what you want. Also some people also engage in a "lotus birth" which means you basically leave the placenta attached to the baby until it falls off. Again... whatever.

I'm not sure if I am ready to return to the land of dosing palliative senior citizens with Ventolin and Respiratory Steroids. Yes - how meaningful.

Tomorrow (totally unrelated to my respiratory life) I am going to San Francisco to watch my partner complete her very first marathon. I'll be all alone there on Saturday night and although I'd like to think I would explore the city and do something exciting, I will probably use the opportunity to catch up on sleep. (Exhausted).

A photo of a lotus birth. Seriously. Is this a bowl they received for their wedding?? A perfect placenta holding device. This is an awesome photo that I found randomly on the internets. GROSS.

Tuesday, October 12, 2010

Blerg

I worked a night shift on Friday night. There was nothing special about it, except that I was EXHAUSTED. And in the morning I had to fly away to celebrate Thanksgiving.

Also, I have looked at the hours I have completed, and the hours yet to complete, and somehow I have a severe shortage of ICU hours. I don't think that'll stop them from graduating me, but will I be good enough? Seriously. After Christmas we are meant to be good enough to work on our own, but I don't see how this will be possible. I don't know how to do anything! I'm freaking out.

I was supposed to work Tuesday, Wednesday and Thursday. Except I woke up this morning in the deepest depths. The kind of deep depths where I can't imagine why I would want to get up at 5 am, and go to a hospital that I am not all that familiar with, and stumble through things all day. The flip side of this is that I know that I still have tons of things to get signed off in my skills book - things that can only be signed off at this one hospital. But I don't care - and I do something that I NEVER do. I called in sick.

So here I sit at home. I've spent the entire day doing book keeping - actually generating some revenue for a change. I'm seriously contemplating dropping out and just having my own business from home. My mom says I am ridiculous. After I have spent so much money on school to want to quit must be so silly. What makes more sense to her is to spend all the money and then do something I may or may not like. It's a sunk cost, the money is gone so it doesn't really matter at this point.

What do I do.

Friday, October 8, 2010

Baby Blue times 2.

I had hardly been at work at all when a code blue times 2 was called. I'm not allowed to go to code blues, so I just stayed back and set up the vents for the 27 week twins which would be coming our way shortly.

So within the span of 5 hours, the twins arrived, were put on vents, received BLES (surfactant), were extubated, and put on CPAP. It was a really good experience for me because I needed practice doing all of these things, so I got all that experience times 2!

Then I was required to come along on a Tim Hortons run. Then something funny happened, because I remember laughing, but I can't remember what it was.

Goodnight.

Thursday, October 7, 2010

Fantastic Day

After suffering through 2 night shifts at the NICU I have been rewarded with a fantastic day shift. I can't really say what was so wonderful, can't put a finger on it, but the day flowed and I got to do tons of fun stuff.

I put CPAP on two little guys. I went to tons of deliveries. I played with a jet ventilator, and also the Drager Babylog in high frequency mode, which is something I didn't even know it did. Amazing.

Some lowlights include - another still birth and a baby with omphalocele. The omphalacele was actually very interesting to see, and in the end the baby is doing alright, all things considered. I provided it with free flow O2 from the bagger for more than an hour! Yay me!

And I found a really awesome picture that goes right here - but blogger is freaking out.


I saw some parents crying today, so that probably means palliative care for some little thing.

We have a baby in the NICU that was born with Idiopathic Infantile Artery Calcification, which is incredibly rare so interesting - but on the other hand usually means certain death. So that's sad too. It's so rare that I couldn't even find a wiki, so I had to settle for this weblink - wrong diagnosis.com.

And back to nights tonight.