Sunday, November 7, 2010

I am Greasy.

I did it. I knew I would eff up this stupid clock thing. So I set my phone back an hour. And then sometime in the night it set itself back another hour. So I woke up at 5.15 (pretend 5.15) and was feeling extra rested and headed to the shower. On the way to the bathroom I happened to look at a clock on one of our walls that hadn't been tampered with. 7.15. OMG OMG OMG. That meant it was really 6.15 and I had to leave in 5 minutes. This was bad on so many levels.

  1. When I work 3 days in a row I generally don't wash my hair on the second day. Just so I can sleep an extra little bit. So two days without hair washing. Gross. And greasy. 
  2. I take a LONG time to get ready in the morning, and believe me it is not because I am paying special attention to my hair and make up. I just seem to be one of those people that operates at a slower speed in the morning. So my waking up time today was actually at someone's bedside while I was doing my assessment on them. 
  3. Breakfast.
  4. Lunch
  5. and Dinner. 

In my 5 minutes of getting ready time, I got dressed, brushed my hair, threw some food in a bag and still left 5 minutes late. And then I drove to the hospital even though it is only 4 blocks away and takes 7 minutes to walk there. 

My preceptor just lets me do all of the assessments and gases in the ICU now. Which I LOVE. Of course he is nearby. And OF COURSE I can't make any vent changes without him actually directing me, but unless I am totally out to lunch he usually lets me make the decisions! I love it! I finally feel like I am hitting my groove. Unfortunately... my brain only has room for so many skills, and now that I am getting good at this critical care business my ABG skill is really plummeting. Thank god in the ICU most patients have arterial lines in. Easy gases 101. 

My patients in the ICU are suffering from major oxygenation issues right now. Both have a PaO2/FiO2 ration of less than 60. That truly SUCKS. As such both are currently being ventilated on ARDSnet protocols. Seriously their gases are nearly identical - they should be room mates. 

One of them self extubated today. This started a chain reaction of chaos. First we were paged to ICU stat, which we were sure meant that he was coding. So we ran as fast as humanly possible. On the way there I passed a wet floor sign, and just in front of me my preceptor lost his footing, but caught it and kept running. I was right behind him and totally bit it on the wet floor, landing flat on my back. He turns around and asks, "are you ok." I replied, "Go on without me." I got up, totally fine but just a bit sore and finished the race to the ICU. So Mr. Extubation was fully restrained, and fully sedated when this happened with no witnesses. I wish I could have seen this. Man, that has seriously got to hurt when you rip a fully inflated ETT cuff through your vocal cords. Anyway, re-intubation took place even though I got yelled at for being too slow with the tube. Seriously, you can't rush quality work. Someone needs to check the cuff, and get the lube ready. 

This was not the first time I got yelled at by that Dr today. Earlier we were cardioverting a ventilated patient and I suggested there was maybe not room for me between the ventilator and the bed - you know, without being electrocuted. She lost it. I am a woman in medicine and I should be prepared to do what it takes, even if it means climbing under the bed. In the end the bed got pulled out so I would fit. I am terrified of being electrocuted during a cardioversion. Surely stimulating a vagal response would be a more reliable method. 

All complaints aside - I really like working with this Dr. She speaks her mind, and truly has compassion for the patients even though she doesn't always show it. And she can be a very good teacher - but she never can remember my name. Oh well, she has months and months to learn it. 

And then... just when the fun was almost over (you know 5 pm - the time when the real fun starts). Code blue. Code blue. More running - but I was more cautious now, what with the previous injury. We coded a PEA for 15 minutes before the Dr. called it. What is a day in the ICU without at least one death. Seriously.

Helpful advice for next time - from Occupational Safety

1 comment:

  1. Woah, interesting day! Remember, safety first!

    Also, I think you described with 100% accuracy my morning routines haha.