Monday, September 26, 2011

My Nose is Itchy.

I worked only one day out of the last set up in the ICU, As such I fell victim to the phenomenon that I like to call - "You will have the patients no one else would like to care for." This included a quadriplegic who is actually quite nice but is a lot of work. In fact, if you take this patient (let's call him Simon) as one of your patients for the day, you will actually only have to take on one or two other patients - just because he is so damn time consuming. Also, since you end up spending a lot of time in his room you end up doing several non-RT functions. So. At 9 AM Simon's day begins with cough assist which is coordinated with physiotherapy. In case you have never heard of cough assist, it is basically a vacuum which blows air into lungs, then sucks it out - which sort of simulates coughing in a patient with no ability to cough. Usually 3 breaths are done (in, two, three, out, two, three), patient is suctioned, and then this is repeated 3 or 4 times. Physio co-ordinates care with us in order to do exhalation vibes.

After cough assist is done physio gets to leave the room. I swear to god they think this is the easiest patient in the entire hospital. Then we do some TLC breaths with the bagger. Phew. Almost done. Ok, so now administer some Ventolin and Atrovent in preparation for the next step. What Simon? Your eyes are itchy? Ok, so now get a cloth and scratch Simon's eyes. Ok. So the cloth isn't wet enough. Get the cloth wetter. Soak the eye. OMG. Wrong eye. Ok. The cloth isn't the right temperature. Fix that. Neck is itchy. Nose is itchy. Ok. Solved the itchy problem. Almost done right? No.

Simon has an antibiotic nebulized through the vent circuit. Easy peasy, pop it in and go? You wish. Ok. The antibiotic is a powder. It needs to be re-constituted right before you give it. So you mix it up with the normal saline. Now you need to exchange the exhalation valve and flow sensor on the vent so that doesn't get gummed up with this sticky mixture. Ok, done and done. Neb mode started on the vent. Now you get to sit around and wait 30 minutes while it runs. Fantastic. Itchy neck. Itchy eyes. Can you put some lotion on my face? Can you put some eye drops in my eyes? Yes, yes, and yes. Increase the volume on the TV. No, too loud. No, not loud enough. WHAT? You want some ginger ale?! Right. So we let him suck up some ginger ale, swish it around in his mouth and then we suck it out with a yankeur. Fantastic. 20 times. Then Simon starts telling me about how he misses coffee, and pringles (which I misinterpret as "pickles" and he turns purple with frustration trying to make me understand), and beer. I feel terrible for him and also feel terrible for not wanting to scratch his eyes or the inside of his nostril. Sigh.

So, the antibiotic finishes and then I have to switch back to the original exhalation valve and flow sensor.

Repeat at 1600 hours.

Oh. Also, I forgot to mention that this patient is on the vent - so you have to bag him between sets of cough assist. With your free hand. And he is fully on isolation - don't forget your gown and mask. And finally? Simon can't really vocalize - better get really awesome at reading lips.

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