Survival Miracles - a ghost story
Every unit has that patient that the nurses decide "he's going to make it.". As a team, they analyze labs, tests, research treatments, etc. They find that one doctor willing to listen and present more facts than he wants to know and change the course of treatment for a patient. Believe me it is not easy to talk a cv surgeon into letting us prone a recent cabg patient with chest tubes, but we had the facts ready for him on safety and effectiveness.Mr. L was lucky enough to be the units chosen one. Round the clock, the strongest, best nurses were assigned to him. He had ARDS most likely from multiple blood transfusions. Rotoprone had never been done in Cvicu, and Mr.L broke us in and proved that Rotoprone works. It took him from the steps of death to walking in with a basket of treats the next Christmas. Even administration thought Mr.L had extended his stay on this expensive bed rental. I know one doctor says "why do you call me, if you don't get what you want, you call someone else.". And he is right. We want what's right and best for our patients regardless of budgets, insurance, or hard-headedness. If you are sick, you want the nurses on your side.....
Mr. L had a CABG on a Monday afternoon. Inter-op and post-op bleeding required a substantial amount of blood products. Mr.L Extubated on Tues without incident. By Wednesday his o2 SAts fell and he required intubation. Thursday showed Mr. L with an o2 sat in the 70's on 100% peep. Abg's had pa02 in the 40's. His chest Xray had a ground glass appearance, no infiltrates. The nurses prayed the right pulmonologist would round that day and he did! Mr. L was placed on 18 peep with high Rr and low tidal volume. The nurses suggested a Rotoprone bed for him as well. Luckily, the right pulmonologist believes in them before it's a last resort.
We pulled Mr. L over, started his Diprivan and norcuron, held are breaths and began his first turn to prone. Sats went from 85-80-70-65-50. OH MYGOD!!!!
We waited what seemed a lifetime, but they started creeping back up. Days went by unknown to Mr. L as he spent most of his time face down, drooling, eyes swollen shut 10x over. But every day, says were improving. Then one day the respiratory therapist didn't believe in double taping. The sound of extubation is not pretty on a paralyzed man, hanging upside down in a big contraption.
We've never flipped and unpacked as fast. Of course the fellow from Er said "I can't intubate like this." He was bluntly told "you're going to have to, NOW".
Airway was re-established and DaoUBLE taped. Sats back to low 80's on his back. Teamwork had him packed and flipped in under 2 minutes.Of course after a week in this very expensive bed, administration brought up he had exceeded recommended time.
The right pulmonologist had to show improvement amd take heat for continuing therapy. An EEG was done that showed (can u guess) moderate diffuse slowing. Neuro gave poor prognosis.One week later another EEG was done. The neurologist went to talk to the wife (without seeing patient) and said there was little chance for brain recovery. Mr.L's wife said "YOUR FIRED." Upon entering room, Mr.L was Extubated, talking, amd eating ice chips. Apparently the neurologist had re-read the initial EEG.
Mr. L came to see us the next Christmas. The only problem he suffered from his ordeal was shoulder dystonia on the right. Physical therapy was handling that. He gave us a basket of goodies and felt blessed to have a unit of angels watching over him.Last edit by Joe V on Nov 19, '12