Quote from petiteflower
I am sure that you knew the exact minute that lady was going to code and timed it just perfect to make sure that you had her in ICU just at the right minute.
Us ER Nurses are crafty little devils!
The other day i get this pt who comes in being bagged by EMS. Doc tubes him, goes on a vent etc. Now I have tried to learn to what the ICU likes in their patients and get it all done for them. So I get the Doc to put in a triple lumen subclavian central line, the pt get's a foley, all labs and cultures done, he's on three drips the doc wants another, and puts in a femoral line for rapid fluids,pt's blood glucose was above 1200, he was also septic. We get his BP up to 66/40 which was great since had no bp earlier. I'm told there is a "ready bed" for him in ICU. I call up and give the report. ICU nurse tells me "Oh you have to get that BP up to 100 before we can take him." Naively I ask why that matters. "Oh it's dangerous for him to have the low bp up here." I reply, "No more dangerous than it is for him down here." And I think and maybe less dangerous because his primary nurse will have only one other pt in the ICU instread of three others down in the ED. And since I do both Critical Care Transport and EMS, I'm of the philosphy that some BP is better than none and 66/40 is respectable when you're in shock.
So I explain to her that we are flowing fluids and have a norepi drip running and the doctor has offered to accompany the patient to the floor to ensure his safety. She replies "He's too unstable." So I say. " Where do you think unstable people go? If he was stable he could go to PCU or med/surg."
She finally accepted the patient, but I really get a pain from these people. They look down on us in the ED because we don't grasp all the nuances of critical care (supposedly), but when we punt to them for help we get a thousand reasons why the pt is too unhealthy to come up. I mean if they are the "best care" in the hospital, isn't that where the pt is going to have the best rate of survival? I just don't get it. If you're so proud to be a critical care nurse, shouldn't you want to take care of a critical patient? Or is it all about low pt to nurse ratios?