[incublissRN]

The last two nights at work have been rough. The first night I had a patient that had a CABGx4, AVR with an IABP. The most unstable patient I've ever cared for. Vasopressin at 4 units/hr, epi at 30 mcg/min, dob at 10 mcg/kg/min. No pulses in his feet, fingers are discolored. They had suctioned his ETT the day before and he vagaled. He hadn't been turned for 2 days because if he just coughed he would drop his heart rate and pressure. Hepatic failure and renal failure - on CVVHD. Temperature of 102-104. Family was ready to turn things off after talking to the surgeon in the morning. I come in to work the next night and he's still there. The surgeon said there was still hope. I couldn't go back in that room.

The next night I had three patients because they couldn't send us any help. I had a patient with a bronchopleural fistula repair vented and restless, a AAA repair, and a CAE. The CAE was awesome and slept most of the night, the vented patient became even more restless from 0400-0700, and at 0700 the AAA repair was becoming confused and getting angry with me.

Needless to say I am physically and emotionally drained after these two nights. I slept well but kept dreaming about work and having 3 patients. Thanks for letting me vent.

[optimus_prime]

pity you... you still have to work in your sleep..... used to have the same thing happen to me....

[BBFRN]

Originally Posted by incublissRN

The last two nights at work have been rough. The first night I had a patient that had a CABGx4, valve replacement with an IABP. The most unstable patient I've ever cared for. Vasopressin at 4 units/hr, epi at 30 mcg/min, dob at 10 mcg/kg/min. No pulses in his feet, fingers are discolored. They had suctioned his ETT the day before and he vagaled. He hadn't been turned for 2 days because if he just coughed he would drop his heart rate and pressure. Hepatic failure and renal failure - on CVVHD. Temperature of 102-104. Family was ready to turn things off after talking to the surgeon in the morning. I come in to work the next night and he's still there. The surgeon said there was still hope. I couldn't go back in that room.

The next night I had three patients because they couldn't send us any help. I had a patient with a bronchopleural fistula repair vented and restless, a AAA repair, and a CAE. The CAE was awesome and slept most of the night, the vented patient became even more restless from 0400-0700, and at 0700 the AAA repair was becoming confused and getting angry with me.

Needless to say I am physically and emotionally drained after these two nights. I slept well but kept dreaming about work and having 3 patients. Thanks for letting me vent.

You must be the trainwreck magnet. I know how that goes . Hope your week gets better!

[TopherSRN]

Originally Posted by incublissRN

The last two nights at work have been rough. The first night I had a patient that had a CABGx4, valve replacement with an IABP. The most unstable patient I've ever cared for. Vasopressin at 4 units/hr, epi at 30 mcg/min, dob at 10 mcg/kg/min. No pulses in his feet, fingers are discolored. They had suctioned his ETT the day before and he vagaled. He hadn't been turned for 2 days because if he just coughed he would drop his heart rate and pressure. Hepatic failure and renal failure - on CVVHD. Temperature of 102-104. Family was ready to turn things off after talking to the surgeon in the morning.

They are not going to just give up after they do a cabg/valve on someone. To be honest those gtts and support devices (iabp/crrt) are pretty run of the mill in CVI.


As far as him dropping his rate, did he not have epicardial wires?

[incublissRN]

The first time he vagaled his wires weren't hooked up to a pacer and they did CPR. They're definitely hooked up now. I haven't been in the room since that night but I heard he is circling the drain. It's been six days and he definitely hasn't improved any, they are increasing and adding drips. I talked to the family about his wishes. It's one thing if the surgeon doesn't want to give up and it's another when you discuss with the family what quality of life the patient wanted. I'm not going to argue about it anymore, you weren't there.

Well I just heard he RHC'd. I guess he made the decision for the surgeon and the family.

[TopherSRN]

Originally Posted by incublissRN

The first time he vagaled his wires weren't hooked up to a pacer and they did CPR.

This blows my mind. You have a fresh heart with wires and the first thing thats done is pound on his chest instead of hook his wires up to the pacer that should be at the bedside of EVERY open heart pt with wires. What about atropine, you know a vagolytic, for someone who is 'vagaling'????

Maybe im just lazy, but id rather pace someone/push atropine/robinul than do CPR.


You probably will get mad and think im trying to be an @$$, but CPR isnt the best option for symptomatic bradycardia in this patient. Always, always use your wires.

I've seen much sicker people walk out of the hospital, you wernt even maxxed on vaso or dopa (not sure on epi as every hosp i've worked at weight based it). Renal failure isn't a death sentence, crrt in the unit then hemo when stable.


You're right i dont know everything that went on. Im just making observations based on my experiences and what you posted. You can take my post as constructive criticism and see how things could have been handled differently or as I suspect you'll just get defensive and insult me.

[incublissRN]

They did hook up his wires and they probably pushed meds I assume. I wasn't there, I probably didn't hear the whole story. I prefer not to do CPR either but I wasn't caring for him at the time. He was maxed out on vaso eventually.

I realize that CRRT is not a death sentence. I have also seen someone with an IABP on CRRT and on those drips make it out of the hospital. I have not seen someone that was possibly septic with MODS make it.

The point of my original post was just to say that it was a busy night and emotionally draining.

[jbp0529]

Had one of those nights myself last night. My pt was s/p cabg, avr, mvr, had an intraop MI and bleeding, and chest was left open. Was on Epi, NTG, Milrinone, Dobutamine, Levophed, Vaso, Insulin, Vec, Versed... All I did was run!! She was young, so hopefully will do ok in the next few days.

I feel for you.

[Zookeeper3]

Since you've received so much understanding and support here, you won't need mine.

It's hard to need to vent and family and friends have no idea what you're talking about or what you go through. Luckily here, your nursing buddies that don't eat thier young or talk badly about others would never do anything but rally support. All in fun. Glad your stretch is over.

[incublissRN]

I have four nights off and I feel better already! Thanks for the support to those who offered it.