That moment when it all felt too dangerous

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    I work in a jack of all trades ICU for them most part....somewhat small town with our own CV surgeon, as well our ICU takes all neuro etc everything CRRP etc.

    An how I titled this thread, at what point with you patient assignments etc has everything you are doing started to make you feel uneasy/things were a little dangerous?

    My first patient on a vent Neo maxxed out and titrating dopamine up, she has no pressure virtually.....also vent mode pressure controlled with 15 PEEP and 100% FIO2, still satting 87-88% ABGs look like crap, pulmonology comes in and decides she just has to go to CT now (we bagged her at 100%, sats were dropping in the 70s all the way and during CT). Problem is im bolusing NS with the 2 pressors maxxed out in a L AC line, so we are getting a PICC placed and the doc wants to know why these antibiotics arent finished yet...... This lady was S/P hip fracture, no surgical intervention yet, she recieved so much pain medicine on the floor she aspirated and is now has ARDS. Her family is composed of 4+ physicians who make it a point to call me every hour, pimping me on her status. Also her cardiologist is a super close friend on the family, and is being overambitious trying to change vent settings etc and really p*ssing off pulmonology

    My second patient, active bleeding esophageal varicies, has thrown up about 600 ml of blood in the last 2 hours, im hanging her second unit of blood and X2 FFP.

    My third patient, just getting back from surgery, S/P upper and mid R lobe lobectomy, Q1hr chest tube and Urine out put. Has a L radial artline, is VERY confused trying to pull everything out.

    On top of this no patient care techs, I ran my a$$ off all night. Didn't get to chart till 3 am....oh good times :/
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  3. 5 Comments so far...

  4. 1
    wow that is bad. for one, where I work, the first patient likely would have been a one to one where I work, at the worst paired with an easy patient, but to have a bleeder and a post op? ICU should be 1:2 tops. Seriously. I would have been on the verge of quitting I'm sure if that were me
    DroogieRN likes this.
  5. 0
    So much is wrong with this picture I am sorry you had to endure this all day/night.
    In our ICU, it is a max of 2 pts period. Second, the family needs to be told to knock it off( in a nice way of course). Explain to them you are caring for their mother/sister etc and answering their questions every hour is taking away from her care. Ask them to have one person set up to call for updates q4h and if something changes, you will call them.

    Hugs to ya, kick back and have a nice glass of wine or something and give yourself a job well done. We can only do so much...
  6. 0
    Quote from Sun0408
    So much is wrong with this picture I am sorry you had to endure this all day/night.
    In our ICU, it is a max of 2 pts period. Second, the family needs to be told to knock it off( in a nice way of course). Explain to them you are caring for their mother/sister etc and answering their questions every hour is taking away from her care. Ask them to have one person set up to call for updates q4h and if something changes, you will call them.

    Hugs to ya, kick back and have a nice glass of wine or something and give yourself a job well done. We can only do so much...
    Im kicking back already, was a hellish rotation, bud light in my free hand. We are severely understaffed, and if I didn't need more ICU exp to make a lateral move to another hospital I would leave. I stay on my manager's butt all the time about this crazy crap they pull on us.

    Its hit or miss, on a properly staffed occasion I will have 2 patients......talked to my manager today we technically are down 12 nurses for all shifts around, but it's true if he staffs us that hard we will be canceling people left and right when the summer rolls around.

    I was thinking one day a pulmonologist needs to accompany me to CT and he wont be ordering these tests on a whim, considering I had to bring her to CT twice in 3 days
  7. 0
    Quote from Creamsoda
    wow that is bad. for one, where I work, the first patient likely would have been a one to one where I work, at the worst paired with an easy patient, but to have a bleeder and a post op? ICU should be 1:2 tops. Seriously. I would have been on the verge of quitting I'm sure if that were me
    Yeah i definitely wish things at my job were the way they are supposed to be. In general once things get this crazy I just go into survival mode, stop giving a crap about paperwork, keep my patients alive and make sure they get the necessary medications
  8. 1
    Just curious, has anyone ever had two of their patients code at the same time? Has it ever gotten to that point? We've had two codes in the unit simultaneously, but it was a 30 bed ICU.
    DeLanaHarvickWannabe likes this.


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