Got told our/ any neuro ICU is not really an intensive care unit

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    Today I had a patient who has a previous MVA post 13 days from a different hospital for neuro declines and further exam from following commands to a GCS of 5, neuo exam L pupil fixed and dilated not reactive R pupil, no corneals, would flicker upper extremities to pain, lower left would flex toe to pain and right quad to pain, had many facial fractures which included a mandible which is floating, occipital bone fx, temporal and spenoid fx to name a few. Bilateral upper arm blood clots and that is it (no other history and his injuries was limited to his head). So the docs wanted to do a stat CT scan with perfusion to check for blood vessel abnormalities, hospital transport and we had no CNAs. So the charge nurse calls SOS which I had an issue with but different story different day.

    Which the whole time this SOS nurse tells me that this patient should have been in the trauma patient because the nurses are better down there (which I guess whatever) he goes you neuro people are good with brains and that is not that critical (just rolled my eyes) and said you guys aren't ICU nurses because you don't take care of septic patients and multiorgan failure. Kind of made me mad.

    What do you guys think of this?? Do your ICUs have this relationship where one thinks they are better then the other???

    kent
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  5. 2
    Quote from labman
    Today I had a patient who has a previous MVA post 13 days from a different hospital for neuro declines and further exam from following commands to a GCS of 5, neuo exam L pupil fixed and dilated not reactive R pupil, no corneals, would flicker upper extremities to pain, lower left would flex toe to pain and right quad to pain, had many facial fractures which included a mandible which is floating, occipital bone fx, temporal and spenoid fx to name a few. Bilateral upper arm blood clots and that is it (no other history and his injuries was limited to his head). So the docs wanted to do a stat CT scan with perfusion to check for blood vessel abnormalities, hospital transport and we had no CNAs. So the charge nurse calls SOS which I had an issue with but different story different day.

    Which the whole time this SOS nurse tells me that this patient should have been in the trauma patient because the nurses are better down there (which I guess whatever) he goes you neuro people are good with brains and that is not that critical (just rolled my eyes) and said you guys aren't ICU nurses because you don't take care of septic patients and multiorgan failure. Kind of made me mad.

    What do you guys think of this?? Do your ICUs have this relationship where one thinks they are better then the other???

    kent

    I would have told that person to get over themselves. Neuro ICU is real critical care. Brain not that critical Oh my oh my do they realize how dumb that sounds? Nope it only controls vital functions of the body . Yes we do take care of patients in multi organ failure, and sepsis. I think this is a problem everywhere one unit always thinks they are better than the other. Their patients are always sicker. Even if our patients aren't on drips other than 3%, some of our house managers don't understand why we need to single the SAH in severe vasospasam. They only have q6 labs, q4 CVP and I/O boluses, constant lytes replacement. HHH pts can be a TON of work.

    Some of our docs have went and transferred the trauma pt with head injuries to our Neuro ICU so that the pt receives better management of the head injury. When a neuro patient goes bad they go bad right away it isn't always a slow onset. You can be on top of those pupil checks, and all the sudden there is one fixed and dilated pupil.

    I don't blame you for being upset. All nurses work hard. Critical care is critical care no matter if it is cardiac, trauma, or neuro. Neuro pts have many other problems as well as the problem with the brain.
    SuesquatchRN and Jessy_RN like this.
  6. 2
    I've worked on a variety of ICU specialities (cardiothoracic, neuro, med / surg, burns, paeds (that's peds for the US) and trauma) and all are Intensive care, the basics don't change it's just the variations that make them specialist. I found burns the most challenging but no more or less ICU than any other unit.

    Critical care is critical care the speciality is just an extra
    labcat01 and nrsang97 like this.
  7. 3
    Neuro often suffers from poor recognition. I have worked in a multitude of positions, everything except peds and burns. I can honestly say that some of the sickest pts I have ever had have been neuro cases. Just because they have a neuro problem does not make them exempt from all the other problems that can occur. Sepsis, MOSF, ARDS, cardio-vascular collapse etc. Then on top of handling all of the usual problems you have to manage cerebral circulation. Every department deserves their credit and no one has the right to dismiss your contributions. It is unfortunate that you ran into someone who suffers from the most damaging of neurological disorders. Intercephalrectalmosis! See how long it takes them to figure that one out.
    SuesquatchRN, psalm, and nrsang97 like this.
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    Quote from Beentheredonethat
    It is unfortunate that you ran into someone who suffers from the most damaging of neurological disorders. Intercephalrectalmosis! See how long it takes them to figure that one out.

    I nearly fell off my chair laughing at that
  9. 1
    We have this problem at my hospital too but the "real" ICU calls us first with any neuro questions. It is frustrating but I just let it go. Our doctors will refuse admissions if we don't have any neuro ICU beds.

    I love neuro and managing neuro patients. The unpredictability is what makes it so unique. Who needs MOSF when you can have pupil changes?
    nrsang97 likes this.
  10. 1
    I work in the neuro unit of a large, level I trauma center in Florida. We have an attending physician in the neurology dept that puts it best... "What's a body without a brain?" It is a constant struggle for Drs. on other services (ahem.... Cardiology) to understand that if you save the heart at the expence of the brain, you didn't save a person... you saved a BODY. Those are very different things. With the development of such advanced cardiopulmonary interventions (ECMO anyone?) we make it pretty hard for these pts to die. However, if the person doesn't have a brain... a mind to sustain them along the way then what good are we doing that person? The answer is simple... none.
    nrsang97 likes this.
  11. 0
    Neuro intimidates me the most of all the areas of critical care nursing.
    At my hospital, we have a large combination unit....so we have to do it all........
  12. 0
    I think we (neuro folks) face the same predjudices. First, ignorance of how extensive neuro care really is and then organ priority. This seems to be especially a problem between brain vs heart. So answer this question. Whats the waiting list for a brain transplant vs other organ transplant?
  13. 1
    i was an neuro icu nurse and now i do research in tbi at a level one with some of the best neurosurgeons and nurses in the country. the "trauma center" nurses are focused on getting the patient in and out, on to the "other" icus. the neuro icu nurses are very specialized and they do not have a "god complex" like what i experience when dealing with some of the trauma center nurses. i understand how difficult it is to be an icu nurse whether in neuro or not specialized. i respect all nurses, techs, aides, technicians and the rest of the "team". no one person is more valuable than another. however, our neurosurgeons, when no one is listening, at grand rounds or whatever, clearly prefer to have "their" patients in a neuro icu where they feel that the care is more focused to the issues, neuro, that face the patient. i agree, get over yourself and remember that one person alone cannot take care of a patient. what one nurse may not have in clinical skill, he/she may have the artful skills necessary to put the heart of the patient back together after the body has begun to heal and vice versa. :heartbeat
    nrsang97 likes this.


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