Baptism by fire...vent session

Hi all,

I've been an RN going on 5 years. My first 2 years were at the bedside in IMC and the last 2 1/2 were outpatient. I recently returned to the bedside but to a 40 bed ICU unit. I had an 8 week orientation (most was COVID related) and this last week was the first week on my own. My first week was what I like to call baptism by fire. I don't really have anyone to vent to so I thought that you all might understand. Sorry for the long vent.

My first assignment was a trauma patient that had 2 crani's in the last 3 weeks. She was on precedex and fent to help keep her from fighting the vent, mostly due to the large amount of secretions that caused alot of coughing. She had a fresh trache as well. Her BP was soft with SBP in the 90's and HR in the 50's. No pressors. 

Yesterday she spiked a fever of 103 and had increased serous drainage from her crani site. A head CT was ordered. Given this patient's vitals and inability to lay flat, I was asked to try a combination of sedatives and add on Neo for BP support as additional sedatives will bottom out her BP (she was already soft to begin with). I added a low dose of propofol, increased fentanyl, and kept precedex the same. She was still unable to lay flat without coughing and her HR actually went down and maintained in the high 40's. I believe this is due to the reflex bradycardic effects from Neo and the precedex as well. I tried suctioning her before laying her flat. I felt that increasing or adding more sedatives would make her dangerously bradycardic. I consulted with the MD about what else he would like me to do as I did not feel I was able to adequately sedate this patient and maintain her in a somewhat safe range. 

The MD went to the room, messed with the sedatives (increased propofol, turned off precedex, increased the Neo, maxed out the Fent). The patients HR dropped to the 30's but she was able to lay flat without coughing. He then administered Ephedrine and increased her HR to the high 40's. He asked me to leave STAT to CT. The patient was packed in less than 5 minutes and a team arranged to help with transport (RT for vent, 2 techs, charge nurse, myself). The MD gave me a syringe labeled with the remaining ephedrine and asked me to give 1 CC every 5 minutes if she dropped under 45. The team flew to the elevator, down to CT, and back in less than 20 minutes without incident. I thankfully did not have to administer any ephedrine or increase her sedation.

I was so incredibly nervous during this entire time! This was my second time ever having to manage anything other than propofol or versed (my orientation was pretty limited). The critical care MD was very patient during this whole event and tried to teach me why he was doing what he was doing during every step of his actions. He even offered to go down with us to CT but we already had enough people going so he stayed and texted me while I was in CT to check in. Earlier that day I assisted this same MD with a bronchoscopy at the bedside (something I had never done either). My charge nurse, RT, and techs were also wonderful in helping me. In talking with the other unit nurses, they felt that this situation was risky but thankfully worked out. Despite the support, I can't help but feel that this was a baptism by fire and I have not even really experienced what it's like to have an unstable patient. 

Anyway, just needed an outlet to vent. Any recommendations for keeping a journal during your nursing career? Or do y'all just find a colleague/friend to talk to? My current friends would not understand.