I just got off a P shift (7p-7a) It was awful. Started off slow but I got a "stable GI Bleed". He was in another ICU but came to our CCU b/c of bed issues...whatever.. doesnt matter
My question to you all is do you ever leave a real busy pt and just feel like you wish you could do things faster??? I had him 1:1 but that wasnt even enough. I actually only had him from 3a-7a. Anyway, he got to us, not bleeding.... bp started to drop, started to get real tachy, ab distended..... ng heme pos but not gross at this point... page intern bc bp is 50/30..tells me to bolus him with whatever (dont you love those orders) give him 2L still bp in the toilet page him again..say hey, i think hes going in to shock, bleeding somewhere.... intern wont listen... dont worry just give him more fluuds.............. half hr later pt has blood frank blood emesis... great... now i know im in trouble...ask him if we can intubate....says no not now want to hold off (i am ready to shoot him...bp is still crappy
well to make a long story short he got about 6u prbc, 5u ffp, 3L NS, levo maxed dopa maxed bp still 90 ...tachy to 130. when i left his hemoglobin was 4.8 he did end up getting intubated.... 4inches north of the carina though (intern insisted on intubating rather than anesthesia)
anyway, i just feel luike i wish i could have done more...feel like there was more i should have done...do u ever leave work feeling like a failure, feeling so bad about ur night????
i keep on replaying things in my mind, wishing i could have been faster, should have done this... ahhhh what do u do to get it out of ur mind... !!!!!!!!!!
Yup, more times than I want to remember in my 14 years in critical care. I find that a support breakfast after my night shift (7p-7a) is best, that way I am taking this home to my family who does not understand nor do they want to hear it. Co-workers are best because they are there, & may know who/what you are so frustrated about. If your frustration continues for a long period, (same problems without resolution, such as irrate boss, unsafe practices) then find another job. I did!
Used to leave work crying alot ... then cut my hours substantially on my unit & pick up per diem in another unit (non-patient care) and find my stress level has gone down. We are all human -- we can only do so much at a given time ... can only push so much. I don't worry about doing things faster -- I just try to do my best and give safe care. That's it. You did great. That intern should have come up instantly when you reported a 50/30 bp. It didn't take a rocket scientist to see what was happening. The patient should never have been transferred from his ICU -- he wasn't stable. The intern should have intervened immediately -- you did great. Have more confidence in yourself and stop doubting your abilities. And, if you need help, ask for it, without feeling incompetent or guilty. Your skills and assessment kept this patient alive. Document...document. And keep up the good work.
And please be kind to yourself and take care of yourself. :) :) :)
Thanks for the advice. This happened a little while ago, but I have definately learned to just utilize the chain of command. I have no problem now calling a resident, fellow whatever if the intern is a big idiot.
The way our ICU's are, we tend to have a lot of overflow from various units. So, it is not uncommon to have an off service pt in the CICU. That's why he was on our unit.
I have definately learned to just utilize the chain of command. I have no problem now calling a resident, fellow whatever if the intern is a big idiot.
Comes with time and experience, doesn't it? You are your patient's best advocate.
WE have all been there. I have been at this for 5 years and I can relate. You did all you could, you notified the doc and he chose what to do. Where I work the RN's wear badges that have a blue background, the docs have a red background. Whenever one of my friends feels like they missed something, and they did all they could I say...."Hey, you wear the blue badge!":) " So remember you are an RN, you did what you were supposed to do. The rest is up to the doc, and God.
Remember, you are new at this experience comes with time, chalk it up as a lesson learned and go from there!
Had a similar incident happen to me not too long ago,,,,,,,,,,,Pt was having an MI with TOMBSTONE elevations...called MD on call and he brushed it off like it was no big deal......said to call Attending in the am........pt ended up dying....I just documented my butt off to cover my butt. I worked too hard to get my RN license to have some LAZY MD risk it being taken away!!!!!!!!!!
I had a very similar incident with a GI bleeder in the unit. He ended up needing 6 units of blood, ffp, vasopressin IV push etc etc. They quickly become a very busy patient when they go bad.
My only difference from your experience is I called the GI guy and he came right in. He was excellent. Thats the difference b/w a crummy doc and a good one.
he did end up getting intubated.... 4inches north of the carina though (intern insisted on intubating rather than anesthesia) 
healingtouchRN
541 Posts
Yup, more times than I want to remember in my 14 years in critical care. I find that a support breakfast after my night shift (7p-7a) is best, that way I am taking this home to my family who does not understand nor do they want to hear it. Co-workers are best because they are there, & may know who/what you are so frustrated about. If your frustration continues for a long period, (same problems without resolution, such as irrate boss, unsafe practices) then find another job. I did!