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... !!!!!!!!!!
I had a similar experience when I started as a new SICU RN. It took me four hours of phone calls to finally get my sedation and my lines from the resident. Like your situation, the intern was hopeless (person could not grasp the rationale for an ng tube on an intubated patient)... by the time I got someone to finally listen I was slamming the phone receiver down in frustration... the patient did make it. But remember, sometimes all the persistence in the world may not pay off and your voice may fall on deaf ears...pray, document, and take comfort in that God knows you did all you could to save one of his children.
I can't say that I've ever cried after work, but I have had to take a deep breath every now and then.
What I'm wondering is why this patient had an intern taking care of him. Why do you call the intern instead of the supervising physician? Isn't their a resident or better yet an ATTENDING physician on call? At my facility we only have family practice residents, so being in a CVSU, I don't get much interaction with them, but how is a nurse to know who to call in a situation like this if the resident or intern isn't doing their job? Maybe this is a whole other discussion, but I always wonder how other nurses dealt with this ordeal. In my situation, I'm kind of thankful that I don't have residents and interns, and that I have a somewhat decent working relationship with the surgeons. They know if I calll 2 or 3 times that they're is definitely something wrong, but on the same end they are sometimes lazy, and don't want to deal with things. So that leaves you with a lot of responsibility. Many times we have to do it on our own. At least the intern came to do the intubation. Sounds like you were persistent enough that the job was done.
he did end up getting intubated.... 4inches north of the carina though (intern insisted on intubating rather than anesthesia) 
NurseBoricua
15 Posts
New Ccu RN,
I had a similar experience when I started as a new SICU RN. It took me four hours of phone calls to finally get my sedation and my lines from the resident. Like your situation, the intern was hopeless (person could not grasp the rationale for an ng tube on an intubated patient)... by the time I got someone to finally listen I was slamming the phone receiver down in frustration... the patient did make it. But remember, sometimes all the persistence in the world may not pay off and your voice may fall on deaf ears...pray, document, and take comfort in that God knows you did all you could to save one of his children.