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papawjohn
435 Posts
Hey Y'all
I do as much (well--probably more) bitching as the next nurse. (Well, maybe a LOT more ;>).
But ya know, I think we've got the greatest job in the world. Last night I got report at 7pm while watching thru the glass as my Pt's HRate was 140 and BP kept alarming at 60/30. Vent showing no spont resps. Foley with empty U-meter. The day nurse was saying, fluid bolus since she got here at 5, NeoSynephrine at 50mcg/min, sposed to start Dobutamine but haven't had time. (Probably everyone here can fill in the rest of the story.)
She was fairly young African-American, HIV, went into flash PulmEdema in ER.
Echo was done--20% EjectFraction. Hgb 8.
Of course, large family. Very frightened she was gonna die in the next hr. Which I couldn't agrue with, eh? And turns out there's a family connection to one of my favorite collegues who works in our Hosp's OTHER ICU. (I dunno about you but I have a superstition that if the Pt is one of US, or one of OURS--bad **** is more likely to happen.)
Went into room. Introductions, smiles. Assessment: the gal is HOT to touch. AxTemp 103!!. Begin sponging w/ H20. She reacts with all four and eyes fly open as I do this--likely to have 'someone home'. Tylenol down NGT.
Dobutamine goes up. (Only have periph IVs but I have grown used to this since leaving TeachingHosp and Trauma Institutes for approaching retirement in Fla--anyhow, IV sites look good.)
Calls to MDs. Attending is obviously hanging crepe over her. When I tell him the VSigns and suggest InfectDisease consult he says 'we'll see about that in the morning'. (Translation: 'she's going die tonite, John') I CANT STAND that, when the Doc is going to let my Pt die. Cardiologist turns out to sound like great Doc over the phone. Made sure she had been pan-Cx (which I'd made sure of--BloodCx done in ER, I got Sput&Urine). Try Dopamine, wean Neo, give 2units RBCs, lasix after 1st. The Intensivist also sound great--NSaline 200/hr, begin ABx.
Orders in process, begin the siege. Pester BloodBank--get 1st unit up. Keep sponging. Temp comes down. BP begins to improve with Dopa--weaning Neo (had been up to 80mcg/m)--begin to get urine in foley tubing!!
Hours of this stuff. About 2330, look up--BP is 125/50!! Temp now 100.4ax.
Family has been in continuously--different folks (very polite, very compliant with 'just one or two at a time please'), they have a matriarch who happily fields all phone calls. Then around MN, "she's awake!!"--and so she is. Eyes open, nods Yes/No, moves all 4, even smiles sweetly into my ugly ol' face as I explain restraints, ETT, etc. Assists with turning.
By 0700, Dopa and Dobut both at 2 1/2 mcg/k/m, IV fluid down to 100/hr, HRate 100, temp 99.1ax. Urine 300/hr. I've called Labs (mag 1.1, K 3.2, pH 7.5) to intensivist--gotten orders--and I'm giving report to a dayshift nurse that will do a fine job with her.
I leave the ICU headed for the time clock and the old ford. The family is still there--in the lobby which our doors open onto. As I walk out they all stand and give me an ocean of smiles. Thank You, they say. Thank you Thank you. 'Shucks,' I tell 'em. 'It's just what we do here'.
And I walk away thinking--this payoff is better that money!!
Anyhow--long post--kinda apologize--don't we have a great job!!!
Papaw John