To make a long story extremely short, we had a patient who was a MVC with multi rib fx some transverse process fx etc. Not bad all thing considered...The call bell light came on and i answered it. I go in and what do i hear but a very omnious noise and from my EMS experience I knew exactly what was going on, get me lasix and CPAP and maybe some nitropaste if your feeling lucky (that would be in the field of course). Any guesses? If you guess CHF then congrats, you're right. This PT was filling up and filling up FAST, i tried to get her to cough because I could hear it in her throat and thought well maybe it's just some phlegm chillen in the back and she can't clear it, I didn;t have to listen to her lungs cuz i could hear it but i did anyways and she's got rales all the way up. I got the RN whose PT it was and said call the doc, threw her on a venti and with sats at 90 i said lets try NRB. Well the 20 of lasix helped for like an hour, and then she went right back in to CHF. I talked to the Dr and he asked me if she needed to be intubated. I said listen I think if we give her about 80 of lasix, diuresis her and CPAP or Bipap her I think we might avoid having to tube her. I said I really hate to jump the gun on this, her lungs are crappy as it is and I hate to jump to something so invasive if it's not needed. . He said ok try and BiPAP her and if they need to intubate then do it, transfer her to ICU and consult the intensivist. So I helped the other RN with the patient and they tried BiPAP, it worked for a little while but apparently I guess her ABG was really crappy and they made the move to intubate. I feel like i did something wrong because it didn't work, I kinda feel like I'm a bad nurse and that I'm gonna get into all this trouble because my 'idea' didnt work. I guess I just need a little bit of encouragement and support and I'm hoping I'll get it here. I do work ICU/CCU so it's not like I don't know what I'm talking about when I speak to a Dr....Idk I'm hoping that she ends up ok
Yea it was not my patient and I had just answered the call bell to help and when I saw what I saw I got the PTs legit nurse and threw a venti and a NRB at her..the patient was 70s, 72 i believe. Someone brought up about the multi rib Fxs, after the Bipap I asked the ER doc who came up to see the patient. I said did I do the right thing, he said because of the Rib Fx you obv increase the pressure and can more pain and in that case and in the case of a lung contusion then BiPAP is not really going to work. He said we'll do a therapeutic trial and if she holds then good, if not then we have to intubate. He said depending on the case sometimes intubating right off the bat is not such a bad idea.
And for those who wonder why I was talking to the dr. We had a nurse who came from the unit to do charge and she screwed my friend and gave her 2 admits, myself 1 admit and sat there with 4 patients and didn't do **** all night. my friend is also a newer nurse and was drowing in everything so thats why I helped. I ended up getting spoken to by the clinical admin who said that I need to not help so much? I sat there and said yes ma'am and blah blah blah but i really wanted to say...are you F-ing serious? So much to team work, I learned that I should just let my co-workers sink..it was 3 f-ing AM one person was getting blood and she was tolerating it fine I was between the transfusion and the one PT who was circling the drain to help out. I understand that she said people have to watch the other patients...I have an LPN on the floor and another RN I think we had it covered and plus everyone was sleeping and there were no meds to give so idk
You bought her a little time off the vent while the situation became clearer but still got her vented before she got too tired to breathe and in even worse trouble.
Sounds about right to me. It was a rapidly evolving situation and that's always a balancing act. Learn without obsessing ... you did a good job, so continue to trust your instincts and let the monday-morning quarterbacks talk to the hand.
Thank you to everyone who replied i do really appreciate everyone input and for the kinds words of encouragement.
Right now I wish I had PTO so that I could go down to Haiti and help with the disaster. I went down to katrina and drove around doing EMS in NOLA and it was the coolest thing ive ever done. I love being in the middle of the nonsense.
Da_Milk_of_Amnesia, MSN
514 Posts
Yea it was not my patient and I had just answered the call bell to help and when I saw what I saw I got the PTs legit nurse and threw a venti and a NRB at her..the patient was 70s, 72 i believe. Someone brought up about the multi rib Fxs, after the Bipap I asked the ER doc who came up to see the patient. I said did I do the right thing, he said because of the Rib Fx you obv increase the pressure and can more pain and in that case and in the case of a lung contusion then BiPAP is not really going to work. He said we'll do a therapeutic trial and if she holds then good, if not then we have to intubate. He said depending on the case sometimes intubating right off the bat is not such a bad idea.
And for those who wonder why I was talking to the dr. We had a nurse who came from the unit to do charge and she screwed my friend and gave her 2 admits, myself 1 admit and sat there with 4 patients and didn't do **** all night. my friend is also a newer nurse and was drowing in everything so thats why I helped. I ended up getting spoken to by the clinical admin who said that I need to not help so much? I sat there and said yes ma'am and blah blah blah but i really wanted to say...are you F-ing serious? So much to team work, I learned that I should just let my co-workers sink..it was 3 f-ing AM one person was getting blood and she was tolerating it fine I was between the transfusion and the one PT who was circling the drain to help out. I understand that she said people have to watch the other patients...I have an LPN on the floor and another RN I think we had it covered and plus everyone was sleeping and there were no meds to give so idk