jaicu

Hi! I've been a nurse in a neurotrauma ICU for about four years now. The last little while I've been witness to numerous life altering or ending mistakes or decisions. Mostly this is due to physician decision or error. After my last set, it is just weighing down on me like a ton of bricks. I don't want to be a part of it. I get sad. It keeps me up. I'll give you a few examples of events the last few months. -I came on. My patient had been given TPa post stroke on a surgical unit and then transferred to us. It was 12+ hours later from the TPA dose and no recovery was noted in her hemiparalysis. I was looking at her IV pole. The TPa was still hanging as a secondary vial. No vented tubing used. The medication was never given. It would have said it was running but just drew out of the main line if there was no vent. The vial was full. I did an incident report. Never heard back. Patient died later on ward. -Patient took a purposeful OD on cardiac meds that had no antidote. Came in talking, very regretful, wanted to live. Severe hypotension that minimally responded to pressors. It was dire. Physician on days opted not to dialyZe him for his kidney failure (due to hypotension). Physician on days also opted not to transfer him for ECMO even though it could have saved his life. Physician on nights came on and was upset. Tried to do some of this but his pH was now 6.8. Tried to put in a hemoline but it was too late. Too late for ecmo. -patient CTd as outpatient months before coming to us. Reported as normal. In hindsight, had pons swelling. Brain dead when we got her. Too late. - patient Ctd as outpatient. Reported as normal. Missed the tumour. Now doing terrible in our unit post op. - young kid. due to fear of anyone recognizing the story, ended up a quad. I know I work in a high-stakes environment where things like this will happen. But man the latest influx is killing me. I don't know how to feel okay about it. As you can see, a lot of these incidents are happening outside of ICU but it makes me doubt the system. I so badly want to say to these families "ask for an investigation" but I know how inappropriate that is. It's just weighing on me. Any advice? Does anyone else feel like this? Sorry if there are typos - on my cell.

Hmm, I suspect this is different for all authorities but also physicians will have their preference. We use propofol primarily as it works quickly, and it works well. It's also incredibly quick to wear off so it is is GREAT in neuro ICU where you need to be able to do sedation vacations to assess their status. Long term use can be liver toxic so there's that problem, but we rarely see it. It's definitely our first line sedative for intubated patients. Precedex. It works well on non-intubated patients. Patients who are difficult to manage due to anxiety, behaviour, aggression, delirium, seem to get this when we are having a hard time caring for them. We rarely find it works on intubated patients to keep the coughing and discomfort at bay. It also often makes patients profoundly bradycardic and hypotensive. We do run it with propofol sometimes when we are planning on war if the propofol in order to extubate. Midaz we use mostly as a prn for intubation or agitation, or when propofol is not sufficient to keep people sedated. We don't use it that often as a drip though when we receive patients from smaller centres, they are often on it. Fentanyl gtt for pain on a variety of patients. We often don't run it when we use propofol, depends on the patient and the likelyhood of pain issues. Ie a trauma would get it, but an influenza is usually good with propofol.