The last two nights at work have been rough. The first night I had a patient that had a CABGx4, AVR with an IABP. The most unstable patient I've ever cared for. Vasopressin at 4 units/hr, epi at 30 mcg/min, dob at 10 mcg/kg/min. No pulses in his feet, fingers are discolored. They had suctioned his ETT the day before and he vagaled. He hadn't been turned for 2 days because if he just coughed he would drop his heart rate and pressure. Hepatic failure and renal failure - on CVVHD. Temperature of 102-104. Family was ready to turn things off after talking to the surgeon in the morning. I come in to work the next night and he's still there. The surgeon said there was still hope. I couldn't go back in that room.
The next night I had three patients because they couldn't send us any help. I had a patient with a bronchopleural fistula repair vented and restless, a AAA repair, and a CAE. The CAE was awesome and slept most of the night, the vented patient became even more restless from 0400-0700, and at 0700 the AAA repair was becoming confused and getting angry with me.
Needless to say I am physically and emotionally drained after these two nights. I slept well but kept dreaming about work and having 3 patients. Thanks for letting me vent.
