switching ICUs?

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Hello all.. This is my first post here and I need some help advice. I've been in critical care since I was a new grad. I started out on a small 8 bed Neuro Critical Care Unit. I was there for about a year and a half and was looking to have more experience/higher acuity so I transferred to our 36 bed Med/Surg ICU. We are a mixed CCU/ICU/CVICU. We take care of STEMI, IABP, LVAD, fresh CABG and typical med/surg ICU patients needing CRRT, vents, pressors, swan ganz, therapeutic hypothermia etc etc. I've been here for about a 2 years now and I'm feeling the need to move on to something with a higher acuity (again). I always have this itch for a "sicker" patient population. A hospital a little farther away from me has a large level I Trauma/Surgical/Neuro ICU with 30 beds and a couple open positions. We don't take any trauma patients in my current facility so this would be totally new territory for me.

I'm feeling like the trauma population might be what I'm looking for as a nurse... So, I would like to hear from any Trauma ICU nurses! How is trauma ICU different? What different skills will I be using? How does the acuity differ? What does a typical trauma patient in your ICU look like?

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Trauma patients are a wild card.

They can be anything and everything. Massive transfusion protocol will likely be utilized more in a Trauma ICU. Lots of blood products to be given. Can tank and get sick very easily. Spinal precautions are used on a near constant basis. Very high dose pain medication is used. Getting a trauma patient on/off a bedpan is a nightmare, it's extremely painful for patients with fractures, even when medicated.

Fluid resuscitation is a big one. I have seen lots of trauma. Here are some examples. Gunshot wounds, to the head, groin, chest, etc. Some GSW's to the head miss hitting the brain matter, and I have seen patients admitted with their faces blown off, while neurologically intact and following commands. Stabbings, MVA's (rollovers, etc.), snowboard/skiing accidents, biking accidents, fall from horse, etc.

Head trauma can make for difficult patients. Most often the frontal lobe is affected. Leading to aggressive behavior while in the ICU and upset families. One of the most difficult aspects of trauma care of patients, is the fact that often-- patients are permanently disabled. Their personalities are changed forever. They end up getting a tracheostomy and being moved to an LTACH. Families are frustrated because their loved one is right before their eyes, but the true them is gone forever.

Many patients are paralyzed for life. This is emotionally and physically devastating to everyone involved. I cannot tell you how many patients I've cared for that are miserable, telling me how bleak their future is when the gravity of what's happened sinks in. The staff of course do our best to keep things cheery but it only goes so far.

I like trauma patients. I think they are very exciting and require a lot of critical thinking. The rush that comes with trauma, can't beat it.

Overall, it's worth it to me.

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Thanks ICUman. How about hemodynamics? Do you utilize ICP monitoring/Ventriculostomy frequently? Just trying to get a better sense of the trauma patient. I'm picturing chest tubes and lots of broken bones.

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Specializes in SICU, trauma, neuro.

ICUman gave a good description. My ICU gets a lot of MVCs/motorcycle crashes, occasional snowmobile crash in winter, pedestrians/cyclists hit by vehicles, lots of GSWs, assaults, falls, and occupational freak accidents.

How about hemodynamics? Do you utilize ICP monitoring/Ventriculostomy frequently?

We don't monitor hemodynamics as closely as you do in the CV pt...actually in my ICU, the only pts who get PA lines are the CV surgical pts. Of course unstable pts have central lines and art lines for close monitoring of BP/CVP and for giving pressors etc; peripheral access is preferred though for lowered risk of infection. Yes, lots of EVDs, sometimes fiber optic ICP monitoring, sometimes Licox for watching PbO2 and brain temp. We do therapeutic normo- and hypothermia quite a bit in brain trauma pts also.

I also agree trauma is a mixed bag. We sometimes get the pt who is still open, brought up from the OR to die. We do massive transfusions where you zip multiple units of blood products in over a few minutes each. We have pts progress to brain death, and then care for them as pre-op organ donors. We have pts who may be reasonably stable from their injuries, but then go into ARDS.

And then there's ones who really aren't badly injured, but are intubated in the ED because they were too agitated to safely care for. A few months ago I discharged a pt maybe 16 hours after he was admitted; he had NO injuries but was intubated because they'd had to sedate him. Obviously that's not the norm. ;)

The hardest part for me is there's no time for families to process the dx before getting admitted. A pt who had surgery for a brain tumor was likely dx'ed in clinic. The trauma pt might have kissed her husband goodbye, left for work and then T-boned at highway speeds. Now she has a non-survivable TBI among myriad injuries...and then the chaplain brings in the husband. Understandably, he is distraught.

Sometimes the family chooses to transition to confort care, and we become the hospice nurse if the pt doesn't die right away (after a few hrs they transfer to the floor; the floor rooms are more private, and of course we may need that bed for an admission). More often they get a trach and shipped to an LTACH to continue to work on vent weaning.

What's really cool is we frequently have pts come back to thank us for saving their life. Sometimes they tell us about all the stuff they've been able to do -- walk their dtr down the aisle, meet a new niece, attend their sister's graduation, start college, etc -- because of what we did for them. I'm getting choked up now. :)

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They often have labile BP so vasopressors are not uncommon. Yes we do plenty of bolts, EVD drains, and skull flaps/craniotomies.

Chest tubes and broken bones are just like you imagined.

Be aware that my experience stems from a Trauma ICU. If you want more "exciting, up front" trauma, work in a Level 1 ER. They deal with more. I like where I'm at though. The above poster gave realistic insight that I agree with.

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Specializes in Trauma Surgical ICU.

Previous posters hit it on the head!! I love trauma but sometimes it's a very sad place to be. We cant save them all and sometimes we are there for end of life and to help the family memebers left behind.

Of course when a new trauma comes in it's exciting and all hands on desk.

Trauma is also heart wrenching. Dealing with a teen that is now brain dead after falling off a balcony. A teen now paralyzed from a boating accident. A GSW 20 year old brain dead. Dealing with those pts families is very hard and no amount of care will fix them. The sadness, the tears, seeing hope in their parents eyes as their ICP is climbing higher and higher despite all the meds, sedation and hypothermia. We can't stop it. Even with all the sadness, I love trauma. I love caring for a C1 fx due to a drunk driver not only survive but now walking and back to baseline. I love seeing the ruptured AAA walk back in the unit every year to say thank you!! I love seeing FB posts of a pt that beat the odds after having their pelvis shattered, 12mm brain shift, Trach peg now vacationing on the beach. That is why I still do it and love it!!

Sometimes the acuity is high but after the trauma pt is "stable" it becomes routine care and we can have that same pt for months. It's rare we have Them that long but it does happen.

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Thanks for the advice everyone. Much appreciated. Fortunately the hospital I'm interested in has a step down/progressive care trauma unit and progressive care neuro for the patients who aren't as sick.. so we would most likely get just the really sick patients. I am 99.9% ready to re-vamp my resume and apply!

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I work in a mixed ICU in a large academic tertiary hospital. I agree with the poster who said if you want the most exciting trauma experience, then your best bet is to work the trauma bays in the ER. I enjoy the big trauma with a labile BP requiring a Level One transfuser and pressors, but most of the time if a trauma makes it out of the field, out of the trauma bay, and out of the OR, by the time they get to the ICU they're usually somewhat hemodynamically stable, and don't require pressors after resuscitation. My point is, a lot of the job is not as exciting as it sounds, and past posters did a good job explaining the tediousness of placing a bed pan under somebody who is on full spinal precautions and in excruciating pain. Big traumas are fun though.

Your current ICU sounds like better experience, but variety prevents burnout and promotes growth, so good luck.

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Specializes in ICU.

I went from a general SICU in a level 1 facility with a large variety of patients (truama, neuro, sicu, cardiothoracic, picu, open bellies, open chests, crrt, balloon pump, etc) to a burn and pediatric truama ICU again at a level 1 facility. I would kill to go back to my last job. Burns, suck. Truama is better but I find that I'm losing my critical thinking skills. Truama is sick when the first come in, and then it's just a long drawn out sad process. I feel like most of the time I'm taking care of step down patients. I always loved truama at my last job, but maybe because I got to do all the other fun patients along with it. Having done what you are doing "trying to find the sickest of the sick" and now I'm stuck bored and frustrated, be careful with truama, maybe it's just my opinion but I felt a lot more challenged in a general SICU then I have in the pediatric truama ICU.

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