Posts Tagged ICU

Jean, ROSC*

So as J mentioned before, I was in a near catatonic state due to my VSA* computer which has fortunately been resuscitated. The hypothermia post resuscitation care was beneficial but it suffered an anoxic brain injury that may not be possible to overcome. Despite this crushing blow (more so financially really since I do not feel like purchasing a new computer) I am okay with the periodic laptop confusion for now. I’ll do neuro vitals qshift on the computer, continue monitoring and provide supportive care. (Sorry for the lame nurse humour; that I cannot fix.)

Aside from my near death computer experience I have been incredibly busy with working in the ER, updating necessary work courses, school work for a critical care course I’ve been taking as well as starting in Acme Regional’s CCU/ICU. It’s a very different world up there (literally not figuratively. . .it’s on the 4th floor). The pace will take some getting used to. On one hand I enjoyed just having one patient to dedicate time and care to, knowing their history and the pathophysiology of their recent admission and not feeling like I’m practicing unsafely or providing my patient with the bare minimum, however, at the same time, having only one patient is a bit boring. The ICU seems a bit tedious: lots of little details and new physician orders that my emergency brain isn’t wired for. We have a lot of autonomy in the ER, more then I think we realize. Either way, I welcome the change in general, be it pace, environment, meeting new people, learning some new skills and learning in general. I had been feeling stagnant in the ER for a while. I still enjoy the ER immensely and I am not leaving, simply picking up some hours in the ICU for now. If anything I hope the added critical care experience makes me a better nurse. I felt like I had hit a roadblock and I wanted to know more but I just wasn’t learning in my day to day work life, so back to school I went!

I’ll have some new posts soon on more phrases junior nurses and most staff do not care to hear, as well as some other burning ideas and issues (with possible sarcasm and complaints) that have been on my mind.  I have a few patient stories I’d like to share also. So, I hope to be more active soon, sorry for the absence!

*VSA – vital signs absent
*ROSC – return of spontaneous circulation

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My New Motto

I had a very pleasant dinner the other night with an old friend I went to school with, and whom I literally hadn’t seen for years. We didn’t have a falling off or anything like that. We just sort of — drifted. Life gets in the way. Children, family, work, and suddenly it’s ten years later and you’re wondering where all the freakin’ time went. She didn’t look much different, to me anyway. She was still married to the same guy and still had the cottage up in Haliburton where we once spent a summer weekend walking in the woods and minding the bears. Her kids were all grown up. She was, to my surprise, an ICU nurse. Surprised, because she was determined when we graduated to be the best med-surg nurse ever. But she’s a smart cookie, and predictably she wanted a challenge. She told me when she first started as a med-surg RN, she would avoid codes because “codes were only for critical care nurses.” Now, she jokes, she avoids codes because she’s old and seen it all. Let the young ‘uns do them. I agree, at least with the sentiment.

We compared notes. We kindly and gently mocked each other’s specialities. We traded war stories, told tales of egregious physician behaviour (a favourite nursing pastime), stories about ourselves, our patients, our profession, tragedy and comedy: the wealth of human experience we are privileged to share.

Another piece of wisdom: “Stupidity,” she says, “is what keeps us in business.”

My new motto.

My other new motto: look up an old friend once in a while.

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Please Help Me

I’m having a really hard time understanding why it takes six hours and twelve minutes to complete two bed moves between 5 South and 2 South so we can free up an ICU bed and get a critically ill patient upstairs —  one who’s already been rotting in the emergency department for ten hours.

I mean, is there some weird breach of the space-time continuum up there, where the minutes pass more slowly?

Or is there some simpler explanation?

Another mystery: when after five hours and fifty-seven minutes the ICU charge phones in me triumph to tell me they’re ready for the patient, why do I thank her for expediting the bed moves when clearly she did nothing of the sort?

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Shift Report [Annotated]

Report  @ 1900 CLINICAL CARE LEADER: [TorontoEmerg] BEDS AVAILABLE: None. [5 North and 5 South are short-staffed and in the event, are over their census anyway. ICU has too many vents. 3 South is at census, but has an outbreak. 3 North can’t bed space. L&D and Paeds are full. NOTE: the ED is never over census. Nor can we refuse to take patients.] ADMITS —- 24

Medicine: 8 [one is dying: all we can do is find a hospital bed and an isolation room. Dying on an emergency stretcher is grosteque.]

Telemetry: 7 [One patient is Day 4 and a no code and has been asymptomatic for 48 hours. Physician refuses to take off telemetry.]

Surgery: 4 [all upper GI bleeds]

ICU: 1 [Intubated.]

HOLDS — 8

Ortho: 3

Medical: 4 [out which 3 will be telemetry]

Psychiatry: 1 [a frequent flyer psych OD who will get the boot as soon as her ethanol level drops below 20.0]

EMS OFFLOAD: 4 [EMS supervisor has called twice, looking for non-existent stretchers. No dice.] Comments: 16 patients in waiting room; 4 will be probable admissions; 1 active chest pain is being treated on the triage stretcher waiting for a monitored bed. Hip night, previous [3 fractures, elderly ladies tripping the light fantastic.] Trauma: pedestrian versus SUV, shipped to Holy Somolians downtown. Code Blue, v tach arrest at triage, cardioverted in two minutes, to to ICU alert, oriented and happy [(and on an amiodarone drip.) Never happens. But it did.] Toilet in the waiting room overflowing.

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Top Ten Reasons ICU Won’t Take Your Patient

10. We’re too busy.

9. We have too many vents.

8. We’re understaffed.

7. We have staff, but the patients are too heavy.

6. Two rooms are being waxed, so those beds aren’t available.

5. We need to do bed moves.

4. The patient is discharged/died, but he’s still in the bed, so your patient can’t come.

3. It’s too close to shift change.1

2. We want to see if your patient gets better.2

1. Your patient is too unstable for the ICU.3

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1Which excludes 2 hours before and 2 hours prior to shift change, eight hours a day; if the ICU nurse is going on break, this can be easily be extended an hour.

2I have actually heard this. Meaning, “We want to see if the patient dies.”

3Ibid.

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