Saturday, November 10, 2007

Sometimes it gets busy.

I've been off for 3 days now and I walk into work at the beginning of my 12hr shift with a note on the desk that says "Come down to ICU and join the fun!", now this is probably not a invitation to a party in the ICU I'm thinking. Nope it isn't after I answer the phone right after I read this it's a coworker wanting me to come on down asap, ok let me just hang my jacket up at least and grab my stethoscope and off to the ICU I go.

In I walk and there my coworker is getting things ready for the Doc to intubate a patient. I can hear this patient outside of the major fluid issues, then I look, puffy like the stay puff marshmallow man and gray, yep this is gonna be fun. We finish getting the intubation stuff ready and the Doc slides the tube in, I place the CO2 tester on and give that first breath and it takes all my hand strength to get a breath in, wow is this patient tight...then I see it, pink frothy and bloody THICK secretion up the tube. Yep that could be a problem, time to suction. Finally I look up and see one of my coworkers, she looks about ready to's been one of those days I can see. The vent is set up and we place the patient on and that vent is just high pressuring, wow this person is tight from fluid time to try pressure control. I adjust the pressure and I times and I get volumes anywhere from 70 - 250ml's, not good we need a bit more but I have the pressure already up to 35 cmh2o time to continue bagging.

Back with the bagging the monitor starts alarming we look up and just watch the QRS's widen on this patient until it turns into V-Tach, not good. Check for a pulse, there is one and she converts back, phew dodged that code. A couple minutes later there it goes again, V-Tach, this time is stays, and we shock, back to a normal rhythm but a BP of 30 systolic. Again back to V-Tach and it stays, but there is still a good pulse so my coworker asks the patient to squeeze her hand, which she does, asks if she is in pain and the patient shakes his head no, can you move your feet, they move all over. We look up and still a full out v-tach on 2 different monitors and a good pulse with good responsiveness but the BP is still 30 systolic, now this is something I haven's seen before, a responsive patient in a condition like that. The doc now decides that there is now way this person can be responsive with a BP that low so it must be wrong. Now we need blood work and a ABG.

Here is where I feel like a stud. A doctor has already tried a A-Line and wasn't able to get any blood, another RT has tried to get a ABG already and nothing, so I say let me do it. I fell zero pulses in either the radial or brachial areas so it's time to use anatomy. I grab my kit, take aim and go for it...nothing...readjust...nothing...again and I strike blood!!!! WOOT!!! The syringe fills and I get the gas, it was said it couldn't be done.

Finally this patient stabilizes for the most part and we are able to ventilate but for most of the night it's back and forth....V-Tach and Sinus heart rhythm until finally in the morning things just give up and HR drops, BP drops and QRS's widen and the patient passes on.

Busy night, and from what I hear busy day I was told from the RT who looked like she was going to break down said and ultimately did break down and cried in a back room. I don't know exactly what all went on during the day but it was enough to get to her and she still felt like she should stay and help us until things got caught up with. I told her to get out of here, go home, have a drink and relax we will be just fine.

Yes our small hospital's can become very busy at times and it ways can be more stressful because of the small amount of staff we have to run with, but you adjust, adapt and make it work with what you have, all in all people do understand that you can get busy.

What is this post about, nothing educational just a post to talk about my night and how it can be. But ya know these are the nights that make this job fun, I enjoy the stressful situations like this.

Keep it up RT's and drive on.


sometimesibreathe said...

I like the adrenaline, that's why I chose this major. I can't picture myself in a mundane setting behind a desk.

Freadom said...

That's the part of the job I like too, when you really get to use your tools and show off your skills. Nice post.

Djanvk said...

Yep, I really enjoy the stressful situations also. Good rush.