bad idea

so we have a morbidly obese dialysis patient with a broken arm who all the sudden can't breathe. of course, the first thought from our merry band of doctor friends after she's maxed out on 02 on 15 liters via nonrebreather mask is Bipap!! Oh yes, we can put her on Bipap and pretend that there's not a problem. which we do, for several hours. then someone comes up with the idea of a chest CT, which is no doubt going to find the massive PE we're all praying she is not going to throw right here, right now. problem with that being that girlfriend only has a foot IV. it is at this moment that someone from the trauma team is smacking themselves upside the head wishing they would have listened to nursing the day before when we suggested a central line. oh well, no time like the present to dig around in a dialysis patient's chest, right?

so the patient looks bad. her sats are fine on bipap, but her ABGs are crap. in preparation for CT, we're pumping her full of bicarb through that trusty foot IV. unfortunately, dialysis patients aren't exactly amenable to IV fluids at 300cc/hr, so her BP is now 220/114. at some point in this disaster, someone finally comes to their senses and gets an ICU bed. so the smart thing to do would be to go to the ICU, get a central line, and then have the ICU RN go with the patient to her CT in case she codes in the scanner.

so naturally, that's exactly the opposite of what we're going to do.

the resident would like to place an EJ at bedside. and he would like me to put the patient into trendelenburg to do it. so lets recap: morbidly obese. on the bipap, and can't breathe that great sitting straight up. already with sky-high pressures. and you think we're going to tip her upside-down on her head?

the day nurse and i just looked at each other. "get the code cart", she says to me.

so yeah...nooooo...we didn't do that. and then the patient went to the ICU and got a central line done all proper-like.

you're welcome, baby doc, for helping you not accidentally kill your patient with your ignorance and bad ideas. and next time, when i politely try to tell you that something you're doing is stupid, why don't you go ahead and listen to me and save the roll-y eyes for when you're back in the cuddly bosom of your MD pals.

k thanks.