narcan

Some might say that I have a touch of OCD. And I'll admit, I do have some hoarding tendencies. I can't tell you how many times I have needed something RIGHT NOW and had to wait for distribution to send it up or pharmacy to bring it to me. Therefore, when I come across something that I think will come in handy, I shove it in my binder for a rainy day. My coworkers know this about me, and make fun of the fact that I have easy access to a pair of wire cutters, several suture kits, and in particular, one vial of narcan. Narcan is a drug that reverses narcotics, and you can give it to patients who aren't breathing well because we gave them too many drugs. I have my vial from a certain fiasco last summer where a nurse gave my patient pain meds less than an hour after I did accidentally. So last week, my vial of narcan came up and the girls were teasing me about it. Well wouldn't you know, at 2200 I get a frantic call that just tells me to "bring the vial of narcan to 11. NOW". Turns out that one of the patient's PCAs was set a touch to high and he was barely breathing. After the narcan, the patient woke up considerably and was talking to us. So say what you will about my OCD. Because if anyone ever needs some silver nitrate sticks, I'm your girl :)

bloodbath

Sometimes I think trouble is drawn to me. It all started innocently enough. Another nurse asked me to come look at a patient with a VAC, basically a big suction dressing, that needed to be changed. She was concerned because the canister had gotten full suddenly, and wanted another set of eyes. We got a new canister, and I turned off the machine and clamped the tubing. As I was trying to attach the new canister, I heard a pop. My eyes immediately went to the leg with the dressing, which was suddenly pouring blood out onto the bed in spurts. I didn't really have time to do anything but react; I clamped both hands down over the bleeding to hold pressure and yelled for someone to call a rapid response. The blood was pouring out between my fingers, and the patient went unconscious. By this time, all of the floor RNs were in the room starting bolus fluids, getting vitals, and drawing labs. The patient's poor wife was trapped in the corner of the room, watching as he was bleeding out from his leg. After we put the head of the bed down, the patient started to wake up just as the rapid response team started arriving. The trauma resident on call was next, asking me to let go of his leg so she could see the site. She cut off the ace wrap and exposed the VAC dressing, which was bulging with the blood collecting underneath it. Someone mentioned the word OR, and the med student ran off to book a suite. The chief resident showed up then, and mentioned taking off the VAC dressing to see the wound itself. We all decided that this was a BAD idea and shared our concerns. He, of course, could care less about our opinions and decided he was taking the dressing off. At this point, I'm picturing what's going to happen when that dressing comes off (blood hitting the ceiling and the patient crashing come to mind), and I decided we had to go over this guy's head. In two years as a nurse, I've never called an attending. But tonight I was scared for our patient, so I DID call and (thankfully) the attending was at bedside in 5 minutes. Of course by this point, the dressing was off, the residents were suctioning out the blood with a yankauer, and the patient was screaming in pain. He started to shake as the doctors pulled away clots that looked the size of organs. Thinking back on it, I think he was starting to go into shock. Or maybe he just needed a little more than the 2mg morphine IV that the MDs ordered for pain. (Seriously, 2mg? Come on.) Once the wound was exposed, it was clear that there was bleeding (duh) and that he needed to go back to the OR (duh again). He was wheeled away and we were left to clean up the bloody carnage than remained...500cs in the VAC cannister, 150 in the suction set, and at least another 200-300 on the bed, the linens, and the floor. In a matter of a half hour, the patient must have lost at least a liter of blood. It was like nothing I have ever seen. Through the whole thing, our group of nurses was AMAZING. The whole ordeal went very smoothly, and I'm impressed by how efficient we were. Guess practice makes perfect :)

things not to do

the following will land you in the hospital:

*antagonizing feral cats
*driving ATVs up trees
*getting a Lincoln dropped on your chest
*falling out of your tree stand
*runaway horse-drawn carriage crashes
*attempting to slit your throat with a circular saw. NOTE: this also applies to shooting yourself in the chest, stabbing yourself in the neck, drinking bottles of rubbing alcohol, etc. etc.
*attempting to crawl in second story windows after locking yourself out of your house following a night of drinking
*running from the police. this includes jumping off bridges, out of second story windows, and (of course) car chases
*DO NOT, i repeat DO NOT strip at an illegal tavern while 9 months pregnant. it will not end well.
*driving your car in thigh-high go go boots
*tripping over your dog and landing on a fire-poker


ok so i lied. sometimes the real world IS like grey's anatomy. truth is stranger than fiction? i think yes.

nurse's week 2010

This week:

1. We had a code. Another PE (big blood clot in the lung). The patient is fortunately still alive and in the ICU. For nurses' day, we all got to help save a life :)

2. We had a patient die. This sounds like a bad thing, but there really are times when it's the best possible outcome for someone. There was a G. A. quote that said "living is better than dying, until it isn't" and I really believe that. Making someone comfortable, giving them pain meds and surrounding them with their family to die in peace with dignity...it's just the right thing to do.

3. We have a morbidly obese patient who requires some MAJOR teamwork. Changing her bed is a 5 person job, and it just reminded me of how fabulous my coworkers are, and how grateful I am for them.

This week was actually just like being a nurse always is. Messy.  Hard.  Excruciating.  Rewarding.

some sad news

I just found out that one of the patients that I took care of about a month ago died. That's always a little weird for me, but this is worse than usual because this patient was still a teenager. He was hit by a drunk driver and suffered from a traumatic brain injury. Usually we get these types of patients well enough to go to a brain rehab program, which is exactly what happened in this case. From there, I'm not sure what happens to them, but honestly, I like to think that some of them get better and start to be able to function in some capacity again. This particular patient made me really sad. He had so much potential...had just turned 18 years old and been accepted to college. I watched his mother sit by his bed every day and talk to him about everything that was going on at home and how he had to wake up to see it. We watched him really closely together and would have hopeful conversations about things like "ooh, he's really moving that left arm today" and "I really think he just followed me with his eyes!". His sister would crawl into the bed with him in the afternoon and the whole family would just sit there, watching tv, every once in awhile talking directly to the patient and asking him questions. This perfect family got ripped apart because one idiot decided to run a stop sign. This could have been MY brother. Could have been someone I knew. You know, they teach you a lot of things in nursing school, but never once do they mention that you will grieve for your patients. They don't tell you how it feels to be talking to a person one minute, and the next minute to be doing CPR on them. They completely left out how to deal with a job where people are going to die, where sometimes you are going to have to WATCH them die. They never told me that I would be expected to hold the hand of a dying woman and whisper to her that it was ok to let go. And I was never taught how to cope with a job where 18 year olds can senselessly die. Yet here I am. And whether or not I always feel prepared to deal with these things, in this job I don't have much choice.