this semester i'm teaching a nursing student. she follows me around, and i explain why we're doing what we're doing, then troll for exciting thing for her to see. as the patients on our floor can get sick fast, more than once i've set her up in the corner of a room and told her to just stay there and watch. personally, i've learned the most from being in rapid responses and codes, even if that is where i often feel most scared and generally like i want to go cry in a corner. for the sake of all of my student's clinical paperwork, we have been calling these incidents "critical situations". and it seems like we didn't go a day last week without having one. some of the highlights:
my medicine patient went into status asthmaticus...basically a really bad asthma attack that doesn't respond to the usual treatments. now i can handle a lot of things. if you're bleeding, i can stop it. intestines coming out of your belly? seen that, we're ok. but asthma? i have NO idea what to do with asthma. so i gave the lady her rescue inhaler and grabbed the respiratory therapist. well after a nebulizer, things usually get better. not so much. so she got another neb. and another. and another. and then we called the rapid response team to come see her, because she was barking like a seal and we still couldn't get her to stop coughing. the MICU resident came down to join our party, and ordered continuous nebulizers. this is a floor no-no. along with the nebs we got an order for q 15 minute vital signs (seriously?) and to run some magnesium in IV really really fast( pharmacist's quote after seeing the doctor's order "no no, we do not run it that fast even during a code". oh great.). my thoughts? this lady needed to go to the ICU. she can't breathe, and i can't leave her long enough to check on any of my other patients. fortunately i work with some amazing nurses, who graciously took over the care of my other patients so i could help fix this lady. after TEN nebulizers in a row, countless sets of vitals, and a bag of mag, the patient was cured!! unfortunately, it also took two and a half hours, during which time i never saw another patient. i like to refer to this phenomenon as "running my own ICU", and despite the fact that we don't have the time or resources to do this on the floor, it happens all the time. i feel that certain doctors see ICU transfers as failures. they don't want to sent their patients to the unit under ANY circumstances, so you have to basically be dying to enter the holy gates. which doesn't put me in a good position when i'm trying to care for an unstable patient as well as 3-4 other people. but i digress.
so on sunday, we get a patient out of the ICU. he's sitting up in the wheelchair, looking pretty good for someone who just got transferred out of the unit. until the nurse realizes that his epidural catheter is snapped in half and leaking pain medication out onto the floor. and he gets nauseated. and dizzy. and dry heaves. until his heartrate goes down to 38. and then passes out. still in the wheelchair. have i mentioned that he's over 350 pounds? the next hour was a blur of running up and down the halls, calling the rapid response team, hooking him up to the monitor, jabbing various tubes and needles in him, bolusing, etc etc. once again, his nurse wasn't able to leave the room to see her other patients for several hours. but of course, despite the fact that this patient required 1:1 nursing care, he was not sick enough for the ICU.
so, in summary: my nursing student learned a lot. i am exhausted. and i may not officially work in an ICU, but then again some days i do.
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