hierarchical feeding...

...aka, when the surgery attending climbs down off his holy mountain and proceeds to eat you.  alive.  in front of his entire service.

i must have missed the day in nursing school that said putting an SCD on a patient who's anticoagulated   is sick and irresponsible.  sheesh, you would have thought i put the thing around the guy's neck...

and then there was the fact that his brace was rubbing his leg and it was all my fault because i had no idea where the stump sock was.  um. well maybe it was in dialysis.  seeing as how that was where the patient had been FOR THE PAST FIVE HOURS.

so excuse me if every pillow is not fluffed quite so, and if there are extra linens at the foot of the bed (gasp!) but i was more worried about the fact that the patient has been repeatedly attempting to drink from an imaginary cup.

oh and also he's oriented x1 and his eyes are doing that rolly "i'm 'bouts to code" thing and frankly we have bigger problems than feng shui-ing his room.

so after i listened to all that noise which was a total waste of my time, we got down to business.  the plan of care.  i'm thinking sepsis: altered mental status, downtrending pressures, known source of infection...easy.  but he had been worked up pretty good and nothing came back.  CXR was negative.  blood cultures negative.  head CT negative.  UA was pointless because he's colonized with VRE.

which leaves us with the last 2 things.  the lactic acid and the ABGs.

i knew what i was getting into before i opened my mouth, and i almost didn't say anything because i was tired of being patronized, but that's just the way that the patient advocacy cookie crumbles sometimes.

did you know that "lactic acid is a $200 pointless test that tells you absolutely nothing and should be removed from the lab".  and that "oxygen saturations via pulse ox are 99.9% accurate and you don't need ABGs to tell you what you already know"?  well that goes against everything i have ever been taught and more than one case that i've seen, but oh well.

so that was that.

and then 2 hours later the patient bottomed his pressures out to 70/40 and got all hypoxic and started doing this weird staring at the ceiling thing with his mouth open that looked a whole lot like dying.  so i packed him up, took him to the ICU, and watched them do all those expensive "pointless" tests that i had requested.

well i tried.


*i later found out that this patient eventually had a MI and died in the ICU.  nursing instinct people...not to be ignored.*