My SuperBowl Sunday (Shift)
Feb. 6th, 2007 12:10 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
fredericksFirst off, Vinatieri = love. Primal, cavewoman-like love, as in I would have no problem thumping the guy over the head and dragging him back to my hovel ifyouknowwhatImsaying. I just had to put that out there.
I worked yesterday, into today. I figured I'd get around to posting in-depth about some of my time in the hospital and since sleep isn't fast in coming (flailing around while dreaming you're trying to prevent a patient from crashing? SO not conducive to restfulness) I might as well start now.
Because LI transportation is for le shit (as the kids might say; whose kids? I'm not quite sure), I usually end up getting dropped off when I work weekend shifts. Of course, as all the pre-game hubbub began at 6ish and I had to get to the hospital around the same time I ended up keeping the fam from their SuperBowl party until dangerously close to kick-off. Oh yes, I was feeling the love/hate from them.
When I got in I saw that the area my preceptor and I were going to work had two empty beds. Empty beds mean you're bound to expect admissions during the course of the night. Admissions mean a lot of extra legwork and can be a crapshoot, as you're occasionally burdened with a patient who a)is a "train wreck" (near death), perhaps because he/she's come from an intensive care floor stable but it's their time to go or b) is erroneously assigned to a general medical floor when he/she presents a more critical case (see - this entry). Either way the fun (and I mean that in the most sadistic way possible) is doubled when you don't have a secretary on the floor to "pick up orders", or transcribe physician orders into the nurse's medical index, enter various labs/orders into the computer, put patient charts together, answer phonecalls from the Admitting Nurse, et cetera (my hospital is not 100% computerized yet, and it's occasionally a pain in the ass). We figured we'd be okay with two admissions as it was the two of us. Wrong. Wrong! (/Charlie Murphy).
First off, one of our patients ended up moving across the hall because she had problems with her roommate. That suddenly left us with *three* empty beds. Mind, we still remained under the mistaken impression that we'd be okay. When we got report from the nurse on the shift I ran through the normal routine (check on the patients, re-check the orders, check to see all meds needed for that evening were available and/or mixed).
[Eleven hours, three cups of tea, two naps, and one dinner later I continue]
Right. So, normal routine. When we'd gotten report from the day nurse she mentioned a patient expected to come up from the ER, an older woman with GI bleed. Treating patients with GI bleeds is its own class of not fun because there's a big chance you'll end up having to run a couple of blood transfusions, and transfusions are massive time and energy black holes, not to mention the risk of adverse transfusion reactions. Just, yeah, not fun. Luckily she didn't come up until after I'd finished most of my evening med distribution. When she came up from the ER she was chatty and rather with it, and I figured she'd be stable enough to hang around for a little while. UNTIL it came time to change her. She'd been admitted with rectal bleeding, see, and the diaper was a precautionary measure. We changed her right before we started her on the colonoscopy prep of a helluva lotta laxatives. There was blood *everywhere*. Through the diapers, into the chucks below her, massive amounts of dark blood with *huge* clots. While we were changing her she'd start coughing and more blood would come out.
Thus began our night from hell. This woman was *not* stable and should *not* have been left on a general medical floor, but instead should have been placed in the MICU immediately with a shitload (no pun intended) of transfusions running. Which is what the Physician-in-Charge (our floor is "covered", meaning interns and residents make up the medical staff), after having his attention brought to the case by my preceptor, tried to do. Of course, that meant calling up his attending physician and asking him if it could be done. Calling the attending at one in the morning, mind. The attending told the PIC to leave the patient on our floor without transfusion and he'd check on the patient when he came in...which would be five or six hours later. The patient's blood counts, meanwhile, had dropped dramatically (duh). I alternated between being pissed and scared out of my mind (my mantra continues to be "no codes, no codes...").
As the PIC went off to another floor to see about another case I ended up watching the patient in-between trying to take care of my other duties. Next thing I know I see the woman attempting to walk unassisted to the bedside commode we'd set up for her. I ran in the room to remove her diaper and help her onto it, as she'd gotten far enough from the bed that I felt it'd be impossible for me to get her back there by my lonesome. I removed her diaper (the second one for the night, again *full* for blood) and set her on the commode, where she quickly went from woozy to thisside of unresponsive. I ran and got my preceptor, and after we got her back on the bed I paged the PIC to get his ass back down to our floor.
Long story (and we were trying to help this patient for a good seven hours of the night) short, the PIC ended up ignoring his attending's orders and started the patient on a RBC transfusion and initiated the MICU transfer shuffle, which required having two MICU physicians take a look at the patient and her lab work. Then there was confusion about whether the patient was going to go to CT scan *first*, and could they wait until after her transfusion had completed (if a patient has a transfusion going he/she must be accompanied by his/her nurse), then whether the rate of the infusion could be increased because the patient was in dire need of the units (in our facility you can run blood free-flow in the ER and in the ICUs because those places have continual ECG/vital sign monitors on patients, but not on the general med./surg. floors as they're without monitors), and blah blah blah a whole lotta rigmarole and figuring out what the fuck was going on with this woman. She was stable enough to continue talking to us and after a 500ml bolus of NS plus the addition of the transfusion her pressure, heart rate, and oxygen saturation were remaining fairly stable (as long as she didn't try to go to the commode again; Jesus).
It was just complicated and terrifying and, my god, she was such a trooper. The last I saw her she was heading down to CT with a physician and nurse from the MICU while on a monitor with the second unit of PRBCs running. Along with that whole debacle we had to take care of our six other patients and deal with another admission *and* stave off a second admission after the woman with the GI bleed had been taken to radiology. By 6AM my preceptor and I were tired, a little snippy, and ready to get our asses home. By some grace or another I managed to finish most of our paperwork before seven, so we gave report to the morning nurse on-time, apologized in advance for any loose ends we might have left her, and then moseyed our asses out of there. Or, rather, my preceptor did. As I was a little wired still I ended up writing a med list for another patient, grabbing breakfast from the cafeteria, inquiring at the Nursing Education office about ACLS classes (I figure after that night the faster I learn it the better off I'd be), and waiting for mumsy to swing by to pick me up (that was fortuitous on my part; it was WAY too cold for me to deal with public transportation that morning).
It took me forever to write that up. I think I'm broken. My writing part, anyway.
I slept through Heroes. I hear it was amazingly awesome. Must watch the Sci-Fi repeat.
I worked yesterday, into today. I figured I'd get around to posting in-depth about some of my time in the hospital and since sleep isn't fast in coming (flailing around while dreaming you're trying to prevent a patient from crashing? SO not conducive to restfulness) I might as well start now.
Because LI transportation is for le shit (as the kids might say; whose kids? I'm not quite sure), I usually end up getting dropped off when I work weekend shifts. Of course, as all the pre-game hubbub began at 6ish and I had to get to the hospital around the same time I ended up keeping the fam from their SuperBowl party until dangerously close to kick-off. Oh yes, I was feeling the love/hate from them.
When I got in I saw that the area my preceptor and I were going to work had two empty beds. Empty beds mean you're bound to expect admissions during the course of the night. Admissions mean a lot of extra legwork and can be a crapshoot, as you're occasionally burdened with a patient who a)is a "train wreck" (near death), perhaps because he/she's come from an intensive care floor stable but it's their time to go or b) is erroneously assigned to a general medical floor when he/she presents a more critical case (see - this entry). Either way the fun (and I mean that in the most sadistic way possible) is doubled when you don't have a secretary on the floor to "pick up orders", or transcribe physician orders into the nurse's medical index, enter various labs/orders into the computer, put patient charts together, answer phonecalls from the Admitting Nurse, et cetera (my hospital is not 100% computerized yet, and it's occasionally a pain in the ass). We figured we'd be okay with two admissions as it was the two of us. Wrong. Wrong! (/Charlie Murphy).
First off, one of our patients ended up moving across the hall because she had problems with her roommate. That suddenly left us with *three* empty beds. Mind, we still remained under the mistaken impression that we'd be okay. When we got report from the nurse on the shift I ran through the normal routine (check on the patients, re-check the orders, check to see all meds needed for that evening were available and/or mixed).
[Eleven hours, three cups of tea, two naps, and one dinner later I continue]
Right. So, normal routine. When we'd gotten report from the day nurse she mentioned a patient expected to come up from the ER, an older woman with GI bleed. Treating patients with GI bleeds is its own class of not fun because there's a big chance you'll end up having to run a couple of blood transfusions, and transfusions are massive time and energy black holes, not to mention the risk of adverse transfusion reactions. Just, yeah, not fun. Luckily she didn't come up until after I'd finished most of my evening med distribution. When she came up from the ER she was chatty and rather with it, and I figured she'd be stable enough to hang around for a little while. UNTIL it came time to change her. She'd been admitted with rectal bleeding, see, and the diaper was a precautionary measure. We changed her right before we started her on the colonoscopy prep of a helluva lotta laxatives. There was blood *everywhere*. Through the diapers, into the chucks below her, massive amounts of dark blood with *huge* clots. While we were changing her she'd start coughing and more blood would come out.
Thus began our night from hell. This woman was *not* stable and should *not* have been left on a general medical floor, but instead should have been placed in the MICU immediately with a shitload (no pun intended) of transfusions running. Which is what the Physician-in-Charge (our floor is "covered", meaning interns and residents make up the medical staff), after having his attention brought to the case by my preceptor, tried to do. Of course, that meant calling up his attending physician and asking him if it could be done. Calling the attending at one in the morning, mind. The attending told the PIC to leave the patient on our floor without transfusion and he'd check on the patient when he came in...which would be five or six hours later. The patient's blood counts, meanwhile, had dropped dramatically (duh). I alternated between being pissed and scared out of my mind (my mantra continues to be "no codes, no codes...").
As the PIC went off to another floor to see about another case I ended up watching the patient in-between trying to take care of my other duties. Next thing I know I see the woman attempting to walk unassisted to the bedside commode we'd set up for her. I ran in the room to remove her diaper and help her onto it, as she'd gotten far enough from the bed that I felt it'd be impossible for me to get her back there by my lonesome. I removed her diaper (the second one for the night, again *full* for blood) and set her on the commode, where she quickly went from woozy to thisside of unresponsive. I ran and got my preceptor, and after we got her back on the bed I paged the PIC to get his ass back down to our floor.
Long story (and we were trying to help this patient for a good seven hours of the night) short, the PIC ended up ignoring his attending's orders and started the patient on a RBC transfusion and initiated the MICU transfer shuffle, which required having two MICU physicians take a look at the patient and her lab work. Then there was confusion about whether the patient was going to go to CT scan *first*, and could they wait until after her transfusion had completed (if a patient has a transfusion going he/she must be accompanied by his/her nurse), then whether the rate of the infusion could be increased because the patient was in dire need of the units (in our facility you can run blood free-flow in the ER and in the ICUs because those places have continual ECG/vital sign monitors on patients, but not on the general med./surg. floors as they're without monitors), and blah blah blah a whole lotta rigmarole and figuring out what the fuck was going on with this woman. She was stable enough to continue talking to us and after a 500ml bolus of NS plus the addition of the transfusion her pressure, heart rate, and oxygen saturation were remaining fairly stable (as long as she didn't try to go to the commode again; Jesus).
It was just complicated and terrifying and, my god, she was such a trooper. The last I saw her she was heading down to CT with a physician and nurse from the MICU while on a monitor with the second unit of PRBCs running. Along with that whole debacle we had to take care of our six other patients and deal with another admission *and* stave off a second admission after the woman with the GI bleed had been taken to radiology. By 6AM my preceptor and I were tired, a little snippy, and ready to get our asses home. By some grace or another I managed to finish most of our paperwork before seven, so we gave report to the morning nurse on-time, apologized in advance for any loose ends we might have left her, and then moseyed our asses out of there. Or, rather, my preceptor did. As I was a little wired still I ended up writing a med list for another patient, grabbing breakfast from the cafeteria, inquiring at the Nursing Education office about ACLS classes (I figure after that night the faster I learn it the better off I'd be), and waiting for mumsy to swing by to pick me up (that was fortuitous on my part; it was WAY too cold for me to deal with public transportation that morning).
It took me forever to write that up. I think I'm broken. My writing part, anyway.
I slept through Heroes. I hear it was amazingly awesome. Must watch the Sci-Fi repeat.
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no subject
Date: 2007-02-07 01:40 am (UTC)You rock!
no subject
Date: 2007-02-08 03:41 pm (UTC)I was still nervous as all hell. I think being in those situations constantly is the only way to prepare.