Been lost in my land of asystole and truama
Sorry about the major lag time in updating on LJ (or being just about anywhere on the net other than playing COH). My critical care roatation just ended last night at school. It went out with a bang (and a gurgle and lots of blood and silk tape).
I had the best experiences in the past week. I was in our small 12 bed ICU on Wednesday night taking care of my first client on a ventilator. Poor old guy was chronically in and out of the hopspital for the past 40 years. Had major cardiac and pulmonry problems (tuberculosis, COPD, Aspergilomas, etc, etc, etc). 70 years old and still here (many of the nurses remember him from 10 or so years ago, and thinkign he would not have lived this long). Basically, I had a simple night with him, just maintain his airway via the proper ventialator setting and give him some meds now and then. The only problem was, he ahd already extubated himself three times in this visit to the ICU (extubation, meaning pulled the artificial airway out of his trachea, pulled the feeding tube out of his stomach and all while the protective straps, tape and inflated pressure cuffs were functional...not bad for 70 and really sick!). So no big deal, but a first time with a ventialted client, so good learning none the less. half way through the night, we get wind that there is a new client coming to us form the ER. 29, seizures, possibly alcohol and drug overdose, hundreds of lacerations, fighting the sedatives and other medications, and NOT INTUBATED!!!! Sound like fun, will get to see the respiratory therapist intubate a client having seizures. Little did I know the night was going to be even more exciting. The client comes up to the ICU, and we are going full force, need to hodl him down, get him stablized for intubation, all the good stuff. Well I threw on gloves and a gown and joined in! I was restraining him as they intubated (not easy, since his airway was full of all things you might not imagine or want to imagine as well as his seizures, which did allow him to bite the tip of his tongue off and break a few teeth while he was in the ER). Then, once he was intubated and the rest of my classmates were brought down from the other units to watch, the nurse on ICU tells my clinical instructor "He needs an OG." (OG = orogastric tube, to provide nutrition temporarily while intubated with the artificial airway). She turns to all us students and asks who want to do it, and I immediately say I will. I had never tubed anyone before, other than a few catherters here and there. So I got the tube lubed and ready to go, and I did it. I put in my first intubation. It took me like 10 tries, but that was nothing from what I was told, since the airway has a cuff that blocks the esophagus, and since youa re basically trying to put a small floppy tube into someones stomach, and once it leaves the back of the mouth, you are going blind, and can only manuver by feel. Compare it to taking a piece of cooked spaghetti and trying to put it into a drinking straw while blindfolded. But I did it! I was damn proud, and got some great feedback from the staff about it. Also got to do post-mortem care on another client who passed away that same night from sepsis (systemic blood infection), which was a first for me too. That made an impact on me, and I felt very pround to be able to clean this man's body up and remove the tubes and lines that were in him, so that his body could be taken care of by the funeral home, and so his fmaily could see him as a person, not a patient before they said goodbye. I cried after I did it, not because I was sad or scared, but out of emotional reverence for the family and the man. it made me realize that part of my job is just making it easier for people to cope with medical problems, death or poor prognosis. That by far was the best learning experience I had that night.
So last night, I was on the post cardiac care unit, with two clients that were my responsibility. Nopthing major with them, one being discharged today to home, the other a new admitt with minor chest pain, so giving her meds and keeping her comfortable while monitoring her EKG. We find out there is a client in ICU who is having an ERCP (endoscopy of the esophagus and stomach) to find out where the blood he began vomiting is coming from. the client has esopageal varices (stretched veins aroudn the esophagus that are thin walled and under high pressure, like varicose veins or hemorrhoids) which are very easily damaged and can cause a person to lose so much blood that they can die within hours of this starting if untreated. We also foudn out they planned to do a procedure that is a very rare one. They take a large inflatable catheter and inflate it is section to tamponade the bleedign in the esophagus tempoorarily until the client is stable enought to get to surgury to have a procedure done to decrease the blood flow to the bleeding varices. The name of the procedure escapes me, but it is seldome done, because the client usually dies before you can ge tot do it. So off we go to ICU again, because this is a once-in-a-lifetime experience. I HAVE NEVER SEE SO MUCH BLOOD IN MY LIFE!!! We all had to glove and gown, since the poor man was spewing blood, Exorcist-like fashion, everywhere! The gastroenterologist was already there, and had tried to do the endoscopy, but there was no way to get the endoscope through some of the blood clots that had formed in the man's esophagus. So time for the rare procedure. We were all helping, passing clamps and tape and gloves and saline and syringes, haniging units of blood and pressure packing them into the man, since his blood pressure had dropped to 50/30 or something near that. It was life or death. But we all worked together and got him stablized. we got his pressure back up to 100/65, not great, but a hundred times better than before. We got him intubated, on a ventilator, an arterial pressure sensor put in and the esophageal balloon tamponade in place as well. It was amazing. The doctor, though a real asshole, was asking us all for help, student or RN, it did not matter.
So over all, i decided that I am a blood and guts junkie! I will be a trauma/critical care nurse! I just love it!
Ok, long story, sorry about it, but that is my life lately. Now this coming week, it is off to Toronto for 4 days to celebrate my 1 year anniversary with wickedone73 . And hopefully to hang with hockeyslave! WOOF!
I had the best experiences in the past week. I was in our small 12 bed ICU on Wednesday night taking care of my first client on a ventilator. Poor old guy was chronically in and out of the hopspital for the past 40 years. Had major cardiac and pulmonry problems (tuberculosis, COPD, Aspergilomas, etc, etc, etc). 70 years old and still here (many of the nurses remember him from 10 or so years ago, and thinkign he would not have lived this long). Basically, I had a simple night with him, just maintain his airway via the proper ventialator setting and give him some meds now and then. The only problem was, he ahd already extubated himself three times in this visit to the ICU (extubation, meaning pulled the artificial airway out of his trachea, pulled the feeding tube out of his stomach and all while the protective straps, tape and inflated pressure cuffs were functional...not bad for 70 and really sick!). So no big deal, but a first time with a ventialted client, so good learning none the less. half way through the night, we get wind that there is a new client coming to us form the ER. 29, seizures, possibly alcohol and drug overdose, hundreds of lacerations, fighting the sedatives and other medications, and NOT INTUBATED!!!! Sound like fun, will get to see the respiratory therapist intubate a client having seizures. Little did I know the night was going to be even more exciting. The client comes up to the ICU, and we are going full force, need to hodl him down, get him stablized for intubation, all the good stuff. Well I threw on gloves and a gown and joined in! I was restraining him as they intubated (not easy, since his airway was full of all things you might not imagine or want to imagine as well as his seizures, which did allow him to bite the tip of his tongue off and break a few teeth while he was in the ER). Then, once he was intubated and the rest of my classmates were brought down from the other units to watch, the nurse on ICU tells my clinical instructor "He needs an OG." (OG = orogastric tube, to provide nutrition temporarily while intubated with the artificial airway). She turns to all us students and asks who want to do it, and I immediately say I will. I had never tubed anyone before, other than a few catherters here and there. So I got the tube lubed and ready to go, and I did it. I put in my first intubation. It took me like 10 tries, but that was nothing from what I was told, since the airway has a cuff that blocks the esophagus, and since youa re basically trying to put a small floppy tube into someones stomach, and once it leaves the back of the mouth, you are going blind, and can only manuver by feel. Compare it to taking a piece of cooked spaghetti and trying to put it into a drinking straw while blindfolded. But I did it! I was damn proud, and got some great feedback from the staff about it. Also got to do post-mortem care on another client who passed away that same night from sepsis (systemic blood infection), which was a first for me too. That made an impact on me, and I felt very pround to be able to clean this man's body up and remove the tubes and lines that were in him, so that his body could be taken care of by the funeral home, and so his fmaily could see him as a person, not a patient before they said goodbye. I cried after I did it, not because I was sad or scared, but out of emotional reverence for the family and the man. it made me realize that part of my job is just making it easier for people to cope with medical problems, death or poor prognosis. That by far was the best learning experience I had that night.
So last night, I was on the post cardiac care unit, with two clients that were my responsibility. Nopthing major with them, one being discharged today to home, the other a new admitt with minor chest pain, so giving her meds and keeping her comfortable while monitoring her EKG. We find out there is a client in ICU who is having an ERCP (endoscopy of the esophagus and stomach) to find out where the blood he began vomiting is coming from. the client has esopageal varices (stretched veins aroudn the esophagus that are thin walled and under high pressure, like varicose veins or hemorrhoids) which are very easily damaged and can cause a person to lose so much blood that they can die within hours of this starting if untreated. We also foudn out they planned to do a procedure that is a very rare one. They take a large inflatable catheter and inflate it is section to tamponade the bleedign in the esophagus tempoorarily until the client is stable enought to get to surgury to have a procedure done to decrease the blood flow to the bleeding varices. The name of the procedure escapes me, but it is seldome done, because the client usually dies before you can ge tot do it. So off we go to ICU again, because this is a once-in-a-lifetime experience. I HAVE NEVER SEE SO MUCH BLOOD IN MY LIFE!!! We all had to glove and gown, since the poor man was spewing blood, Exorcist-like fashion, everywhere! The gastroenterologist was already there, and had tried to do the endoscopy, but there was no way to get the endoscope through some of the blood clots that had formed in the man's esophagus. So time for the rare procedure. We were all helping, passing clamps and tape and gloves and saline and syringes, haniging units of blood and pressure packing them into the man, since his blood pressure had dropped to 50/30 or something near that. It was life or death. But we all worked together and got him stablized. we got his pressure back up to 100/65, not great, but a hundred times better than before. We got him intubated, on a ventilator, an arterial pressure sensor put in and the esophageal balloon tamponade in place as well. It was amazing. The doctor, though a real asshole, was asking us all for help, student or RN, it did not matter.
So over all, i decided that I am a blood and guts junkie! I will be a trauma/critical care nurse! I just love it!
Ok, long story, sorry about it, but that is my life lately. Now this coming week, it is off to Toronto for 4 days to celebrate my 1 year anniversary with wickedone73 . And hopefully to hang with hockeyslave! WOOF!