Wednesay is crap put day!
It's true, from the first day that I started, I was told that the shit always hits the fan on Wednesday, and so far I have not been proven wrong once!
Last Wednesday, the day before Thanksgiving, I worked in ICU. We sent our patient to the OR to get a permicath for dialysis. My pt was a older gentleman, around 60's who was in chronic renal failure and liver failure. He was vented and just did not look good. My preceptor says to me, 'watch, we are going to have to code this guy after he comes back from the OR'. After he came back from OR things seemed to be ok. And mark her words she was right, 3 o'clock, Wednesday afternoon he coded, TWICE. We couldn't get a blood pressure, no oxygen saturation on him (it's that clip they put on you finger with the red light that is annoying, it was reading anything, not good), he was cold, we couldn't get brachial, femoral, or brachial pulses on him. Then, all of a sudden his heart rate started dropping quickly, he bradyed down and went asystolic. A code was called: we started CPR, mechanically vented the pt with an ambu bag, and pushed 1 epinephrine and 1 atrophine. Finally there was a pulse and the code stopped but we waited in the room and exactly 1 hour later the drugs wore off and a second code was called. I was so scared, I stayed by the side of the wall listening to everyone yell out stuff.
Then this Wednesday, the one after Thanksgiving, the same thing happened but I swear it was like an episode of ER (but accurate lol). I get onto the floor waiting for my preceptor, it was 6:48am and the monitor goes off that the blood pressure is low, 60's, OH CRAP, that's not good! The patient was unresponsive and so there was emergency intubation. I stayed by the door running around getting things for the people in the room because the patient was on isolation and once you were in and gowned up it was easier to stay in that ungown and run around and gown up again. So I ran around getting stuff, IV fluids, IV kits and just a whole bunch of crap. After she was intubated, she wasn't doing any better, they were getting a pressure on her, so they started vasopressors, medications that force blood to the vital organs of the body, the heart and brain. What it does it that it constricts the vessels in order to shunt more blood to where it is needed and less to the other organs. The first vasopressor was Neosynephrine run at a continuous drip at the maxed out rate, that didn't help. They they started Levophed a second vasopressor, and they say that Levophed is nicknamed "leave'em dead" because it constricts so much that it leaves the patient with blue hands and feet which can cause necrosis (tissue death) and loose a limb from that. In the mean time, the doctors are putting orders for 2 units of blood, giving Vitamin K to clot because they suspected internal bleeding because the pt had a huge hematoma around her liver area. And all the while it's just not looking good at all. Our second pt was a little old man who spoke little English and was very bradycardic, he was talking to me and his heart rate was 30, that is not compatible with LIFE!!!! It's just not right I tell you! But he was feeling ok, he was talking to me, asking when was breakfast! And I'm just staring at the monitor and starting at him, like OH MY GOD I CANNOT BELIEVE THIS! Another nurse runs in and she's like 'Did you see his heart rate!!' and I look at her like "Yes, he's fine, he's talking to me, tell her sir.' LMAO! And he looks over at her and smiles! So back to the other lady, she started crapping out and them it was like, oh crap, slap an external pacemaker on her and let's pace her! That did not work! She wasn't capturing, she wasn't picking up a faster heart rhythm and we couldn't get a pulse and then all of a suddem we called a code blue again!! I was doing was bagging the lady (using the ambu bag to give her oxygen) then I turn around and there's like 5 people behind me and they are like what can we do to help. Meanwhile my preceptor is getting tired from doing CPR and we switch roles. I swear, my first CPR push, there was ribs cracking! CRACK-CRACK-CRACK--------CRACK! OH FUCK! I'm not that powerful, I'm barely 5'4 and 125lbs when I'm full, but I did that! We pushed almost every drug in that cart, 3 epi, 2 atrophine, 2 bicar, 1 calcium gluconate, and a whole bunch of other things that I can't remember. We shocked her 3 times (for which one time this dumbass resident almost pushed the shock button and everyone was STILL TOUCHING HER!! Hello, you are supposed to yell YOUR CLEAR! I'M CLEAR! EVERYONE'S CLEAR! INITIATING SHOCK!! stupid!!!!!!!) , had 3 doctors poking her trying to a central line (a different type of IV access) in her whole CPR is going. It the most terrifying experience ever! But I learned sooooo freaking much, and I actually got to do something instead of standing there clueless. Sadly, our lady was a very sick lasy and she died! It was her time to go, she gave it a fighting chance and so did we, we did everything to try and save her, but when it's time to go, it's time to go. :(
Last Wednesday, the day before Thanksgiving, I worked in ICU. We sent our patient to the OR to get a permicath for dialysis. My pt was a older gentleman, around 60's who was in chronic renal failure and liver failure. He was vented and just did not look good. My preceptor says to me, 'watch, we are going to have to code this guy after he comes back from the OR'. After he came back from OR things seemed to be ok. And mark her words she was right, 3 o'clock, Wednesday afternoon he coded, TWICE. We couldn't get a blood pressure, no oxygen saturation on him (it's that clip they put on you finger with the red light that is annoying, it was reading anything, not good), he was cold, we couldn't get brachial, femoral, or brachial pulses on him. Then, all of a sudden his heart rate started dropping quickly, he bradyed down and went asystolic. A code was called: we started CPR, mechanically vented the pt with an ambu bag, and pushed 1 epinephrine and 1 atrophine. Finally there was a pulse and the code stopped but we waited in the room and exactly 1 hour later the drugs wore off and a second code was called. I was so scared, I stayed by the side of the wall listening to everyone yell out stuff.
Then this Wednesday, the one after Thanksgiving, the same thing happened but I swear it was like an episode of ER (but accurate lol). I get onto the floor waiting for my preceptor, it was 6:48am and the monitor goes off that the blood pressure is low, 60's, OH CRAP, that's not good! The patient was unresponsive and so there was emergency intubation. I stayed by the door running around getting things for the people in the room because the patient was on isolation and once you were in and gowned up it was easier to stay in that ungown and run around and gown up again. So I ran around getting stuff, IV fluids, IV kits and just a whole bunch of crap. After she was intubated, she wasn't doing any better, they were getting a pressure on her, so they started vasopressors, medications that force blood to the vital organs of the body, the heart and brain. What it does it that it constricts the vessels in order to shunt more blood to where it is needed and less to the other organs. The first vasopressor was Neosynephrine run at a continuous drip at the maxed out rate, that didn't help. They they started Levophed a second vasopressor, and they say that Levophed is nicknamed "leave'em dead" because it constricts so much that it leaves the patient with blue hands and feet which can cause necrosis (tissue death) and loose a limb from that. In the mean time, the doctors are putting orders for 2 units of blood, giving Vitamin K to clot because they suspected internal bleeding because the pt had a huge hematoma around her liver area. And all the while it's just not looking good at all. Our second pt was a little old man who spoke little English and was very bradycardic, he was talking to me and his heart rate was 30, that is not compatible with LIFE!!!! It's just not right I tell you! But he was feeling ok, he was talking to me, asking when was breakfast! And I'm just staring at the monitor and starting at him, like OH MY GOD I CANNOT BELIEVE THIS! Another nurse runs in and she's like 'Did you see his heart rate!!' and I look at her like "Yes, he's fine, he's talking to me, tell her sir.' LMAO! And he looks over at her and smiles! So back to the other lady, she started crapping out and them it was like, oh crap, slap an external pacemaker on her and let's pace her! That did not work! She wasn't capturing, she wasn't picking up a faster heart rhythm and we couldn't get a pulse and then all of a suddem we called a code blue again!! I was doing was bagging the lady (using the ambu bag to give her oxygen) then I turn around and there's like 5 people behind me and they are like what can we do to help. Meanwhile my preceptor is getting tired from doing CPR and we switch roles. I swear, my first CPR push, there was ribs cracking! CRACK-CRACK-CRACK--------CRACK! OH FUCK! I'm not that powerful, I'm barely 5'4 and 125lbs when I'm full, but I did that! We pushed almost every drug in that cart, 3 epi, 2 atrophine, 2 bicar, 1 calcium gluconate, and a whole bunch of other things that I can't remember. We shocked her 3 times (for which one time this dumbass resident almost pushed the shock button and everyone was STILL TOUCHING HER!! Hello, you are supposed to yell YOUR CLEAR! I'M CLEAR! EVERYONE'S CLEAR! INITIATING SHOCK!! stupid!!!!!!!) , had 3 doctors poking her trying to a central line (a different type of IV access) in her whole CPR is going. It the most terrifying experience ever! But I learned sooooo freaking much, and I actually got to do something instead of standing there clueless. Sadly, our lady was a very sick lasy and she died! It was her time to go, she gave it a fighting chance and so did we, we did everything to try and save her, but when it's time to go, it's time to go. :(