Monday, August 1, 2011

Welcome to the ICU... part one

It started out as a normal weekend shift.
Two stable patients, one of which I'd had before. 
Both vascular surgery patients, one that was two weeks out from a complicated case.
He recovered well and was slotted to be transfered out first from the unit monday morning. 
A funny guy... slightly confused but in a pleasant way. 
Had a smile like a cheshire cat and hair like Don King. 
We laughed a lot with him.
 We were all glad he was doing so well. 
His family was glad he was doing well too.

Midnight rolls around and as I enter his room something is different now. 
He looks uncomfortable... something is not right. 
He is asking for cold medicine and because he is suffering from ICU delirium I know this is not good. 
I listen to his lungs and hear crackles in the bases and wheezes throughout his upper airways. 
A sign that fluid is building up. 

I page the respiratory therapist and a treatment is given.
The symptoms don't change. 
I page the intern... three times. 
No response.

I complain to everyone around me about how much I hate July in a teaching hospital.

I page the resident and right as he comes out the code pager goes off.
I quickly relay the symptoms. He orders a blood gas and says he will be back to check the results and then is off to the code downstairs. 
While he intubates the patient downstairs we try to get blood from my patient's artery... a painful but necessary process. He is acidotic.... not a good sign.

I look at my patient and he has that look.... that look of doom.
His breathing is rapid and labored.
He looks frustrated and scared.
He is getting tired now.

I can feel it in my gut... this patient is sick.... and I mean sick sick.
It just isn't adding up... something is not right.
It is one of those times when a nurse's intuition kicks in. We order a chest x-ray, bipap mask to force air into his lungs and lasix to help get rid of the fluid in his lungs. 

Meanwhile I bring the intubation kit to the bedside... I just have a feeling.
Sure enough within the hour the patient is intubated... we are inserting central lines.... arterial lines.

I tell him that it will be okay... we will put this breathing tube in until we find out what is causing his respiratory distress. We will fix this and hopefully in the morning we can get the tube out. 

I give him the sedation that was ordered and I watch him close his eyes 
as he falls into a deep chemical sleep. 

From 3:00am until 8:30am I am in the room assisting the docs with the intubation and line insertions. I am giving drugs and starting drips to maintain his crashing blood pressure.
We are drawing labs and throwing around possible causes. 
A clot?
A pulmonary embolism?
An illeus? 

We run the tests and everything comes back inconclusive. 
We have no answers but the patient is not getting any better.
He is getting worse.

By the time I give report the surgical team has been in to assess. We are trying to get him stable enough to go to CT scan... and yet we only continue to add more medications to chase his crashing pressures.

I ask if anyone has called his wife? 
It is now time to go home and my patient is still not stable.

I give report amidst the craziness in the room. I thank the co-workers that helped me and as I drive home... exhausted and weary... I say a prayer for my patient.... knowing that he will most likely head back to the OR that day. Hopefully they find out what is wrong.... 

To be continued...

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