D2 ICU

[whitewriter]

Today she called me stupid (to my face) for not putting my name on the two patient list.

I can tell you right now, I don't mind being called all sorts of things for all sorts of reasons but I can tell you I didn't enjoy it. Missing clinical knowledge, fine. Forgetting the existence of a 2 pt list... come on...

Hence I ended up with two patients, two days in a row.

TT was kind enough to then show me where the 2 pt list was and how to put my name on it.

In neuro we didn't have a 2 pt list because there's only 10 pt and its very hard to allocate to acuity and experience if you add in a 2 pt list in as well.

As a casual, you basically always have 2pt. or 1:1 special (aka. super confused or super combative pt whose side you cannot leave for even a second). I hadn't had a vent in >1.5 years now due to this. I've watched vented patients, I'm sure its just like riding a bike.

I'm well looking forward to it. They got a bunch of new Drager ventilators just when I went casual too which are smaller, tidier and much quieter than the older Dragers.

I had a real general pt today: infective pancreatitis, leading to 3x, purulent, foul smelling drains requiring frequent dressing changes but essentially, this poor man will forever be smelling like
he's sitting in a puddle of dihorrea. Each drain site is excoriated and red and the output is a concrete/milky grey.

Grey.

What the hell is grey.

There's serous.

Or rose.

There's bloody.

I'd never seen grey before.

My other dude had SIADH without surgery (that's interesting) and they think its due to his diuretic anti hypertensive medications which he's had for the last 2 years - and not had any problems with - all of a sudden creating a problem that has dropped his sodium to 120.

That's low. Normal is 135-145.

So as the ex-neuro nurse (am I ever going to be "ex-" anything? Doesn't it just accumulate? I suppose I was ex- regional hospital nurse. Defiantly not keen to go back to that nightmare anytime soon.

Surprisingly Mr low sodium's only symptom was dizziness (and hence they were questioning a posterior circulation stroke initially until his bloods came back).

Reminds me of when my dad came to a small hospital (smaller than SSH, in fact: its their lower acuity sister hospital) with dizziness and vomiting, and instead of thinking posterior circulation stroke they though, oh, ulcers, and sent him home with pantoprazole oral tablets.

2 weeks of nausea caused by dizziness or the room spinning around; and I took him to MSH where he was diagnosed with... posterior circulation stroke (basilar artery to be specific) and admitted to the stroke ward and commenced on a heparin infusion...

I get that nausea and dizziness can mean a lot of things, but how come bigger hospitals tend to pick up the things that smaller hospitals miss.. Or that small hospital mindset from the nursing staff. Toxic small mindedness. Anything beyond care awaiting placement is beyond their capabilities.

The only solution I can see to that is to rotate staff. I bet the staff would hate that. I'd hate it. Two rotation programs later I can tell you I did not those programs for the enjoyment of rotating. I learnt a lot of new things, and met a lot of new people. It's painful but

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Rita Ann Muscat (Western Sydney LHD)
Fri 01/01/2021 16:38
Inbox; Sent Items

I've always been a little afraid of TT.

Today she called me stupid for not putting my name on the two patient list.

Hence I ended up with two patients, two days in a row.

In neuro we didn't have a 2 pt list because there's only 10 pt and its very hard to allocate to acuity and experience if you add in a 2 pt list in as well.

As a casual, you basically always have 2pt. or 1 special. I hadn't had a vent in >1.5 years now due to this. I've watched vented patients, I'm sure its just like riding a bike.

I had a real general pt today: infective pancreatitis, leading to 3x, purulent, foul smelling drains requiring frequent dressing changes but essentially, this poor man will forever be smelling like
he's sitting in a puddle of diarrhea. Each drain site is excoriated and red and the output is a concrete/milky grey.

Grey.

What the hell is grey.


There's serous or haemoserous if its pinkish yellow- or rose (like the wine would you believe it).

There's bloody. or

I'd never seen grey before.

My other dude had SIADH without surgery (I found that really interesting) and they think it's due to his diuretic antihypertensive medications which he's had for the last 2 years - and not had any problems with - all of a sudden creating a problem that has dropped his sodium to 120.

That's low. Normal is 135-145.

I was thinking: random health kick and over drinking water/ Hx diarrhea and not eating for a few days as other possibilities but neither was the case.


I've been fielding questions about what happened with midi, why did I leave, did I finish? and the surprise: what? you weren't doing them at MICH? They sent you to MSH? and then SSH? How's SSH...

All in all I enjoyed being back. Seniors seem pleased I picked them (and juniors seemed surprised I managed to get in when lesser experienced have been knocked back lately). After IP rotation; those who finished the program get to "put in a preference" of which ICU they want to stay in. If you say blue, there's a high chance you'll be told its full (it's popular due to management style these days and also the pt cohort type) and if you choose green you'll either get it- or get convinced to go to neuro.

So really it isn't a choice at all.

I do feel like actually, this time coming back as a senior, that I got a real choice.

I have 4x 12 hr nights next week though so ask me if I enjoy it after night 3...