Events of today in ICU
Mar. 24th, 2021 08:40 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterIt was simply nuts.
Key learning point: get your vaccination done at the earliest time slot in the morning because the it only takes an hour round trip.
I was allocated:
Stroke man
1:1 for pulling lines.
90 yr old male
Had a stroke 5 days ago- had an endovascular clot retrieval(ECR) which didn't work too well.
so now he had had a one way extubation.
He had cheyne-stroke like breathing but Sp02 >93% on room air.
He didn't obey commands but would intermittently and independently open his eyes and look about, and or reach for things. Then go back to sleep.
His wife was near hysterical on the phone at 0800 when she asked how he went through the night, and then said she was coming.
When she arrived she spent the entire day flapping about the bed. Worrying about his hands. About his mouth (she said it looked swollen but honestly I couldn't see it) about why he wasn't opening his eyes (he did, just not when you asked him to)
When she left she made J feel bad because previous days they had vehemently disallowed her to stay overnight. Seriously, she's 90 as well, and we don't have facilities for people to stay : no bed, no showers for them etc.and so they'd sleep on an uncomfortable recliner at the bedside , and have zero rest. So what to happen the next day over? That's why unless the person is likely to die that very night OR. they're a nightmare to deal with due to language difficulties-- we don't let the family stay.
When I said he was wardable and could get a ward bed anytime from now : she asked me which ward was he going to, the Dead ward?
I was taken aback by the question but answered it plainly: dead ward does not exist - we have a stroke ward for him.
I didn't want to say --do you mean the morgue? --...?
After she left he promptly threw up the movicol I had earlier shoved down his NGT and his feeds were paused. This happened all as I was trying to get my other just as uninteresting lady up to the ward.
The TOE that turned into a pharyngeal perforation
70 yr old lady came for a TAVi, and during the TOE, whomever was doing it perforated her pharynx or throat.
Therefore she had to have an NG inserted and wasn't allowed to eat.
She was severely overweight and her legs were +++++ swollen. She was on frusemide (just 20mg via NG)and I had to empty her IDC almost every 3 hours because she basically peed 3-400mls an hour.
The best bit was whilst I was getting handover from B -- she piped up and said "they tried to kill me-- the doctors, they did this to my throat and they tried to kill me." and B looks at me and said to her "Well I'm sure they didn't mean to cause injury on purpose..."
She would sleep all the time but immediately upon waking would say how much pain she was in.
When I transferred her to the ward, there were only 4 of us to move her over. We used a patslide and thank the lord I brought a slide sheet with me. I should have brought two-- might have helped having a second. Anyhow. Moving her from the ICU bed to the regular bed was a nightmare. She wasn't light lets say and I've stopped gymming so. Yeah. If we'd been any less fit group of 4 people; I think we would have to have called more hands.
The extra kicker about the TOE and the pharynx is that somewhere along her admission, she got up for some reason: and had a fall: and broke her NOF. She's already the nightmare pt who got injured during a procedure (and probably not an injury they would have talked about in consent. They always talk about bleeding, infection and death. Not mistake/perforation etc.).
Hospitals aren't nice places.
Then there was-
The suicidal lady who was in a DV relationship.
She was scheduled 1:1 meaning that whomever was looking after her had to have eyeballs on her at all times. She could not be left alone for even a second. If her nurse had to pee, then one of us would have to take up the post, and stay with her, whilst her nurse went to pee, and came back.
I tried to organise my work so that everything was done early. Because you never knew when you'd need to take one of my 2 pt to the ward. -- I got word there was bed for the NOF/TOE lady, so I stuff for stroke guy done super early.
Or perhaps scheduled nurse needed something and I should be available to her for that.
I took the lady out for a cigarette a few times. She smokes like a chimney. There was a dog she was in care of that was living in the security guard's office. She said the guy had taken money out of their?? accounts. They were about to let her go home - with supports - and we walked back into the unit and the doctors got a phone call from her partner saying that the pt had texted him that she was going to commit suicide when she got home. She was rather happy chappy to go home (but anyone would be super happy, no?) And so the doctors decided to ask her if it was ok if she would show them her messages so they could rule out that she had what he said she said (that's a tongue tie).
The pt allowed the doc's to see her phone - it didn't say what he said she said - so she was allowed to go home.
The shift ended with me realising my guy was for a "stroke bed" (dude. He's palliative ... they are not going to do more procedures for him: the initial procedure already did not assist his functioning except to give him a poor quality of life)- it was 5 days post stroke, he had been monitored already, for 5 days: and stroke bed patients need to be monitored for a certain length of time (4 days?). I forgot this information after being out of neuro ICU for 2 yrs. I'm also fairly certain that he will have his NG out overnight by "accident" because he wasn't specialized for the night- because all day, he had his wife next to him. Watching his every eyeblink, every time he lifted his arm up.
So I predict two things: he doesn't end up in a stroke bed (those should be reserved for people who have better functioning and improvement and who need active investigation and treatment for their stroke: not some guy with brain stem and communication area damage but frontal brain intactness who is not for CPR and not for reintubation). and i predict that the NGT is out in the next 12 hours- and perhaps he will have an AIN then.
As I was walking out, the nurse who had suicide lady was making a statement to police about what happened.
I forgot a lot of subtle things since July 2019.
That stroke bed monitoring thing for example. I was trying to find it in a policy just before I left but I couldn't after 10 mins so I left it for later.
Key learning point: get your vaccination done at the earliest time slot in the morning because the it only takes an hour round trip.
I was allocated:
Stroke man
1:1 for pulling lines.
90 yr old male
Had a stroke 5 days ago- had an endovascular clot retrieval(ECR) which didn't work too well.
so now he had had a one way extubation.
He had cheyne-stroke like breathing but Sp02 >93% on room air.
He didn't obey commands but would intermittently and independently open his eyes and look about, and or reach for things. Then go back to sleep.
His wife was near hysterical on the phone at 0800 when she asked how he went through the night, and then said she was coming.
When she arrived she spent the entire day flapping about the bed. Worrying about his hands. About his mouth (she said it looked swollen but honestly I couldn't see it) about why he wasn't opening his eyes (he did, just not when you asked him to)
When she left she made J feel bad because previous days they had vehemently disallowed her to stay overnight. Seriously, she's 90 as well, and we don't have facilities for people to stay : no bed, no showers for them etc.and so they'd sleep on an uncomfortable recliner at the bedside , and have zero rest. So what to happen the next day over? That's why unless the person is likely to die that very night OR. they're a nightmare to deal with due to language difficulties-- we don't let the family stay.
When I said he was wardable and could get a ward bed anytime from now : she asked me which ward was he going to, the Dead ward?
I was taken aback by the question but answered it plainly: dead ward does not exist - we have a stroke ward for him.
I didn't want to say --do you mean the morgue? --...?
After she left he promptly threw up the movicol I had earlier shoved down his NGT and his feeds were paused. This happened all as I was trying to get my other just as uninteresting lady up to the ward.
The TOE that turned into a pharyngeal perforation
70 yr old lady came for a TAVi, and during the TOE, whomever was doing it perforated her pharynx or throat.
Therefore she had to have an NG inserted and wasn't allowed to eat.
She was severely overweight and her legs were +++++ swollen. She was on frusemide (just 20mg via NG)and I had to empty her IDC almost every 3 hours because she basically peed 3-400mls an hour.
The best bit was whilst I was getting handover from B -- she piped up and said "they tried to kill me-- the doctors, they did this to my throat and they tried to kill me." and B looks at me and said to her "Well I'm sure they didn't mean to cause injury on purpose..."
She would sleep all the time but immediately upon waking would say how much pain she was in.
When I transferred her to the ward, there were only 4 of us to move her over. We used a patslide and thank the lord I brought a slide sheet with me. I should have brought two-- might have helped having a second. Anyhow. Moving her from the ICU bed to the regular bed was a nightmare. She wasn't light lets say and I've stopped gymming so. Yeah. If we'd been any less fit group of 4 people; I think we would have to have called more hands.
The extra kicker about the TOE and the pharynx is that somewhere along her admission, she got up for some reason: and had a fall: and broke her NOF. She's already the nightmare pt who got injured during a procedure (and probably not an injury they would have talked about in consent. They always talk about bleeding, infection and death. Not mistake/perforation etc.).
Hospitals aren't nice places.
Then there was-
The suicidal lady who was in a DV relationship.
She was scheduled 1:1 meaning that whomever was looking after her had to have eyeballs on her at all times. She could not be left alone for even a second. If her nurse had to pee, then one of us would have to take up the post, and stay with her, whilst her nurse went to pee, and came back.
I tried to organise my work so that everything was done early. Because you never knew when you'd need to take one of my 2 pt to the ward. -- I got word there was bed for the NOF/TOE lady, so I stuff for stroke guy done super early.
Or perhaps scheduled nurse needed something and I should be available to her for that.
I took the lady out for a cigarette a few times. She smokes like a chimney. There was a dog she was in care of that was living in the security guard's office. She said the guy had taken money out of their?? accounts. They were about to let her go home - with supports - and we walked back into the unit and the doctors got a phone call from her partner saying that the pt had texted him that she was going to commit suicide when she got home. She was rather happy chappy to go home (but anyone would be super happy, no?) And so the doctors decided to ask her if it was ok if she would show them her messages so they could rule out that she had what he said she said (that's a tongue tie).
The pt allowed the doc's to see her phone - it didn't say what he said she said - so she was allowed to go home.
The shift ended with me realising my guy was for a "stroke bed" (dude. He's palliative ... they are not going to do more procedures for him: the initial procedure already did not assist his functioning except to give him a poor quality of life)- it was 5 days post stroke, he had been monitored already, for 5 days: and stroke bed patients need to be monitored for a certain length of time (4 days?). I forgot this information after being out of neuro ICU for 2 yrs. I'm also fairly certain that he will have his NG out overnight by "accident" because he wasn't specialized for the night- because all day, he had his wife next to him. Watching his every eyeblink, every time he lifted his arm up.
So I predict two things: he doesn't end up in a stroke bed (those should be reserved for people who have better functioning and improvement and who need active investigation and treatment for their stroke: not some guy with brain stem and communication area damage but frontal brain intactness who is not for CPR and not for reintubation). and i predict that the NGT is out in the next 12 hours- and perhaps he will have an AIN then.
As I was walking out, the nurse who had suicide lady was making a statement to police about what happened.
I forgot a lot of subtle things since July 2019.
That stroke bed monitoring thing for example. I was trying to find it in a policy just before I left but I couldn't after 10 mins so I left it for later.
