whitewriter | Memories from Friday nightshift April 29 and today 4/5

Especially if you require an abdominal washout: and the surgeon chooses to leave your abdomen open: with a vac dressing in situ that is the size of your entire abdomen.

That's the current bed 23.

so between getting him reviewed at 0300 because he was thrashing about and uncomfortable and sweaty and tracheostomy at risk due to the trashing --
and hydromorphone boluses were just not cutting it:

we restarted the propofol and thats when Bhumika the RN who is now a general ICU incharge said "when I was an IP rita, you taught me how good propofol was"

heh.

Yeah. I've been around. Before you started, and now I'm asking you to teach me.

Oh how things have turned around since 2015.

The second memorable thing that happened that night:
Bed 37 had a new admission and whomever put in the IDC must either have not put it in properly or shortly after it was put in the pt pulled it out cause i found the IDC in the bed, flapping in the breeze, baloon fully inflated. I asked the doc (who didn't put it in but was around at the time) if there was urine when they first tried to put it in - and she said no.

which comes back to principal number one about placing IDCs.

If you don't see urine- unless they are previously diagnosed as anuric or have an extensive kidney Hx -

if it's in the right place:

you will.

see.

urine

So due to my now high experience in putting in IDCs (thanks to midi) I was keen to do the hardest IDC possible (confused lady, uncooperative, and supposedly potentially anuric.

Nope.

Plenty of urine.

So much in fact I sprayed the jeans of the Doc who was standing super close and not wearing a gown.

It was 06:00 and no one could give a f. We just need the IDC in so we could move on and finish up.

The poor thing was so confused with ?unknown diagnosis.

I pulled her super long public hairs (sorry... but they were so long. It wasn't on purpose I promise) and I won't forget her disquiet re: that.

She even asked us "why we were being so mean to her".

Sighs.

Lady.

It's 06:00. If we weren't overloaded and it wasn't a late admission on a night shift we might have been less short with you but your too confused to be cooperative and that's not good for anybody.

I came back for a day shift today and that lady was going for an MRI where they'd found some extensive intracranial pathology and she's been a GCS 3 all day: intubated and now, funnily enough: on dialysis.

Today I had the new Bed 24.

71 YR OLD MALE.
Diabetes and hypertension leading to chronic kidney disease
leading to super long history of dialysis.
kidney transplant.
Complications.
Biopsy.
infection develops post biopsy.
on antibiotics that are nephrotoxic
Goes to the ward.
deteriorates.
hypotensive and fluid resuscitated.
now overloaded.
APO.
Gets admitted to ICU
Gets sent for a washout
Now in ICU with the infamous vac dressing everyone seems to have.

Today he asked me for the injection to die and told his wife that: he can't do anything but lay in bed. He can't even kill himself if he wanted to.

She tried to tell me he's joking.

Their English is also, not very good. Conversational.

Apparently after the transplant he was almost good enough to go home at one stage but then.. well.. yeah.

This is his second ICU admission during this admission to hospital.

Honestly, he looked crappier today than previous.

I started a frusemide and potassium infusion on top of his insane antibiotics.

He was only a HDU patient, but it was more work than a vent.

His wife commented that yesterday, the nurse had sat there and didn't have much to do.

Well. I had loads to do. They wanted bloods every few hours and all sorts.

He failed the speech path swallow test after a very half hearted breakfast where I was thinking something wasn't quite right.

NBM.

I supervised the medical student in putting down the NGT.

Feeds started at 20mls/hr

I left right after he vomited all 80mls that went down that NGT over the 4 hours it was running.

Sighs.

Doesn't feel like we got anywhere with Mr 24 today.