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whitewriterThat all you do, all day is sit there.
And press a button- all ur numbers come (Cause the computer now saves the data from the monitors! -- back when I started in 2013, this was not the case), u press F9 - then u save.
Then you go to the next page.
For obs,
For resps.
for your fluid balance.
write in a few things the computer wouldn't know (like how much urine came out or what's the drain output).
Save
wait for the next hour.
Check your emails....
maybe a roll, some mouth care...
But no. I had those impervious gowns on all day and i sweated like a pig getting all this stuff done.
Marj tells me she did a full line change overnight as it was due.
but could I change the bung on the TPN line because - i'm gonna change TPN at 10:00 as per usual anyways (certain things are always done at certain times and I wonder if this goes beyond Australia...
like
heparin is always BD 07:00 and 19:00
warfarin is always 16:00
TPN is always 10:00 (not 0900 or 1500 or any other time)
Those are the ones I can remember.
Anyway.
My pt is waking up from 45 days of extreme illness to realise he's in hospital and he wants to go home.
Oh and he wants a shower.
and like. everything. He wants to get out of bed too.
Never mind the VAC dressing to his huge distended abdomen, the 2 drains that are filling up with grey green pussy output or the large grafts on his upper L and R thighs, the quad lumen CVC and arterial line .. the tracheostomy (which whilst he's off the vent: didn't tollerate a cuff down trial yet).
And ICU want me to take him outside for sunshine therapy.
So
I put up the TPN at 10:00.
Then at 10:30 ICU tells me they want to do a line change.
Marj did a full line change of all the infusions and bungs already,
and I did the TPN and bung change in the AM.
and now they wanna do a line change in the PM
WHICH MEANS i have to RE DO. everything marj did overnight and the TPN again....
cause new line means new everything.
You can't take an old infusion bag and old medication line from the old subclavian CVC and then wack it onto the new internal jugular vein CVC.
The reason is because if there happened to be an infection in one line, your gonna spread it to the new line.
I took my pt out.
I titrated all the dexmedetomidine and hydromorphone down,
He became clearer in his writing.
He wrote to his dad whilst we were outside that he wanted to go home and how long was he going to stay like this cause he cannot live like this.
Anyways so we get back to ICU cause I didn't bring suction and his sputum load was too much for no suction.
He (my pt) argued with the doctor (in writing because remember, the tracheostomy cuff is up) that he wanted to have a shower( an actual shower) before the line went in cause he felt sticky and crappy.
Doctors are notorious for messing up sheets and all sorts with a line change.
But he argued black and blue. He even argued that last sunday 2 weeks ago, a nurse gave him a real shower.
....
um buddy.... there's like no way. There's 2 showers in the 54 bed ICU for a reason. it's because very few people in ICU are able to have a shower. If they can have a shower, they'd be on the ward.
anyhow. So I do a full bed wash with hair wash. I change the dressings around both drain sites: which was way more time consuming than I thought it would be
I also changed the skin graft sites dressings on his thighs.
And by the time I got around to washing his back (after doing his arms and legs before the drains and thigh graft sites - the water had gone freezing in the bowl so he got a quickie cold wash on the back (which looked super unpleasant and I apologised but we'd been at this process for an hour by now)--
and at the end. He looked decent. but then the line change.
and oh the doc wants him on a ventilator
and propofol and hydromorphone boluses
so I become an anaesthetist for 45 mins whilst they do that.
The resident hold ths tracheostomy (thank god cause I had things to do)--
'and then they want the vent weaned asap.
Well. Now it's 16:00 and I still haven't had lunch yet. But i weaned him from SIMV to PS modes.
so I went to lunch.
When I came back my lovely buddy next door, had taken my pt off the vent and spun the bed around for the CXR to confirm the line (Cause after we came back from inside I had the bed face the window for a few hours - the tiny window that is behind the bed - rather than the door. So at least my pt could see half a tree.
Then of course i had to re do all the infusions Marj had already done.
Then his partner visited and my pt just wanted this and that and a bed pan....
wow. he was amazing. lifted his bottom. I half expected nothing in the pan but he left me an amazingly huge present. neat and tidy in the pan.
Good job pt !
I missed my PM break in favour of sitting down and actually writing my notes.
When I left, I handed over to an old mentee from neuro days - and she had made a pretty huge mistake in ICU recently, which I found out about randomly - and got the chance to talk about it with her. It happened on a super super busy night, a check thats supposed to catch mistakes was not done due to the busy, at the same time, her bf of 4 months who she really liked - broke up with her and demanded an invoice for (whilst she was on a night shift).
What a douche.
so if the doc had told us they wanted to do a line change on Sunday: Marj probs wouldn't have done the line change and I would have left the TPN until 15:00 and done it all, in one neat and tidy go. and not wasted like, how many syringes...
When I got home I realised I left the box containing the spare cake from Bels' Big Bird cake on the flight deck, empty of cake - and unwashed.
Ooops.
And press a button- all ur numbers come (Cause the computer now saves the data from the monitors! -- back when I started in 2013, this was not the case), u press F9 - then u save.
Then you go to the next page.
For obs,
For resps.
for your fluid balance.
write in a few things the computer wouldn't know (like how much urine came out or what's the drain output).
Save
wait for the next hour.
Check your emails....
maybe a roll, some mouth care...
But no. I had those impervious gowns on all day and i sweated like a pig getting all this stuff done.
Marj tells me she did a full line change overnight as it was due.
but could I change the bung on the TPN line because - i'm gonna change TPN at 10:00 as per usual anyways (certain things are always done at certain times and I wonder if this goes beyond Australia...
like
heparin is always BD 07:00 and 19:00
warfarin is always 16:00
TPN is always 10:00 (not 0900 or 1500 or any other time)
Those are the ones I can remember.
Anyway.
My pt is waking up from 45 days of extreme illness to realise he's in hospital and he wants to go home.
Oh and he wants a shower.
and like. everything. He wants to get out of bed too.
Never mind the VAC dressing to his huge distended abdomen, the 2 drains that are filling up with grey green pussy output or the large grafts on his upper L and R thighs, the quad lumen CVC and arterial line .. the tracheostomy (which whilst he's off the vent: didn't tollerate a cuff down trial yet).
And ICU want me to take him outside for sunshine therapy.
So
I put up the TPN at 10:00.
Then at 10:30 ICU tells me they want to do a line change.
Marj did a full line change of all the infusions and bungs already,
and I did the TPN and bung change in the AM.
and now they wanna do a line change in the PM
WHICH MEANS i have to RE DO. everything marj did overnight and the TPN again....
cause new line means new everything.
You can't take an old infusion bag and old medication line from the old subclavian CVC and then wack it onto the new internal jugular vein CVC.
The reason is because if there happened to be an infection in one line, your gonna spread it to the new line.
I took my pt out.
I titrated all the dexmedetomidine and hydromorphone down,
He became clearer in his writing.
He wrote to his dad whilst we were outside that he wanted to go home and how long was he going to stay like this cause he cannot live like this.
Anyways so we get back to ICU cause I didn't bring suction and his sputum load was too much for no suction.
He (my pt) argued with the doctor (in writing because remember, the tracheostomy cuff is up) that he wanted to have a shower( an actual shower) before the line went in cause he felt sticky and crappy.
Doctors are notorious for messing up sheets and all sorts with a line change.
But he argued black and blue. He even argued that last sunday 2 weeks ago, a nurse gave him a real shower.
....
um buddy.... there's like no way. There's 2 showers in the 54 bed ICU for a reason. it's because very few people in ICU are able to have a shower. If they can have a shower, they'd be on the ward.
anyhow. So I do a full bed wash with hair wash. I change the dressings around both drain sites: which was way more time consuming than I thought it would be
I also changed the skin graft sites dressings on his thighs.
And by the time I got around to washing his back (after doing his arms and legs before the drains and thigh graft sites - the water had gone freezing in the bowl so he got a quickie cold wash on the back (which looked super unpleasant and I apologised but we'd been at this process for an hour by now)--
and at the end. He looked decent. but then the line change.
and oh the doc wants him on a ventilator
and propofol and hydromorphone boluses
so I become an anaesthetist for 45 mins whilst they do that.
The resident hold ths tracheostomy (thank god cause I had things to do)--
'and then they want the vent weaned asap.
Well. Now it's 16:00 and I still haven't had lunch yet. But i weaned him from SIMV to PS modes.
so I went to lunch.
When I came back my lovely buddy next door, had taken my pt off the vent and spun the bed around for the CXR to confirm the line (Cause after we came back from inside I had the bed face the window for a few hours - the tiny window that is behind the bed - rather than the door. So at least my pt could see half a tree.
Then of course i had to re do all the infusions Marj had already done.
Then his partner visited and my pt just wanted this and that and a bed pan....
wow. he was amazing. lifted his bottom. I half expected nothing in the pan but he left me an amazingly huge present. neat and tidy in the pan.
Good job pt !
I missed my PM break in favour of sitting down and actually writing my notes.
When I left, I handed over to an old mentee from neuro days - and she had made a pretty huge mistake in ICU recently, which I found out about randomly - and got the chance to talk about it with her. It happened on a super super busy night, a check thats supposed to catch mistakes was not done due to the busy, at the same time, her bf of 4 months who she really liked - broke up with her and demanded an invoice for (whilst she was on a night shift).
What a douche.
so if the doc had told us they wanted to do a line change on Sunday: Marj probs wouldn't have done the line change and I would have left the TPN until 15:00 and done it all, in one neat and tidy go. and not wasted like, how many syringes...
When I got home I realised I left the box containing the spare cake from Bels' Big Bird cake on the flight deck, empty of cake - and unwashed.
Ooops.
