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catchup ICU stories - makeshift ICU life
Aug. 22nd, 2021 05:49 pmCatch-up ICU stories
Rose
Rose wasa 62 year old woman from regional NSW who had approx 2 weeks of redness and pain in her R) foot.
With a past history of PVD she was diagnosed with cellulitis.
The GP who was monitoring her gave her antibiotics.
2 hours after a review, the HITH nurse came to review Rose and looking at the foot stated that she better get to hospital quick, because she didn't think it was celulitis.
One air ambulance transport from the regional hospital later,
Rose was in overflow ICU (my new home since smallICU became a covid unit), intubated, on IVABs and a smidge of noradrenaline after having underwent a cutdown in her calves for compartment syndrome, as well as a bypass graft of R to Left femoral artery such that she now had hourly circ observations and pulses via doppler to her pubic symphasis as well as the usual pedal pulses on her foot.
The R) big toe (Hallux as I learnt) looked a dark purple - beyond mottled. Quite the colour of ribena before its diluted with water. and had a 2 other spots on the 2nd and 3rd digit quite distal.
The fate of the R) Hallux is unknown.
Post extubation Rose wanted to talk to her husband and I got him on the phone. The first thing she said was (after Id explained over the phone she'd been extubated and was doing well and could talk now) - was that she begged him to come visit her. Due to her hearing impairment the phone conversation was one way.
Oh I hadn't said, Rose was both hard of vision and stated she was very deaf.
I had to take the phone away and explain to the husband that unfortunately due to covid rules, he could not come and visit but could call anytime, and that I'd find her own phone so they could communicate.
Then Rose proceeded to spend the most of the next hour writing on paper (sore throat from ETT) the many ways in which she felt she had been misdiagnosed and mistreated in the past and the side effects from medications she had been given that hadn't been adequately monitored. Like clindamycin given for too long (? 2 months+) gave her hearing loss and that seroquel that was perscribed for difficulty sleeping had given her diabetes.
In anycase. It seemed to the medical team she was on so little fentanyl (1ml/hr) +boluses for rolls and etc. that they thought she could manage on oral tablets, endone. Which, she didn't seem to comprehend the seriousness of that decision. But as medical teams go, the wait and see approach is not unusual when it comes to pain relief in people who aren't typically on regular pain medications.
This made my afternoon go from plesant to horrible. As Rose became like an animal in pain --unable to properly express that was the problem -- but unwililng to do anything - apearing miserable and uncommunicative and when I would question her about the type/severity etc. she would say things like "I cannot even dignify that with a responce" or "you don't seriously think I will answer that question".
I advocated for a PCA for her.
The medical staff fobbed me off. (say theyd reveiw in 15 mins)
A new admission came in.
We were so short, I had no one to hand over to at 1930- instead, "next door RN would keep an eye on her" until someone came at 22:00 and they were doubled with her and another (unlike the luxury I had of just Rose).
It was 20:00 and I had to go home - her pain relief not improved, instead just handed over from day doc to night doc.
I knew she wouldn't be getting a PCA, and I was doubtful they would chart anything stronger.
The next day
When I came back in the morning, the night staff had had a horribly busy night.
She'd had one of what I'd call the legendary nurses of neuroICU all night, an old Chinese migrant RN who'd been here for 15+ yr and whom Im no doubt would have a hard time with Rose.
She hadn't been washed.
My buddy nurse for the day had Rose and I did everything I could to support her - pretty much doing all her meds for her other pt
Rose
Rose wasa 62 year old woman from regional NSW who had approx 2 weeks of redness and pain in her R) foot.
With a past history of PVD she was diagnosed with cellulitis.
The GP who was monitoring her gave her antibiotics.
2 hours after a review, the HITH nurse came to review Rose and looking at the foot stated that she better get to hospital quick, because she didn't think it was celulitis.
One air ambulance transport from the regional hospital later,
Rose was in overflow ICU (my new home since smallICU became a covid unit), intubated, on IVABs and a smidge of noradrenaline after having underwent a cutdown in her calves for compartment syndrome, as well as a bypass graft of R to Left femoral artery such that she now had hourly circ observations and pulses via doppler to her pubic symphasis as well as the usual pedal pulses on her foot.
The R) big toe (Hallux as I learnt) looked a dark purple - beyond mottled. Quite the colour of ribena before its diluted with water. and had a 2 other spots on the 2nd and 3rd digit quite distal.
The fate of the R) Hallux is unknown.
Post extubation Rose wanted to talk to her husband and I got him on the phone. The first thing she said was (after Id explained over the phone she'd been extubated and was doing well and could talk now) - was that she begged him to come visit her. Due to her hearing impairment the phone conversation was one way.
Oh I hadn't said, Rose was both hard of vision and stated she was very deaf.
I had to take the phone away and explain to the husband that unfortunately due to covid rules, he could not come and visit but could call anytime, and that I'd find her own phone so they could communicate.
Then Rose proceeded to spend the most of the next hour writing on paper (sore throat from ETT) the many ways in which she felt she had been misdiagnosed and mistreated in the past and the side effects from medications she had been given that hadn't been adequately monitored. Like clindamycin given for too long (? 2 months+) gave her hearing loss and that seroquel that was perscribed for difficulty sleeping had given her diabetes.
In anycase. It seemed to the medical team she was on so little fentanyl (1ml/hr) +boluses for rolls and etc. that they thought she could manage on oral tablets, endone. Which, she didn't seem to comprehend the seriousness of that decision. But as medical teams go, the wait and see approach is not unusual when it comes to pain relief in people who aren't typically on regular pain medications.
This made my afternoon go from plesant to horrible. As Rose became like an animal in pain --unable to properly express that was the problem -- but unwililng to do anything - apearing miserable and uncommunicative and when I would question her about the type/severity etc. she would say things like "I cannot even dignify that with a responce" or "you don't seriously think I will answer that question".
I advocated for a PCA for her.
The medical staff fobbed me off. (say theyd reveiw in 15 mins)
A new admission came in.
We were so short, I had no one to hand over to at 1930- instead, "next door RN would keep an eye on her" until someone came at 22:00 and they were doubled with her and another (unlike the luxury I had of just Rose).
It was 20:00 and I had to go home - her pain relief not improved, instead just handed over from day doc to night doc.
I knew she wouldn't be getting a PCA, and I was doubtful they would chart anything stronger.
The next day
When I came back in the morning, the night staff had had a horribly busy night.
She'd had one of what I'd call the legendary nurses of neuroICU all night, an old Chinese migrant RN who'd been here for 15+ yr and whom Im no doubt would have a hard time with Rose.
She hadn't been washed.
My buddy nurse for the day had Rose and I did everything I could to support her - pretty much doing all her meds for her other pt
