Friday, November 21, 2008

Code Blue

Last shift I worked, I came in to get report. J had recieved a new pt, who honestly, looking from the door looked like the foot was on the bannana peel. I asked her "why's he here and not in ICU?". "Oh, well they will have a room for him when the relief gets here...". "Ok, I tell her, I'll get report on the rest of my patient's from the other nurse and by that time the ICU nurse will be ready for need in giving report to me...and me giving a 2nd hand report to ICU is there?" "Uh, OK she agreed (relunctantly because she really wanted to just leave and go home). She had had a long day. I had given report to her in ICU that morning and she had transferred patient's out and they had floated her to tele and given her a butt-load of admits. She looked like she had been basically run through the ringer.

Half-way through my report, J interrupts to tell me that the Powers-That-Be had decided to leave the patient in Tele because "he is doing better" (!). I asked her, if any of them had stepped out of their ivory office to take a peek at the man, because he doesn't look too good. She assured me that he looked better than he had on arrival, and had on his C-Pap and was resting.

I finished my report, then she starts giving me report on the "Banana Peel" guy, I'm looking in the door and I stop her cold...."Let's just go in the room, so I can be checking him out while you're talking, because to me he doesn't look good". "He's got a foley, and it's draining good, and he got lasix and he had C-pap, he's X-years old, and he seems to have some sort of sleep......."

At this point I interupt her, my stethoscope on his chest...."He ain't breathing!" "Uh, she says, his chest is going up and down.." "Yup...that's the C-pap working...he doesn't have any lung sounds..." I start trying to wake him up, shaking him ... doing sternal rubs...calling his name. Hey, J , was he responsive when you were in here...? "He was talking to me", she says. "Well something ain't right now...he's out of he diabetic (I'm observing the ring of sweat on the bed, feeling the patient's skin which is diaphoretic and pale). "No"...

GET THE CRASH CART NOW.....I call the Supervisor for rapid response team, and call respiratory for rapid response team.

The Supervisor comes in and I let the Powers-that-Be know the situation...IE: He isn't moving any air, but he has a pulse and is sinus rhythem...

By this time respiratory is there and checking the O2 sat...which was to say the least dismal....We hit the button...Code Blue...and the rest of the team arrives. The er Doc tubes the guy, but they cannot get it in position, and bagging him is making him puff up like a puffer frog. The man had two docs working on him trying to get him intubated and an OG To get the air out of his stomach. In between we were getting good sats with bagging, just blowing him up like a puffer frog. Mid-way through he had a seizure (damn that sure isn't a good sign!), they finally got him tubes and over to ICU...where they had to CALL IN THE ICU nurse they had put on call. Didn't save any money there folks.

Last I saw, the guy was still tubed and looking pinker, but sedated...don't know how that will turn out. J stopped on her way out 2 hours late and thanked me for looking at the guy with "new eyes", because to her he looked better, and sometimes appearances can be deceiving.

The rest of my night was pretty good except I had one patient that the family even wanted me to come out of the CODE because their mom had some blood in her spit....hello....that's not life threatening...I'll be there when I'm thru here...saving a it folks??? Later they complained to management that "I wasn't treating them right"....hummmm was it the code when I wouldn't desert my patient to look at spit...or was it me asking them to quit sucking her tonsils out through the yanker because she was gagging and that was putting her in pain (gallstones people!!!) and we had just pulled out the femoral line and there was that little bitty thing about possibly causing her to start bleeding....YOU KNOW talking common sense to the contrary!!!!??? I'm just a bitch I guess. Anyhow, my boss just shook her head...and went to her office..., you just cannot please everybody and GIVE GOOD CARE at the same time!

Thursday, November 13, 2008

Wal-mart Go-Cart's!!!!

Yesterday at Walmart there was this little old man on the handicap cart. One foot sported a blue foam foot guard and the other an ugly podiatry shoe...the kind you were after surgery. He was over in the dairy section looking at milk, he swung around and did a "U' turn , then he swung around and made it into a doughnut...then he did it about 4 more times. The funniest thing: the look he gave me.

Milk: $2.89
Cottage Cheese: $3.89
Blue Shoe: $25.00
Looking cool on the Wal-mart Go-Cart: "Priceless"

Add to it all the toothless grin full of wonder.....I was giggling all the way to the check-out.

Monday, November 10, 2008

Just do it.

The whole USA only 40-50 cases ANNUALLY of TETNUS...if you get a puncture wound, or a sore, just do it...get the shot. Nothing like being one of the few nurses in the whole USA caring for somebody with learn more than ya want to ever know about LOCKJAW.

Did you know that if you have lockjaw:

1. You require respiratory trach, because much liike meningitis ya cannot bend your neck.

2. That you will have TETNANY all over which means you are like in a spasm all over...particularly your LOCKJAW. (kinda like grinding your teeth all night long, except with a bite block in...and loosened or broken teeth)

3. You probably won't live no matter what is done for you, because by the time it is reconized, being so rare and all, it is usually too late.



Damn, I guess you can tell it was another hellious night.....tucking bundles of ice packs under 102.8 degreee armpits....

Damn, one more beer and I may just be unwound enough to go to bed. I think I've gritted my teeth all shift trying to do everything I can....wish I could just make everybody well. No body deserves to suffer like this.

Thursday, November 6, 2008

The Giggle Box Turn Over

When I was little I spent a lot of time at my Aunt Corabell's with my cousin Jimbo. We would giggle and tell secrets all night. My Aunt would knock on the door and tell us "hush up in there and go to sleep" and Jimbo would always answer "I can't Ginger knocked my gigglebox over!" That would set us off into another gale of laughter! I miss those days.

Well recently I had two incidents that knocked my gigglebox over. I actually woke up thinking about them and now I have to blog or I'll never get back to sleep.

Two weeks ago R had a patient that was in the middle group. I had A side, so I knew nothing about her patients. Half of her call bells ring at my station, and half of the call bells ring at the other station, so if she is on the other side, we answer the call bells. Well, one of her call bells was going off and I couldn't find the aide so I went to see what the lady needed. Well her daughter tells me she needs pulled up.

Now here a little physical description can go a long way: She was like 4 foot tall and really really round. She had very large bosom's and a double chin. I'm looking at her and thinking "Man, no way can I handle this alone." I go looking for reinforcements.

Everybody is busy. P is prepping a patient for surgery. I can't ask her to leave this man naked except for a towel and half his body hair in a cold room. R is in another patient room with a patient who is going south in a hurry and obviously she can't come. I go back to the room and tell the daughter it will be a little bit because everybody is busy. The daughter gets pissed at me and offers to help. I instruct her how to do it without hurting herself, and she's not really listening to me, so we get the pull pad and 1-2-3 HEAVE!!!! Nothing...this ladies butt is literally glued to the bed. Again, 1-2-3 HEAVE!!!! Nothing. I'm thinking "Damn...what the heck". I put her in reverse trendlenburg , "OK Honey, we've got to stand you on your head and let gravity help us out a little here." 1-2-3 HEAVE!!!!! Well she moves like 3 inches...and mind you, she was already all the way to the foot of the bed. Ok, I think, this really is not working. I put her back down flat and go and get another aide from the other side.

On the way to the room, I explain the problem. We get in the room and I put the patient back in trendlenburg and M gets on the other side. 1-2-3 HEAVE!!!! Ok, that daughter must have really been a wimp! Granny goes flying to the top of the bed, pillow behind the top of her head, up against the head of the bed, face between her massive breasts with the funniest look I've ever seen on a person's face. I look at her, I look at M and *choke* *cough*. "Oh my God miss, you've got head crunch here", I state as I straighten out the pillow and put the bed back up. M looks at Granny and *snort* lips twitch...she looked at me...I look at Granny who is trying to rearrange her neck rolls and bosom's and I literally lost it. I had to run out into the hallway. I was giggling and my mascara was running. My gigglebox turned over...I had to go into the doctor's dictation room because I was howling with laughter...and I could NOT stop. Co-workers were looking at me like I was deranged. GIGGLEBOX turnover I would snort and start laughing again. I laughed a full thirty minutes. I think stress had just caught up with me, I sure let it all rip! When it was all over I had no makeup left. I had to go to the bathroom to repair the damage. It was freaking hilarious!

Then last week I was taking care of a tubed patient and she had an air leak in the endotracheal tube. When the tube leaks the patient makes this funny gurgle sound that they should not be able to make. So the other nurse training me tells me to call respiratory and tell them the tube is leaking. I'm like, well can't we just add 1/2 cc of air until they get here? So we problem.

I go to the phone, I phone respiratory and I'm telling F about it. Now we got this nurse that is from Kentucky working with us...her and I hold the trophy for hillbilly talking. No body seems to be able to understand us sometimes. So I'm telling F (who is Hispanic) about the cuff leak, and he doesn't understand I repeat it...only the second time instead of cuff leak I say:

"The lady in Bed 7 has a cuff link in her ET tube". I realize what I said and I start laughing. I try to recover....I look to my right and M is rolling around in her chair snickering, I look at Ms. Kentucky and she is literally rolling her eyes and laughing...."uh, guess ya'll heard that huh?". F is still on the phone...and he's like" what, what, how did she get a cuff link in there?" I'm like...."no, no, damn it , you know what I meant!".

Well, they are still teasing me about the "cuff link"...hey...Gingerjar...was that Gold or Silver Cuff Link that lady had in her ET Tube????

Giggle Box Turn Over...God...I love my job!

Bracelet giveaway

Oh, in case I didn't do it right here is the other blogspot id for the giveaway:

I'm not computer literate to know how to insert a link into my post. Just not sophisticated I guess.

Bracelet giveaway: Follow the blogspot!!!

Aleta is giving away a beautiful bracelet. You can get all the rules and details here:

All you have to give up is a holiday memory....Isn't that easy!!!!

Darn I wish I had time to craft! I'm making my grand-daughters quilts...but they are the easy kind that don't take any real thinking to do. I just work on them in front of the tv, while the dogs snuggle down under my handiwork. I love doing it, and it is very relaxing. Between that and the gym I am probably the most kicked back ICU nurse you can imagine!

Saturday, November 1, 2008

Fall has Arrived

Wow! November already. I have so many things I need to do. Decorate for Thanksgiving (although I will be working), start my Christmas shopping (Samm's Warehouse...look out), clean house (never ending job).

It's chill here...just a little touch in the air. Yesterday I got off work early enough to actually see a sunrise!!!! It was amazing. The pinks, oranges, golds and that deep deep velvet blue of the tail end of the night. I was just really amazed! Working nights, I usually don't get off work till about 9 a.m. and then I've been trying to go to the gym, so I have sunshades on most days! I got off work yesterday at 7:10. I cannot remember ever leaving work so early.

I worked ICU, and I had my vented patient fairly stable with only one drip running and Good to go for surgery. Basically had nothing to do for her except titrate the drip and chart because had explicit orders not to turn her or do anything that could dislodge the temporary pacer lines inserted through her groin into her heart. It's been awhile since I've worked with a temp pacer and I had to look some stuff up. That's ok, since I'm re-training for ICU I had "people" who could "tell" me what to do...but I'm very particular. I like to know why I'm doing what I'm doing, and how everything is suppose to work...that way if it isn't working properly I know it before it becomes a problem! The patient only understood Spanish, so I would explain everything to the daughter who would translate. The nurse "training" me didn't like me explaining so much, but you know, the family is scared...they are scared their mother is dying, they need to know what I am doing and why I am doing it. They need to know what is planned for their mom to help "fix" her heart. They don't need false hope that "everything is gonna be ok". Their mom would not be in ICU with a tube down her throat and a billion wires everywhere if she was "ok".

I can't tell them what happened to her or why it happened...she came to us from another facility...they were just lucky as hell she was actually in the hospital when she coded. She got timely well performed CPR. She is actually able to communicate a little even with a tube. If that had happened at home, she probably would have been brain-dead by the time an ambulance would have gotten to her! So, even it she is intubated, she has still got a real fighting chance at living. I cannot tell you how many times we code a patient...and even if we get a heart rhythm and vent them for breathing, how many times it is just delaying death by only a few hours. This lady...she is aware of where she is, she can nod her head to questions, she was mouthing her daughters name when she was out of the room, she was following simple commands. I hope her surgery went well, I think she is going to be one of the lucky ones!