wasn't so bad other than the face it was a holiday and I wanted to watch fireworks and eat junk food rather than hang out in a lonely hospital for 24 hours with no one to talk to.
My day started at 8am on the 4th. I did a history and physical on a new patient in the morning and was finished by noon. I sat around on edge all day just waiting for my pager to go off. Finally, at 5pm, I started to get paranoid that maybe the hospital operator had the wrong pager number down for me so I called her to make sure. Everything was fine. I tried to take a nap, but it's hard to sleep when you know you could get paged with a crisis at any moment. At 10pm I finally got paged to go see a new patient. That took a couple of hours. Then I got paged to see a guy whose family was anxious about him. I basically just took a look at him and reassured the family that he is stable.
I finally fell asleep and woke up at 2:30 this morning to my pager going off. It was an ICU nurse who needed me to come up and check a breathing tube of a patient. I didn't really understand what she was saying on the phone. So I get up there, and there's a bit of excitement because this patient was restless all night and had managed to dislodge his breathing tube and wasn't getting any oxygen from the ventilator. One of the nurses was manually "bagging" him so he could get air. I started putting gloves on and went to the head of the bed to get ready to replace his breathing tube. He was really squirming and fighting me (I don't blame him). A nurse asked me if I wanted to paralyze him. I really don't have much experience with that yet and told her I didn't want to do that because if I can't get the breathing tube in, I'll have to bag him for 15 minutes while the drugs wear off, so, I ordered etomidate to sedate him to go along with the versed they had already tried. It worked great and I was sort of able to get the tube back in. I couldn't really tell if it was in the right place, but I could hear breath sounds over both lungs and the ventilator indicated that he was getting oxygen again. I ordered a chest xray to confirm placement of the tube and then waited around for the radiologist to call me with the results. As it turned out, the tube was a little high and I briefly considered retrying and then I stopped: why fix something that isn't broken? He's oxygenating fine now, and he quit fighting the tube because we sedated him, so I decided to leave it where it was. I was so relieved that ended fine without any catastrophe. I was also glad I didn't have to call one of the ER docs to come help me with him. I managed it by myself with the help of some awesome nurses.
So by then it was 3:30am. I went back to my room, finally fell asleep and got paged at 6am. That call was just settled on the phone, but I was so excited to know my shift was almost over that I couldn't get back to sleep. I went home at 8:30am and slept for 2 hours before I had to be back at the hospital for noon teaching conference. By then I felt like a train wreck but the conferences are mandatory-even if we have been up all night. I came home at 2pm and slept another 1 1/2 hours and then got up. I felt a lot better after my 3 mile walk. I haven't walked since Sunday and I really missed it so I was glad to get to do that today. Hung out with my boyfriend tonight and now I'm going to bed early.
In all it wasn't a bad night. I'm starting to feel better about all this. What I'm really glad about is that I stayed calm during that whole ICU incident. I didn't even have to think about staying calm, I just was calm on my own.
1 comment:
From the early years of ER, it always seemed like "intubating" (have I got it right?) a patient was one of the hardest things to do.
I remember the hospital nurses trying to shove a tube down my grandma's throat one time when my folks were out of town, and they were being so pushy and insensitive to how they were hurting her, I finally yelled at them to make them stop -- turned out later they had torn her esophagus, from what I remember. They decided she didn't need one, after all.
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