cardiovascular intensive care unit is, apparently different than your regular old medical-neuro-trauma-surgical intensive care unit.
who'da thunk?
i was in between a couple of night shifts and called to pick up an extra on days, and ended up in the CVICU. normally i work in the MSICU, but hey, how different could it be, right?
wrong.
it was WAY different.
for one thing, with the sick hearts, they still do paper charting. the first patient i had was super easy. she had IV access, but wasn't even running anything, nor did she require any O2 or really, much of anything else. she had undergone a heart cath that had gone bad (blown out the angioseal somehow, and caused a fairly large hematoma) and had lost pulses and sensation in her right leg/foot. so she had to get cathed again, only this time they went in the other leg to the heart and then back down to site of the original catheterization and fixed it.
easy peasy. i transferred her to the fifth floor and then i had no patients. fine. but, two of the other nurses (the more experienced ones, that could Do Things, like fresh hearts and balloon pumps) were getting two fresh hearts. so i took over for one of them. the nurse is giving me report on this dood and looking over her shoulder because she's getting this fresh heart real soon. plus, she's giving me all this information that i'm like, huh? LIMA? that's the capital of Peru, right? why are we talking about Peru? AVR.......i'm familiar with AVP, Aliens versus Predator, what the crap is AVR? then, it gets better. she hands me this flow chart thingy.......and i'm like, whats this? and, still looking over her shoulder like she's got Tourette's, she's like, oh yeah, we do paper charting.
wow. by this point, i'm laughing. in my head of course, because this is WAY different.
stoopid paper charting. later i spent 5 minutes looking at that damn paper trying to figure out how to chart the blood pressure, and then i still had to go and ask somebody.
turns out LIMA is CVICU slang for left internal mammary artery, which is what the docs harvest to re-vascularize the heart. during a CABG, or coronary artery bypass graft (pronounced just like the vegetable that gives me gas, cabbage. thats probably more information about me than you needed to know, but hey, now its out there, so what? cabbage gives me gas). anyway, there were a bunch of other letter combinations that she spat out for me, and when she saw the confused look on my face, she says, just write them down and tell the next nurse what i'm telling you, they'll understand. oh, and AVR? thats atrial valve repair. i think.......
nice. now if only i understood anything about my patient, that would be great.
so.....that was that. i paper 'charted' to the best of my ability, didn't kill anybody, and left.
coupla nights later, i get pulled to CVICU. staffing calls and says, so yeah, tonight you're gonna be over on CVICU. huh? okay, whatever. probably more easy patients right?
wrong again boyo.
i like to show up early for my shifts, like 10-15 minutes minimum, to scope things out, and the nurse that i'm replacing isn't done charting yet, so i'm just chilling next to her waiting for her to finish. the way our critical care units are set up, there is usually a computer station outside and in between two rooms. so if you are assigned to two patients in adjoining rooms, from your computer you can see right into both rooms. so, Dayshifter Nurse is charting, and i'm leaning into the one room. i notice on the monitor that she (the patient) has a lot going on. including some numbers in yellow i have never seen.
lemme see here....those red numbers are the blood pressure from an ART line. okay, got that. theres also the heart rhythm, pulse, oxygen, respirations per minute........and then there are the yellow numbers that i have never seen. hmmm.......?
being the curious sort that i am, i casually ask the nurse i'm taking over for, 'say, what are the yellow numbers?'
she stops charting. looks over to me, presumably to see if i was being serious. because then she says, 'are you serious?'
and i reply, 'um, yeah.'
'that's a Swan-Ganz.'
me, with as much nonchalance as i can muster, 'oh.'
her, with more and more concern, 'you.........you've had those before, right?'
'um, nope.' stoopid grin on face. hey, i didn't ask to be here. not this time anyway.
so she gives me report. i have two fresh hearts, both about 2-3 days out. more paper charting. yay.
thankfully, there were some other awesome nurses that had time and concern enough for me to walk me thru stuff. thankfully.
again, no patients were harmed in the making of this post.
the next night, i got pulled again. only the one lady didn't want me back. understandable. it happens, and maybe not because of anything wrong that i did, she just didn't want me back. fine.
so i got sent to the b-side. easier patients. hopefully. and by easier i mean more stable, less special-CVICU craziness.
my patient was this totally a/o pleasant little old dood that had also had a heart cath and stent placed to open up and occluded coronary artery. Abilene Rob has a great post about your heart and blood and such, view here; http://www.abilenerob.com/?p=330 .
so, i check on my guy throughout the night, sooper easy. didn't need any meds, didn't need O2, just a little bit of help peeing once in a while. guy ackshully slept most of the night. i got a great head start on my shift end stuff, and was ready to give report at 0530.
so i'm thinking, great, easy night. this patient could have had something Really Bad happen to them, but nothing did, so we're good. got my charting done, next shift paper work printed up, i'm great, ready to go.
then my replacement shows up, Mr Chipper.
heres the thing about day shift nurses. there are two types that replace us night shifters. type numero 1; sleepy. they just woke up, rolled out of bed, and barely remember getting to work. they're gonna need some combination of and or all three of the following-coffee/energy drink/breakfast before they really wake up. type numero 2; bright-eyed and bushy-tailed. this type is READY TO GO.
(you night shifters know what i'm talkin' about right? the weird thing is coming back that night and getting report from them-its like two different people.)
well, my guy was Mr Chipper. which type do you think he was? type 2? correct. i give him report on my 'easy' patient, and meanwhile, he's looking through the chart and just checking things out.
i'm confident. i mean, why shouldn't be? i did everything i was supposed to, right?
right?
Mr Chipper, 'did you give plavix or (some other med)?'
me, 'huh? why?'
Mr Chipper, 'well, because anytime a stent is placed, we have to give a anti-platelet aggregator right away.'
me (always the eager to learn beaver, and also, my stomach was s-l-o-w-l-y deciding to decend into my shoes thru my now puckered up sphincter) 'why?'
Mr Chipper, 'well, the body views the stent as a foreign object and will form a clot around the stent the same as any other foreign body, so you could REALLY have a problem. he could clot off and have a much worse MI (myocardial infarction, or heart attack) than what he came in with. thats why, like, we wake them up as soon as possible and give them a loading dose, then they have to be on this therapy for a coupla months at least, until the inner lining of the stented vessel has time to grow over the stent.'
me (in my head) 'SHIT!!!' (then, out loud, in a normal voice. okay, i might have sqeaked. a little.) 'that makes sense.' then (again, in my head) 'SHIT!!!'
so he ends up going thru the chart, looking for orders that i missed (i didn't miss any) and documentation that maybe the med had been given by somebody else (nope).
sigh.
great. so, turns out, the cardiologist does the catheterization to see where the vessels are occluded, but then, when the stent needs to be placed, the cardiovascular surgeon comes in, places it and leaves. sometimes, he doesn't even write orders for the patient, since he's just on the procedure. or something like that.
so, the patient didn't die, and it wasn't my fault. still, i HATE HATE HATE HATE that feeling. walking away from the job knowing that there was more to be done, that SHOULD have happened. in this case, it was a med that was missed (a pretty important one) but the patient suffered no real damage.
augh.
the heart's that beaty thing in the middle of your chest, right? okay good, just checking.
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