Southern Comfort; Um.........anything else?????

illustration 1
illustration 2

my ICU is a pretty big deal. basically, there are two kinds of hospitals; ones that the helicopter takes off from, and ones where they land. mine is the kind where they land. pretty much anything serious happens in the south end of my state and it comes to us.

so we can get some sick people. i was working a shift the other night, and i started out the night with 2 patients. when that happens on ICU, it usually means that it is two less sick hoomins you have for patients. if you have a really really sick hoomin, you usually only have to take care of 1. well, one of my patient's wasn't really that sick, so we triaged him down to our step down intermediate care floor, just in general anticipation of getting somebody really sick. which means that if we did get somebody really sick, it would be my patient.

i got somebody really sick. (said the only-been-a-nurse-six-months ICU nurse)

the report did not start off well. in that south that i mentioned before, there exist a number of smaller hospitals. bless them, they do the best they can with what they have.........but there are great reasons why if they get a really sick hoomin, they ship them to us.

so i get word that i'm going to get an admit, some kind of respiratory distress. alright, bring it. the call for report comes thru, and i get on the horn.

Report Person: 'so this dood has been here for a coupla days, was satting just fine on 2 liters, then the sats dropped allofasudden, so we intubated and the patient is on the way to you.'

me: waiting.......'anything else?'

Report Person: 'what else do you want to know?'

me, in my head, 'what the f*** do you mean, what else do you want to know? you're the one calling report and THAT is all you tell me?!?!?!? -then, out loud, 'why did he come to the hospital? was he alert and oriented? what has he had for pain? what are you using for sedation?when? where? how? who? do they have IV access? is he running a temp?

sigh.

every question i asked bought me an, 'uh, i don't know, lemme find out.'

turns out that the patient was so sick that the nurse who was responsible for the patient was on the ambulance helping to bag the patient. the patient was so sick that they intubated, but either did not have ventilators or did not have a transport ventilator, so they had driven in the ambulance from PoDunkville the hour to my facility baggin' all the way. and the Report Person who was trying to give me report was an LPN whose only assignment had been to take vitals and, tragically, call me with 'report.'

and, to top it all off, the patient arrives with his sats in the 40's. FOURTY'S. that is out of a possible hundred. and the transport team claimed that the sats had actualy been in the nineties, and had only dropped in the last 5 or so minutes. riiiiiiiiiiiight.

the problem with that 'claim' as we observed it, was that they had been bagging him incorrectly as they came into our facility. had they been doing that the entire hour long trip?

i never did find out. if you will direct your attention to the picture above (illustration 1), you will notice someone appropriately 'bagging.' (of course, our victim, erm, patient was already intubated, so instead of a mask over the patients mouth, imagine the bag the right hand is holding connected to a tube that, hopefully, goes into the patient's lungs). a key component of this device is the tube at the end, the part at the very end of the bag-valve or bag-mask combination. it is connected to an O2 source, and in order for it to function at it's best, it should be completely open. it looks like a vacuum cleaner hose, only it is collapsible. it should be filled with 100% oxygen. if it is collapsed, it can't hold oxygen.

our 'transport' team did not have that hose fully extended.

so my patient made an hour long journey with inadequate ventilation.

which put him at risk for an anoxic (without oxygen) brain injury.

sigh.

so, anyway, we hooked our patient up to a real ventilator and ended up doing a bunch of cool interventions. central lines, pronating beds (illustration 2), feeding tube placements, etcetera. pretty cool stuff from a technical standpoint.

*the pronating bed is a medieval-looking device that you strap a patient into, and it turns them like a rotisserie chicken. it helps patients who have compromised lungs to breath. pretty cool Star-Trekian stuff.

moral of the story; don't get sick in the south of my state. and if you do, don't stop at the little hospitals, just keep on drivin' north.

also, i may be starting to maybe possibly kinda getting this whole nursing thing. i am, after all, at the six month mark.