Are you still here???? Yep! Wouldn't miss it!

My partner & I arm wrestled for a CRRT trauma crush patient last Friday. I had first choice the weekend before so she took him. The next highest acuity patient was in the room down the hall according to the shift charge, so I grabbed the chart and started to prep. While prepping on my patient, I noticed the neuro doc stopping by to meet with the family. The code status was downgraded from full code to DNR. My patient 'Pebbles' had a brain aneurysm that ruptured and she was not doing well after surgery. I finished my prep at midnight and went to bed. The next morning I arrived to find that she had died two hours after I left the hospital. Picking a new patient, I got report, started reprep and began to take care of a patient with a brain mass, status post surgery, ventricularostomy and ICP monitor. I learned about calibrating his arterial line and ICP line, how to monitor intercranial pressure and doing frequent neurological assessments. My patient was affable, talked a lot and was very alert and oriented to his situation. I hung several IVPB medications and took care of his needs for the day. I was able to take out his arterial line, foley catheter and get him out of bed several times to assess how intercranial pressure would be affected with increasing levels of activity. Learning about brain compromised patients is fascinating and exhausting at the same time. I finished his care plan and helped with other patients on the unit. My partner's patient had a Swann Ganz line and an expert on the line taught us about it as we looked at his monitors.

In the midst of caring for this patient, my care nurse had a patient who also had a stoke, whose family withheld treatment. In that regard, we were providing comfort measures to him. His lungs were filling with fluid, so I was able to help suction and clear his airway to ease his breathing and offer reassurance. By the next day he was gone. Two patients in one weekend. ICU is fast and furious in one respect and slow and intense in the next. The contrast in the ICU was black and white. Such differences with each patient.

On Sunday my happy patient was downgraded and I re-prepped (again) on a new admission from a motorcycle accident who had broken his femur and ribs. He had a chest tube and his leg was pointing in several different directions in a Bucks traction device (something invented in the Civil War - much like a weight and pulley system) that stabilizes the bones and joint while the patient waits for his surgeon to fix his leg. I was able to do some patient teaching on pain management using a PCA device which is a button system the patient uses to deliver his own analgesics. Assessing his breathing was interesting. When someone has a pnemothorax (collapsed lung) due to trauma, their breathing sounds like hiccups..short inspirations which are cutoff midway. I made a bath blanket splint which he could use when he felt the urge to cough and help ease the pain from his broken ribs. We talked about his surgery and a few of his friends came to check on him.

That afternoon I went to the OR with my patient and watched his surgeon prep him and open his leg at the thigh. What resembled a car (up on a jack), ended up being huge rods, nails, pins, and drilling sounds with hydraulics set against the sound of Enya playing on the surgeon's IPOD. I saw more blood with this procedure than I saw with my previous OR rotation ( thorocotomy, total neck and ventriculostomy)...the blood was all over. Everything was done with X-ray for placement so we all had to wear to protective aprons in addition to our OR gear.

In the middle of my patient's surgery, one of the OR nurses came in to grab me to help with a trauma coming in (a self inflicted gunshot victim who had severed his popliteal artery which was being held closed with an EMT's finger ETA 8 minutes)...while the room was being prepped, I sterile gloved and waited with my heart racing as to what was going to show up. (Apparently, not realizing while cleaning his gun, a bullet was lodged in the chamber, it fired into his leg...owwwie)

As they wheeled in the man, his clothing was being cut off, I grabbed all the gurney materials, clothing and bags and sorted through the bloody mess to get the patient belongings into a separate bag. Throwing the gurney back into the hallway I re-gloved and went in to assist the prep. The patients legs needed to prepped and elevated for sterile wash and possible vein grafting. I had one leg and another nurse had the other. It felt like each leg weighed about 100 pounds each. 10 minutes later, the surgeon was there, draped and cutting into the leg to secure the leg to repair the artery. The anesthesiologist was the same one I had observed with my OR rotation and I was amazed at how fast he was able to get this trauma patient under and intubated.

With the muscles in my arms still shaking from holding the gunshot victim's leg up for so long, I walked back to the other OR to check on my patient who was coming out of OR and going back to ICU. I escorted him back to the unit and with my care nurse, completed the PACU assessments in the ICU, which involves assessing all his vitals every 15 minutes, getting blood samples and cleaning him up after surgery. My patient had been intoxicated when he was injured. Earlier in the day we talked about drinking and driving. My patient verbalized how fortunate he was to be alive and that his friend (riding on the rear) had not been seriously hurt. You wonder if it is a wake up call or a pattern of risk taking that will eventually catch up to the patient. We are there to treat and teach.

As my patient woke up, he looked at me and said, "Are you still here?" "Yep!" Wouldn't miss it!