CLICK HERE FOR FREE BLOG LAYOUTS, LINK BUTTONS AND MORE! »

Saturday, April 27, 2013

Highs and Lows

It's the highs and the lows and the joys and the pains and they call the damn thing...

not the rodeo; but trauma. I think I'm becoming a trauma junkie. Dead one night in the Minor Care, so I went up to watch/try to help with a patient who came in unresponsive. The medics brought him in on dopamine and yet his BP was still only 50/30. When the seasoned RT comes in after pulling the results from an ABG, shaking his head, I had a feeling this might be interesting. "Goddamned pH is 6.5...I can't believe it. Not compatible with life..." The MD didn't think he'd make it out of the room alive, and the other nurses are putting on defib pads, preparing for the worst. Several hours later he's still holding on, but now intubated, a Foley put in, IVs started, several amps of bicarb and other meds given, an NG put in, etc and escorted up to the ICU nurses to let them take over his vigil. Three days later, and he's still in ICU, but being weaned off the vent. I don't enjoy seeing people that ill, but when they do get that way, I love the process and the way people come together to put them back on track and return them to their lives.

The next day I'm slammed in Minor Care, and I feel myself getting more apathetic with each low-income person who comes in, appearing in distress and telling me the only thing that will help them is a shot of morphine, of Dilaudid. They're allergic to Toradol, to Tylenol, to Motrin. They are unemployed, on disability for one thing or the other, and they don't care they're siphoning my tax dollars for a temporary high. One lady stubbed her toe (not even her big toe...) three nights earlier, and the only thing she felt would help was some Percocet. The provider, under the ever increasing DEA surveillance, firmly tells her she won't get anything more than ibuprofen or Tylenol. I don't want to be a jaded, judgmental nurse. I need to figure out a way to look past their situations/habits and see them as people. But only to a point...we can only do so much to try to help them get pointed in the right direction; the rest is up to them.

On the other side...

I don't know if I should have been more intuitive, but Dillon didn't eat anything today. He's 2. Sometimes he just doesn't eat. He was acting like his normal self, getting into everything. He felt a little warm this morning, so I took his temp: 99.1. Hardly anything to get excited about. He's passing gas, and it smells as awful as the dog's, if not worse. Maybe he just ate something and it's messing with his system. I take him to TCU with me, so I can help out with Marci's MDSs while she's swamped and so I can earn a little extra cash. He's cuddly, but he hasn't taken a nap.

Nate comes to get him and they go home. I carry on with my MDSs, and then I get a frantic phone call from Nate telling me he's taking Dillon in. I think he's overreacting; it's just a little throwing up. I don't want to be one of those parents that take their kid in for every little thing...He was fine just a few hours ago; unless he had some fall or some other injury, he doesn't need to go to the ER! I clock out, and meet them in the waiting room at the ER. Dillon is lethargic, and his eyes are glazed over. Maybe Nate knows what he's doing after all. So he's a little tachy, and Deb wants to give him IV fluids. Wait a minute; how did he get so bad so fast?...a small tremor of fear goes through me, and I know it's for the best, but how really, how did he get so dehydrated so fast? Teresa pops the IV in, and with each drop of saline he becomes more animated, more like his usual outgoing into everything self Dillon.

It's hard being on that side of the emergency room. I forget too easily the fear, the anxiety, everything that goes with having a sick loved one waiting to be taken care of. But my co-workers are amazing, and if I can have half as much knowledge and finesse as Teresa someday, I'll be satisfied. Dillon tells her, "Good job buddy" as we leave.

I kissed Nate good-night tonight, and thanked him for being such a good father. He has some good instincts, and maybe I should listen instead of automatically thinking he's wrong...

Wednesday, April 3, 2013

Pushing Propofol

"You never push Propofol..."
"Patient is waking up, give her some succinocholine and some Diprivan!" The moment where the patient is intubated and starting to pull at lines, what do you do? There isn't a doc in the room so what do you do now?
Maybe I need to get in touch with my ER training person.