Your fluid and my air
I drown in your pink sea.
Acute pulmonary love edema.
I drown in your pink sea.
Acute pulmonary love edema.
I am going to write about some people in the hospital that have always taken care of me on the job. Everyone knows about how nurses often treat new nurses and while I did not have any major terrible experiences with the experienced nurses it seemed early on that the respiratory therapists around along my journey have turned my new and lately not so new nurse experiences into an irreplaceable affection for the respiratory department.
This tenderness was clear to me from week two off of orientation and my first code blue. I walked down the hall on the way to another patients room and I see while walking by the room the patient is ripping off the gown and appeared to be in distress. I go in the room and the patient goes into cardiac arrest, I got no pulse, so I call the code blue and the first person to arrive is the RT (cause he just always seems to be around) he just started bagging and I just started compressing till the code cart arrived and everyone else just came in and started working. The whole time while trying to resuscitate the patient I see my RT ventilating the now intubated patient squeezing that bag and trying to find my face that was lost while trying to blurt out the facts about the patient and answer the questions that the intensivist kept trying to get out of me while desperately trying to find the differential for this problem. All I could see was his face filled with empathy, knowing this is my first time and knowing that I was 2 weeks new. He was just so calm and steady at the head of the bed doing his job and assessing the scene. I was so nervous, everyone was doing their job, chest compressions, emergency meds, checking the rhythm, feeling for pulses and there I was all new…racing with verbage out loud to try and get all the information out and my words were directed towards the probing intensivist but my eyes and speaking were fixed on RT because it was the only way I could read off of my paper and explain the patients clinical facts without losing my thoughts amongst the chaos. I just really wanted to be inside that ambu-bag hiding, but of course that is not possible: I would not fit inside anyway! And when it was done he did not just walk away like everyone else did, leaving me with a trashed room post ACLS for 40 minutes with drug vials littering the floor, a code cart empty, and a dead body staring at me. He was there till I told him to leave so I could clean up the patient, perform post-mortem care, and bring in the family.
That was just the beginning of my fondness for respiratory. It was over and over again, every week a rapid response, and every time RT was there: performing interventions with this calmness that screamed to me: it is ok new nurse lets just get it done: the bedside intubations and transferring to ICU over and over again to what started out as worry and fear for me the first year lead to the second year turning to frolic and probably inappropriate but relieving humor of you wanna play this game again nurse? It got to the point that when I found my patients in distress or anticipated distress I would just call RT on his cell phone and tell him…guess who? (as if my voice is not the dead give away) I am about to call a rapid response on my patient can you come to the room now?
I will not soon forget the intubation with thick pink frothy fluid spewing out all over while I am gasping out loud literally and oh my Godding and what is this stuff with descriptions (and making a funny spectacle) and then laughing while sucking it all out all with my unconcealed surprise and giddiness at my aggressive suctioning and fumbling for my space around RTs hands as he tried to intubate my patient, all while thinking this is not the same nurse as last year. And when that episode was over and was succesful he starts pushing me slightly to laugh about my reactions and animation.
This affinity towards some of the RTs at my hospital is not just limited to effective super skills in an emergency situation. They just generally make my day brighter, listen to my rants, make me smile and they cheer up my patients, assess our patients. I feel at times like they are following me, or I am following them especially during my first assessments and I find all my patient’s oxygen saturation around 100% because they are all getting blasted with 6 liters on the nebs and I can not get my oral temps at that time either. When all 48 beds are full and all 48 patients are being nebulized I like to take down the treatments on my patients when they are done to get them all happy. I remember at first wondering…is this done yet and shaking up the device to see if there was medicine left in the cup or not and was so embarrassed when RT saw me doing this he just started telling me: 1o minutes, or 20 minutes depending on how much of that stuff that comes out of little plastic vials is being administered. I always get happy when RT slips those little extension connectors into my pockets for oxygen tubing for patients that need oxygen therapy, or home oxygen patients to walk to the bathroom, it just gives me a giggle because I can not stand when nurses cut the oxygen tubing to make the connection and it always seems to look ugly and come apart during treatments (ugggh drives me crazy). So I always have some and even nurses ask me for them knowing I have some slipped into my pocket.
The rest of this post describes some breathtaking (no pun intended) RT bloggers that I read every post (only just 3 of them) and a few of my previous posts related to my experiences with the respiratory therapy department at my hospital (I left some out due to laziness of searching for them) and I left out the rant about ABGs not being drawn on time for my patients because they were not ordered STAT. (but heh I understand and get it).
So with all this attention towards the respiratory department especially after the first code blue I found Keep Breathing and have been reading him ever since. His kind words after my sadness and guilt over that first code blue really meant lots to me.
This RT made me laugh so hard when I was feeling like green poop from the job. I mean I came home feeling all crappy and stumbled upon his description of Ventolin types and nearly peed in my pants from laughing so hard, and I was no longer feeling crappy from work I was feeling the pleasing release of laughter endorphins. It is my perfect dose of humor, my style, and his blog is so educational I love it.
RTs are important, we all know that, this house MD made us all laugh when during a rapid response he wanted to know where the hxll the RT was…we were like dude…the RT is right here. (bagging the patient duh)
RTs usually get the ETT in the first time…at least in my experiences so far as still new nurse *giggles* but sometimes they can not and that is when a stat page to the anesthesiogist comes in right on time.
This future RT writes about all kinds of experiences from different perspectives in health care and he likes trauma too. I cried reading his post about a pediatric code blue, something that I would never be able to handle (I am strictly adults) his writing is genuine and I feel for his experience and need to get it out there. He is really going to be a super duper RT. (and hopefully nice to new nurses) !
And that is all I have to say about that except other cool factors to add: I always get the bag of ice ready for the ABGs that need to be drawn. I just like to. I will never call for PRN treatments that are not ordered or indicated. I will always laugh about what kind of trouble I will be up to each shift with you. I will never blast up the oxygen on the CO2 retainer. I will always put the patient back on BIPAP (instead of calling you to do it) when I am the one taking them off . I will always take down your finished treatments !
Listen to this nice calm narrator. Ahhhh.
Acute Respiratory Distress at change of shift:
A rapid response is called. We start ventilating with the ambu-bag which brings the saturation up and of course the patient needs immediate intubation.
So the RT attempts twice and does not get it in.
Another RT tries twice and does not get it in.
The MD tries twice and does not get it in.
STAT Anesthesia is paged: He strolls in all calm in his surgical scrubs and bandanna, we give him the stuff and he slips it right in, and strolls on out of the room, happily and calmly.
Oh! I went on vacation and have been totally out of the loop! I have to play catch up to read everyones goings on–in this sick I-am-not-alone world known as health care. I wondered how it would be to step into the work again after being on vacation as if I would of forgotten how to do my job.
No. Nothing of the sort! I started lines on my patients, managed the drippy drips. Helped people to poop (and pee). Provided emotional support for families. Listened to the hearts and lungs of all my patients and my own heart too! :) Fixed a flash pulmonary edema (again) as realized by: Shortness of breath, Hypertension, Rales 3/4 the way up the lungs, Respiratory rate >30, all in a patient with a cardiac history admitted with rapid Atrial fibrillation on amio drip and getting IV fluids of NSS @125ml/hour for the last 24 hours. I should of known to shut off those fluids as soon as I started working but I hesitated as the patient was dry and not eating and also renally impaired with metastatic cancer to top off the problems. So I let them run and then ended up: fixing the problem by: getting from the MD: (can anyone guess?) Lasix, Morphine, Hydralazine, and of course shutting off the fluids immediately.
So I get report from one of my favorite night nurses (seriously, I luv her) It goes on and on about the patient, one part sticks out in my mind though, ” The patient came in wearing a holter monitor that she is not wearing now because she is being monitored on our monitors and she also has a chest tube to 20cm of H2O suction, status post lymph node removal in the operating room yesterday.” I go to the room and find “LIFE VEST” batteries plugged into the wall, and I am thinking what is this?
The real story: Patient came to the hospital wearing a life vest due to an increased risk for sudden cardiac arrest, and is status post thoracotomy for partial lung removal with a chest tube to fix the ensuing pneumothorax.
Two very different scenarios and care.
Where I work it is the job of the respiratory therapist to obtain all blood gas samples on the floor. Most nurses are not certified to collect ABGs although if they want to get certified they can, by taking a test and doing a minimum of 5 ABGs in the presence of an RT to sign them off. Now I usually love love love the RTs at community X, but after this weekend, my patience has run dry. I had 3 patients this weekend with respiratory problems and 2 of them were on and off the bipap and needing multiple ABG samples. The patients needed it! The physicians ordered it! And the RTs gave me crap all weekend. One day because the MD ordered ABG today, the RT did not collect it until 10pm at night!
I am really sick of it. Now they all “do” their job in the end, but why do I have to be abused? Why do I have to call over and over “begging” them to do their job? Why do I have to be on the receiving end of negative attitude and nasty comments?
Why does the patient have to be “coding” or near it for the RTs to take this stuff seriously? And even then I still try to work as a team and when the results are back they do not even want to know about it! I understand that they short staffed and have lots of patients and they have to prioritize but HELLO! My patient in early resp distress with abdominal use for breathing and cyanotic nail beds that can not even talk is more important than the neb treatment to the chf patient that probably does not need it on the other end of the hallway is not more important than the ABG my patient needs now to determine how bad off it is.
I even offered to call the House MD to obtain my samples for them but of course the offer was declined. Maybe I will work on getting certified so my patients do not have to WAIT.
I guess I am just going to have to be the bitch nurse in order to get what I need done for my patients, and I never intended to be. That is what it comes down to.
So today the patient in the room next to one of my patients goes into respiratory…well arrest…she stopped breathing! So the code was called and the response team came which of course included the RT–so the RT is bagging the patient and the House Doc arrives and says “Where is the RT?” Everyone was like duh…bagging the patient.
Anyway the outcome was actually ok this time.
Pneumo Vaccine: It always seemed to annoy me that in the acute care setting I was worrying and spending lots of time making sure that all my patients were given a Pneumoccal vaccine. It seemed whether they liked it or not: if they fell into the category they got the shot. It is like a crazed mission to eradicate this type of pneumonia. Of course Pneumococcus has 80 different strains but the vaccine does cover 23 strains! :)
Well… as Karma, and Murphy’s law do work. I received a very sick young man with lobar pneumonia. The patient was very sick under the age of 25 and presented with chest pain, cough, pleuritic pain. Chest x ray revealed the pneumonia, and the patient was admitted to a general medical floor. The patient was assessed by the nurse to be tachypnic, tachycardic, and hypotensive, febrile. His BUN and creatine were elevated–the patient was becoming septic and going into mild renal failure. They transfered him to the ICU where he received close monitoring, fluids, antibiotics and aggressive treatments. One day after that the patient was transfered to my tele floor–stable, less tachy, still hypotensive and in alot of pain. And the cough! IT was harsh. IT hurt me to listen to it.
The patient of course wanted to know when he was going home, back to his life, his job, not really knowing or understanding that it was not palm trees mountains or apples in his lungs. That he was seriously ill, and could not go anywhere anytime soon.
The most common cause of bacterial pneumonia is Streptococcus pneumoniae or pneumococcus. Pneumococcus usually causes lobar pneumonia, attacking an entire lobe or portion of a lobe of the lung. The signs are usually: shaking chill pain in the chest while breathing, a cough, and blood-streaked sputum. This usually happens after a viral respiratory infection→ than bacteria get in.
I guess I do not mind so much injected those huge needles anymore into muscles–if it really helps knock out some pneumonias.
I have been reading….and there still are some uses for these external pressure ventilators.
This is the modern negative pressure respirator!
She looks so peaceful!
This is just one of those concepts that amazes me.
It was this before……