Last night was pure chaos in the ICU. I took the first admit from the ED while trying to balance a patient who was busy trying to hop out of bed restraints and all. So here is the initial report I got,
60 something male c/o SOB, Respiratory failure and now intubated and ventilated.
Ok no problem, I actually like working with vented patients, and no it's not because they are out cold, I've actually worked with them before as an LPN. So we get the respiratory room set up complete with a special bed that rocks and shakes them. Next thing I know I get the SBAR faxed over and it says: 60 something male, c/o SOB CHF exacerbation, 16L O2 non rebreather mask.
Hold up, what on earth made them think he was vented earlier? Ok, whatever I take report and tell them to bring him on over. Five minutes later the ED nurse arrives with a patient on a gurney and the following equipment: heart monitor, IV pole with a Nitro drip hanging and the fellow on a nasal cannula. Not to mention one measly 20 gauge in his arm.
Nurse Twit then gives me a quick bedside as we are transferring him into his new digs.
"Oh yeah BTW he still has that inch of nitro paste on his chest in addition to the drip because I couldn't find a doctor to give me an order to take it off"
Ok Brilliant, now the guy is getting a double dose of nitro, wonder what his blood pressure looks like.
"Um yeah and he was diagnosed with pneumonia in the ED but we didn't start any core measures. He's going to need two antibiotics and he's only got the one IV. So you'll need to start another one. Lucky for you he's got veins."
Great, how many hours has he been here and you couldn't draw the blood cultures or get a sputum? And that IV looks like a field stick so how the heck would you know what his veins look like since you obviously haven't examined them?
Nurse Twit heads back the the ED and I settle our guy in and tell him that I need to poke him again. He's pleasant as all heck about it and I don't tell him this is the first time I have ever stuk someone without a person hovering over me giving directions. Oh yeah his veins were crap, huge and easy to see but all gnarled. I found a decently straight one in his hand and dropped a 22 gauge in there like a pro. Thank god because my other guy was trying to crawl out of bed again.
I somehow manage to survive the night. I nearly kill my relief who takes 30 minutes to get report from the nurse with her other patient and then finally makes it to me. Great now Mr is late for work (yes we still don't have enough for another car so we carpool) and the director is giving me the evil eye because I'm overtime.
I bolt from that place screaming TGIF (my Friday at least) and hop in the car. Almost home free! Until we get to the intersection a block form home and wonder why no one is moving. I poke my head out the window and my heart just sinks.
From around the big truck blocking my view I see feet, on the concrete, in the middle of the intersection. I holler at the Mr to sit tight and jump out, to take a look. Yep hit and run in the middle of a busy intersection at rush hour, on a Monday with some dear strangers standing around him to keep the jerk drivers who are trying to cut around because they are too busy to care, from hitting him. Thankfully an EMT was on the scene and paramedics were screaming up as I got the the fellow.
I got back into the car and the Mr just looked at me and asked
"Is it a full moon?"