Revelations

  Last night I spent my shift keeping a dying man alive.  I know, this is what I am paid to do, this is my job and as some people say is my "calling". But when you watch and infection ravage a person in this way and make them nearly unrecognizable to loved ones it becomes hard to see the good that you are doing.


  I spent the night asking myself why. Why were we working so hard to keep a person alive when his body was telling us it wanted to do exactly the opposite? His body was shutting down, system by system.  Why were we pumping medication into him to keep his heart beating when the medications were just as damaging as the illness that had him here? The pressors needed to keep his blood pressure high enough we starting to have damaging effects on his fingers and toes.   Why did we force his lungs to breath with a machine when they had already decided to stop working.  If he was able to tell us would he have told us to stop?


  At about 3am I got my answer when his family arrived to the unit, arms encircling one another they went into his room. I had tried my best to clean him up and hide the damage the medications and the infection had done to his body by covering him up to his chin in blankets.  There were a lot of them, and they surrounded his bed talking softly to one another and touching his face.  When the came out the wife came over to speak to us, asking us to not go through life saving efforts when his heart gives out the next time. 


  She smiled at us and said,  "He's heard his trumpet, he's going to see Jesus and I am happy for him. He'll be there waiting for me when it's my turn."


  Then she and the family thanked us, all of us for taking such good care of their loved one, for making sure he was there so they see him one last time and say good bye to him. Everyone one of them hugged us as they filed out of the unit to go home and get some rest. And everyone of them smiled through the tears, everyone of them was at peace as they left, knowing that they had one last moment with him.


  Last night I learned that sometime we don't always save the lives of our patients, but me make a difference in lives of the people who remain here on Earth.

Can You Read Your Dr's Handwriting?

Yeah some days this is how I feel when I try to read orders.

Normal Hemodynamic Values

    Holidays are over and I know all you student nurses are heading back to school.  Cardiac monitoring was always a hard one for me to keep straight with all the values that you need to remember. I used to get a small pocket sized note book, type up my norms in charts and then past the little charts into my notebook.  I know a little OCD but WAY cheaper than those pocket books they try and sell you in the bookstore.

  So as a little back to school present for you all here is a nifty little chart that will give you all the norms for hemodynamic monitoring.

  Feel free to cut and paste it!

Parameter	Normal Value
Mixed venous oxygen (SvO2)	60% -80%
Cardiac output (CO)	4-8 L/min
Pulmonary artery pressure (PAP)	25/10 mm Hg (20-30 / 8-12)
Pulmonary artery occlusive pressure (wedge) (PAOP)	4-12 mm Hg
Central venous pressure (CVP)	2-8 mm Hg
Stroke volume (SV)	60-70 ml
Stroke index (SI)	25-50 ml/beat/m2
Cardiac index (CI)	2.5-4.0 L/m2
Systemic vascular resistance (SVR)	900-1400 dyne/s/cm-5/m2
Pulmonary vascular resistance (PVR)	100-240 dyne/s/cm-5/m2

Back to Reality

  Sorry for the total lack of any substantive posts my friends, the holidays really did a number on my free time.  Not only have I been on orientation at Local Hospital, but also taking an education program that is offered to all nurses moving into the critical care specialty by our regional education department. 
  This program has been in classroom a couple times a week plus online learning time, all paid! I cannot say how incredibly useful this education has been, I feel so much more prepared for what I might encounter in the ICU. 
  On that note, orientation has been going great. I actually ran with a full load (2 patients) yesterday, both on Cardizem drips and had no major mishaps. Charting is getting better now that I have a handle on the system and how to use it. Looking good!
  I have a ton of information to share with all you New Grad's and Student Nurses, they have loaded me up with all kinds of great teaching tools and resources...just have to get through the ACLS that's coming up, wish me luck!