Bend Over and Take It
Best of intentions, right?
Before I even left Friday morning I had been moved to Green. I slept like a ROCK Friday and woke up at 8pm to get ready and carry my sorry ass in. When you are greeted by the other charge nurse, the clinical coordinator and an "I'm sorry" maybe you should fake a prolapsed uterus and run for the hills. Yeah, I got FUCKED.
I had WBL (the Wandering Brownie Lady), a nurse who has been here for a thousand years, left and came back (slooooowwww) a decent nurse and an LPN who just celebrated 35 years with the hospital. Ummm.... do the math, I was down an RN. I was expected to do charge, the fishbowls around the nurses station and be backup for the LPN who was assigned a zone. On a Friday night, no less. This place continues to baffle me.
We managed, barely. The WBL took her sweet time and I ended up writing up most of her people. The slow nurse bitched any time I gave her a patient (and then expected that I write them up and get an IV) the good nurse, bless her heart, busted her ass to help me, and the LPN kind of walked around looking lost.
The WBL got a guy who had pain from coughing too much. So, like any other smart citizen of the city, he paid $20 for some liquid morphine off the skreet. He went home, had a beer and took a swig of his new "juice." EMS found him unconscious on the floor with a GCS of 5. A little narcan and he was back with us. Another gem saved from Darwin's evil clutches.
SLOW nurse got a guy who was in and out of VTach with a pulse. He was awake and had stable vitals. She wanted to argue that he needed to go in someone else's zone. At that point all she had was 1 psych patient. I know we have the code room, but I'm not going to overwhelm the good nurse because you are lazy and probably a little scared. (plus, with the way my night was going, I'm sure the best was yet to come).
and it was.... follow your gut friends....
I get a call that there is a possible STEMI (ST Elevation MI) enroute. 39 years old with a past history of htn and that's it. He's in really good physical shape and started having chest pain while watching TV. We don't alert him as an AMI, but we all jump on it nonetheless. His 12 lead showed flipped T-waves in V1-V4. Not an acute MI, but not pretty. He bought himself a nice lil cardiac workup. He was brady in the high 40's to mid 50's but his pain was relieved by nitro and a little fentanyl. Chest xray, nuclear medicine study and labs were negative.
He arrived at about 2am, At 645 I was getting ready to write up a drunk 18 year old who got his ass beat downtown when I hear myself, the coordinator and medics paged to the code room. Our young friend has brady'd down and coded. When I ran to the bedside CPR was in progress and he was in fucking PEA. We threw him on the geezer squeezer, got him tubed and started doing the code drug thing.
NADA. NO response whatsoever. He was in PEA so we didn't shock him. At 39 years old, what the fuck was wrong with him?!? The attending is one of the younger guys who is much more aggressive than a lot of our docs. He suggested we try a pericardiocentesis. People were yelling for betadine and there was none to be found, so a big squirt of hand foam did the trick. Needle in.... nada out. Bigger needle in.... approx 5cc of blood out. The attending looked a little frustrated when he said "the last thing we have to offer is to open his chest and see if he needs a window.
Immediately a gown and mask was tied on me and the chest stuff appeared from the trauma room. The second year resident and I worked together and cracked this guy's chest. He cut, I pulled. He wedged, I cranked the spreaders. I held lung, he opened the pericardium. I pulled a HUGE clot out while he did internal massage. He suctioned while I did internal massage and then he got the internal paddles ready while I gave intracardiac epi into the left ventricle. All of this with a growing audience and an attending who let me talk the resident through the procedure. After the internal paddles failed to produce a rhythm he was pronounced. All of my special forces were able to look and touch and ask questions, as long as it was done with some dignity and respect. I think there is a picture that was taken of my hands in the chest (no identifying pt info) so if I get it I will put it on here.
The oncoming charge nurse had already gotten report from the other nurses so I didn't have to do that and the guy getting that zone (BLESS HIM!) told me that the only thing I was allowed to do to help him was to carry my tired ass home.
So, that was quite an eventful way to end a very long and painful night. Definitely a first for me, but having the attending pull me aside and say I did a great job did feel pretty good.