Wednesday, January 05, 2011

Epic Fail

I don't know how to put the last week into words. Epic... maybe. Heartbreaking... definitely. An opportunity to really stretch my brain cells? Absolutely.

Jan 30: I was in charge in green. We have been steady busy leading up to New Year's. People are drinking, partying and generally not taking care of themselves. I started my night walking in to get my shoe covers. (I walk through so much crap that I don't want my new and FABULOUS zebra danskos to get gross). The pharmacist is looking for me. The attending in green is having a problem with an intubated patient on a levophed drip. Her solution...? Wait until I get there and let me sort it out. I guess that is a pretty profound compliment. The levo was for an intubated inmate with crap pressures who was going to the ICU. The femoral line was running well, but the leg was mottled and cold to the touch. The question was: is the leg mottled from the levophed extravasating or from something else. I checked the line, the pulses above and below it (including dopplar) and the CT scans. My conclusion: there was a known clot in the iliac artery. The levo was clamping down and preventing and further collateral circulation. In short, the leg is toast... as well as the patient.

My next call from from our communications room. 74 year old, down greater than 10 minutes, King Airway in place, CPR and drugs (via IO) in progress. So 30 minutes into the shift we get a code. We have a great team and everyone is ready. I then got a call that the patient is one of our paramedic's grandfather. FML. I told the coordinator, the chaplain and the attending. Everyone else was told afterwards so as not to compromise the resuscitation. It went well, but there was nothing we could do. The medic is also a city firefighter and he took it very well.

The rest of the night was steady, but not bad. At 645 I get another one of those calls. Found down in a truck, warm to the touch, CPR in progress. Another code that went very well with my great team. What a way to start and end a night.

Jan 31 New Year's Eve: NEVER A GOOD NIGHT

Let me say that again. New Year's Eve is terrible. As my EMS friends say "Welcome to the SUCK." I started out "floating" in yellow. There was an old dude hit by a car in the trauma room. He was pretty stable. As I was clocking in we got the call that an 11 year old girl hung herself in one of the projects. The crew couldn't get her intubated and CPR was in progress. They worked her for a while. The anaesthesia attending had to intubate because her airway was so destroyed. The EMS crew was a wreck. I tool them over to a waiting room and just sat with them. They are amazing providers who were just taking this very hard. She (obviously) didn't make it. It was a difficult code and a lot of people were affected.

After she was moved home dude in the trauma room promptly tanked and coded. His scrotum was swollen to the size of a volleyball.... obvious internal bleeding. We worked him, squeezed blood in and (for the first time in my career) they actively did external CPR... he didn't get opened... all the way to the OR. He survived, but not sure how bad the outcome will be. Our next contestant was a transfer via helicopter that was either run over by a car or assaulted. He had a depressed skull fracture and a degloving of the scalp down to the skull. Intubated with a GCS of 3. All of this was in the span of about 3 hours.  I also helped one of the nurses give tPA to an acute stroke. She went to the ICU and is currently better and terrorizing the staff.

I spent the rest of the shift at the screamer desk fielding the many walk in assaults and their many MANY drunken family members. We did make it outside to hear the midnight gunfire... until it started to sound really close. There was also a pretty big fight at one of the drag clubs. Weave was ripped out and "girls" were struck in the face with beer bottles, wine bottles etc. To Wong Foo + Fight Club.   Holy Shit I love my job.

Jan 1: Princess in triage. 4 hours that were beautiful and wonderful. What can I say?  :)

Jan 2: Trauma Room     Started my evening with a transfer GSW to the chest. He had a pressure of 80. He got tubed, chest xray, 2 units of blood in and to the OR pretty damn fast. He had a liver injury but will probably be ok. The next was a scene gsw. The other half of the first. They apparently shot each other. This guy was not doing so well. He was awake, but his shot to the flank had much more devastating aim. He was paralyzed from the waist down. The bullet went through his cord, took out the head of the pancreas, some spleen and bowel and DESTROYED a kidney. He also went to the OR pretty quickly.

Following that I was blessed with an overdose on Seroquel, Trazadone and Xanax. There was also some heroin and marijuana thrown in for good measure. (I found the pt's stash in one of the pill bottles)  She was very large and very, very disgusting. She smelled like she hadn't bathed in weeks. One we got her tubed we started to strip down and clean up. There was a very old and foul pad that was part of the culprit. Bleh. She was moved out to another room to continue to get treated. The nurse was going to put in her foley when I heard my named yelled. She was pierced.... everywhere you can imagine. Head to toe. If you can pierce it, it was pierced. Now I have 2 in each ear and a belly button. My skill with piercings is simply because of my experience.  The nurse said she called me because I seemed to know "everything about everything." From a nurse who I really respect that was another great compliment. I went to work with a pair of hemostats and a ziplock bag. I lost count but my best guess is... maybe 25-30 piercings. There were 2 that I couldn't get out and that was because they were placed with a biopsy needle. The metal was actually embedded in the skin.

To end my wonderful run of days in a row. A young girl decided to kill herself. She goes to the pest control business that she works at, Writes a note and takes a canister of chemicals. She sits in her car breathing in and possibly drinking the crap. She then calls the police to tell them where she was and what she was doing. They get there when she was still alive and break out windows to get her out. Fire douses her with the hose and brings her to us. She seizes in our driveway and it just doesn't stop. We intubated and then coded her for over an hour. Her airway was burned, she was pale and mottled. We couldn't get calcium and bicarb in fast enough. She had so much pink frothy sputum coming from her ett that we couldn't keep up with the suctioning. This of the WORST flash pulmonary edema you have ever seen and then act like its a faucet turned on. I was lucky I was gowned, masked and covered because I got sprayed, big time. She went from sinus tach, v-tach without a pulse, brady, v-tach, v-fib, pea and then asystole. It was awful. Who on earth would want to die that way?

We then had to decon the room, bag and tag her appropriately and call the ME. We also had an engine company, ambulance crew and half a platoon of police officers who had to either be decon'd or observed   for a couple of hours. They were all great guys who knew this was just something that had to be done. I made a lot of friends that night. I don't know if they found her family. They didn't come to the hospital.

So I am on a 4 day break. No hospital. Craving somewhere warm away from it all. Maybe its time to put that overtime to some good use.


Blogger A Nurse's Curses said...

I worked new years eve and day too...crazy stuff happens, but the really sick criticals get flown out to the trauma center (we're just a hick hospital). The best thing I read was that you have Danskos! I live in those things, I will never buy anything else to work in.

4:27 AM  
Anonymous Anonymous said...

I work as a nurse in a jail in a large city. I worked graveyard shift NYE... everything was so nice and quiet until the bars closed and it all went sideways from there. I agree.... NYE: NEVER A GOOD NIGHT!!!

8:54 PM  
Blogger battynurse said...

Sad and interesting how around the New Year or Holiday season suicides seem to be more prevalent. And what may seem like a good method to someone often turns out to be a horrible method. Glad you made it through the weekend with your sanity mostly intact. I hope you enjoy your time off.

4:22 AM  
Blogger GingerJar said...

My God, you do more in one night that I see in a year. My New Year
s Even I worked ICU and my patient was ETOH withdrawal and going get his drink on, and he yanked me literally off my feet into the bed with him. Hurt my back, I was only able to work 1/2 of New Year's day (time and a half!!! baby@!!!) Then I was sent to the ER then Home, for anoter day. Sprained back, anyway, hope all is good with you.

12:12 AM  
Blogger jberry said...

thank you for sharing. hardcore stuff. I'm a new grad and reading your blog makes me appreciate the profession even more. thank you for your compassion.

ps, I just got zebra danskos too, now I just need a job to wear them to. I take my NCLEX next week.

11:07 PM  

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