Well, to get started, let me say that work last night was just a thinly disguised chaos (I am an RN and have worked in the ER for 11 years in case you don't know anything about me). I get there and see my assignment, which included the "code room". We don't keep this room occupied all the time and try to save it for critical patients only. And that's exactly what I happened to inherit last night. Mr 43 found down by his roommate, who initiates CPR after calling 911. EMS arrives, intubates, and begins ACLS (advanced cardiac life support - drugs & shocking). Mr 43, it seems, had been indulging in a massive amount of drugs. Positive for marijuana, benzodiazapenes (valium, ativan, etc), and opiates (heroin, pain pills, etc). Most probable scenario would include respiratory suppression followed quickly by cardiac arrest. No pulse or respirations when EMS arrived. Was a PEA (pulseless electrical activity - means electrical activity put out by the heart w/o contractability, otherwise no heartbeat) on the monitor at the scene, same when he arrived at the hospital. Pupils fixed and dialated. No neuro response at all to deep painful stimuli.
Okay, here is where the story gets a little more interesting. Mr. 43 was found by his roommate after seeing him "just fine" before getting in the shower, and not breathing 10 minutes later when he got out and started CPR immediately. Okay. How many of you have seen anyone walk by someone, get in the shower, bath, get out and dressed, check on someone, and initiate CPR in 10 minutes, male or not? I found that hard to believe. It was probably more like 20 minutes. Add another 10 minutes or so for EMS to arrive, intubate and begin ACLS. Then add transport time to the hospital and another 30 minutes of code activity to obtain a sustainable rhythm. Are you keeping score? Looks like at the least 1 hour of minimal-moderate cardiac perfusion activity. Ending result? Massive cerebral edema (brain swelling caused by drug overdose and hypoxia - no oxygen), no spontanous breaths (so total ventilator assisted), cardiac output by drugs only. Basically...dead.
When I arrived at 7pm last night, Mr 43 was just returning from CT Scan. I hurried into the room and helped get him re-situated, i.e., placed back on the monitor, vent reconnected, etc. I come back out and go to the day nurse "Okay...tell me about the other rooms" because I not only had the code room, but another three additional rooms. Here is where my night went bad right away because I can't handle a 1:1 patient and be expected to have any free time to take care of 3 other patients! I said as much to the charge nurse, too, but what could she do? Every other nurse there had 4 patients. Could I expect them to have 5 apiece? Neither situation was safe. So what happened? My patients waited anywhere from 1 hour to 2 hours to receive much needed medication. Thank the good Lord they were all stable because if not...never mind, I don't want to think about it. Oh sure, if something bad had happened I could argue in Court that the charge nurse should have made sure my other patients were being taken care of while I had my critical 1:1 patient, and I'm pretty positive that I would be exhaunerated, but I really don't ever want to face that situation.
Okay, this is what I'm going to do. I got name stickers from each of the patients I had at the beginning of the shift and wrote down what was wrong with them and how long it took me to get to them from the time the orders were written until I completed the task. Now I'm going to write a very long letter to our Nursing Director and Medical Director and explain the situation and the hospitals legal liability, along with making suggestions on how to fix the problem. I can only hope this catches someone's attention and changes be made accordingly.
So, because I had to start my shift drowning, I was so far behind on my charting by the end of my shift that I didn't clock out until 8:54am, a full two hours after my shift ended. That sucked! I didn't get home until after 9:30am and I was so worked up I couldn't go to sleep until 11:30am. Add that to the fact that I couldn't sleep past 1:00pm yesterday, and I wasn't 100% at my game because of getting over my tummy virus, and I was pooped! Up side? I slept like a log!
I do work again Sunday and Monday night, so here's hoping for calmer nights. Oh shucks! I probably just jinxed myself, lol.
Hope your Friday and Saturday were spent with family and friends. Catch up with you later! De ;)
Extra Food For Thought:
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7.1
5.5
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