Well you know the old saying "be careful what you wish for"? That's exactly what I got at work last night. Sunday and Monday were down right weird with hardly any patients after midnight. I mean we only had one patient for two hours on Sunday night (unheard of) and we didn't have any patients several times for about 15-20minute intervals on Monday night. Being charge I don't usually take a room assignment until the 3pm-3am nurse goes home, that way it's easier to facilitate the flow of the ER and be a resource for whoever needs it. I usually "swat" meaning I triage the patients from the lobby and all incoming ambulance and help out whoever needs it. Well I had felt like a tech (and don't get me wrong, please, i love techs...I'm just not one) Sunday and Monday only doing the barest minimal nursing, so what did I do? I wished for us to be busy last night, and I wished for me to take rooms. Well, I got both, lol.
I decided come hell or high water (which I think we got both of last night) I was taking rooms and that I did. Okay...we got hammered, and I had two ICU patients at one time. One of them I wasn't surprised ended up in the ICU. She was 81yrs old, has been undergoing radiation for mouth cancer, and was feverish. Good golly, her WBCs were 1.4 and her H&H were in the toilet. Poor thing needed emergent blood transfusions which we initiated in the ER. Poor sweet thing.
The second one kinda snuck up on me. I was busy with my 81yr old and my other patients got placed unintentionally on the back burner. Well I had a 60yr old diabetic woman who had a UTI and all I had to do was give her some insulin, antibiotics, fluids and then send her home when her glucose got more under control (she started out with a blood sugar of 405 and normal is 80-110). Well I kept popping back in there when I could and was all ready to let her go after checking her blood sugar at 255, but while I was taking her blood pressure it read 55/32. I'm like "oh let me adjust the bp cuff and retake this". 60/36. Grrrrr. "Hey hon, let's sit you up in bed, there you go. I'm gonna switch this cuff to the other arm." 72/54. **Sigh** Okay, hang some more fluids to get the pressure up and recheck later...68/50. **double sigh**. Hang some more fluids and recheck later **80/52** Get PA to look at her as something obviously isn't right (and no, Veronica, she was not tachycardic, pulse was in 70s, or have a fever). He does and agrees. Big, big workup, more work on my part, lots more work. Her WBC went from 12.4 (normal 4-10) at 6:30pm to 16.8 at 12:30am. Big jump for four hours considering we were already giving her antibiotics IV. Another thing which caught my attention was that she was soooo lethargic, I mean she couldn't stay awake long enough to finish a sentence. That's not right either. I think she must have been about to go into septic shock when I caught it because the other thing that led me to believe she might be headed there was when I placed the foley catheter she only put out about 200mls of urine when she had received 2000mls of fluid. Doesn't equal out. I really do think I kept her from crashing, even the PA said "thanks for keeping such a close eye on her". Lots of work later, got her settled into the ICU. BP was 104/66 by then. Must of cured her, lol.
Yep, sometimes it is definitely easier to be lazy.
Ciao! De ;)
I decided come hell or high water (which I think we got both of last night) I was taking rooms and that I did. Okay...we got hammered, and I had two ICU patients at one time. One of them I wasn't surprised ended up in the ICU. She was 81yrs old, has been undergoing radiation for mouth cancer, and was feverish. Good golly, her WBCs were 1.4 and her H&H were in the toilet. Poor thing needed emergent blood transfusions which we initiated in the ER. Poor sweet thing.
The second one kinda snuck up on me. I was busy with my 81yr old and my other patients got placed unintentionally on the back burner. Well I had a 60yr old diabetic woman who had a UTI and all I had to do was give her some insulin, antibiotics, fluids and then send her home when her glucose got more under control (she started out with a blood sugar of 405 and normal is 80-110). Well I kept popping back in there when I could and was all ready to let her go after checking her blood sugar at 255, but while I was taking her blood pressure it read 55/32. I'm like "oh let me adjust the bp cuff and retake this". 60/36. Grrrrr. "Hey hon, let's sit you up in bed, there you go. I'm gonna switch this cuff to the other arm." 72/54. **Sigh** Okay, hang some more fluids to get the pressure up and recheck later...68/50. **double sigh**. Hang some more fluids and recheck later **80/52** Get PA to look at her as something obviously isn't right (and no, Veronica, she was not tachycardic, pulse was in 70s, or have a fever). He does and agrees. Big, big workup, more work on my part, lots more work. Her WBC went from 12.4 (normal 4-10) at 6:30pm to 16.8 at 12:30am. Big jump for four hours considering we were already giving her antibiotics IV. Another thing which caught my attention was that she was soooo lethargic, I mean she couldn't stay awake long enough to finish a sentence. That's not right either. I think she must have been about to go into septic shock when I caught it because the other thing that led me to believe she might be headed there was when I placed the foley catheter she only put out about 200mls of urine when she had received 2000mls of fluid. Doesn't equal out. I really do think I kept her from crashing, even the PA said "thanks for keeping such a close eye on her". Lots of work later, got her settled into the ICU. BP was 104/66 by then. Must of cured her, lol.
Yep, sometimes it is definitely easier to be lazy.
Ciao! De ;)
Never a dull moment... well, maybe one day... then not... lol
ReplyDeletebe well...
Almost had her treated and released. We were hammered yesterday also, I ran most of the 12.5 hours. One day pressures in the toilet, next day through the roof. I am sooooo glad I am off until Thurday.
ReplyDeleteSounds like a very exciting day!
ReplyDelete