I love sundowners
I love the bed alarms
I love old gentlemen
And their eccentric charms
I love telemetry
And its adventures
Boom de yada
Boom de yada
Boom de yada
Boom de yada
I love the C-Diff
I love the GI Bleed
I love CHF
Even COPD
I love telemetry
And all its smells and sounds
Boom de yada
Boom de yada
Boom de yada
Boom de yada
I love AV blocks
I love my rhythm strips
I love new A-fib
And starting heparin drips
I love telemetry
My job is pretty cool...
Boom de yada
Boom de yada
Boom de yada
Boom de yada.....
(copyright by me. written after watching one-too-many youtube videos)
Readers!! I need your feedback, as I'm torn on the very last line. Should it be "my job is pretty cool" or "my job is killing me"? The latter is (much) more accurate, but I was actually thinking of making a video for it that management could someday see...
Friday, November 20, 2009
Wednesday, November 11, 2009
The V-Fib came out of nowhere....
It had been a slightly rough start to the shift. I found out I had two patients with behavioural issues on either side of the station. Luckily my ETOH W/D had a sitter, but the other one did not.
She was under 50, but had had a recent stroke. Until a couple days ago, there had been no residual. But then she stopped being able to perform ADLs, and her husband brought her in. Now she was agitated, trying to crawl out of bed, and almost nonverbal. Plus she mostly only spoke a foreign dialect that only one of our CNAs (the one who was supposed to be siting with my ETOH) knew, so he was in there trying to keep her calm.
The offgoing nurse let me know that she'd gotten haldol a couple times his shift, and he saved a X1 ativan for me. A little before 1600, the ANM said that now might be a good time to give the ativan so the CNA could go sit with my other patient. Within 10 minutes she was calm and sleepy, all systems normal.
The MDs were concerned about her having seizures because of the location/type of brain damage she suffered, so we started her on dilantin.
I went to go print my strips. She was normal sinus rhythm. I turned to say hi to a nearby doctor, then turned back to the monitor to finish the strips. All of a sudden, V-Fib. For a split second I thought "This can't be real" so I went to go check on her.
There were 2 nurses outside her door, about to go in and do a skin check (THANK YOU GUYS SO MUCH FOR BEING THERE FOR ME!!! YOU ARE AMAZING NURSES!!!) They saw the look on my face when I went into the room, and followed me.
She was slumped over in the bed. It almost looked like an absence seizure or a stroke. Her tongue was protruding, and she was making blubbing noises. We sat her up a little more, did a shake and shout, sternal rubbing, checked for pulse. I had almost hit the code button when she took a deep gasping breath. We felt a moment of relief before we realized that she was probably not going to be taking another breath.
I hit the code button and we started CPR.
From that point, it's a blur of people and activity. Within 10 seconds there were at least 20 people in the room. It felt completely unreal. Like I was trapped in a TV hospital drama, except this was my patient.
I remember people hooking her up to the defibrillator. She was in Torsades de Pointes. The MD yelling for Mag, which was *not* in the cart where it should have been. Finally they bring another tray and we get the Mag for him.
We stop the dilantin infusion, start NS running full blast. Put a compression sleeve on the bag to make it go faster. Starting a central line. CPR still going, intubation in process. Everyone clear for the defibrillator. Still no pulse, CPR continues. I try to clear debris off the floor so no one slips. There is packaging everywhere. Another shock. I took over for chest compressions for awhile. More feeling of unrealness. Drugs are going in. Triple lumen central line in place in the groin. One of the docs stitching the line down to the thigh. That must hurt, I thought, then remembered my ACLS instructor saying "It doesn't matter what you do in the code. The person is dead and not feeling a whole lot" The MD forgetting to let go of the guide wire before the next shock until another doc told him to drop it. Shock again.
The pulse came back. I go give report to ICU who has a bed for her. She's on the unit even before I finish giving report.
From hitting the button to sending her to ICU was around 30-35 minutes. Part of me feels like it lasted so much longer than that. Part of me feels like it was over so fast. I totally forgot I had other patients. It was probably the most in-the-moment I've ever felt. It was also probably the most disconnected from reality I've ever felt as well.
The ANM congratulated us on doing a good job. I was certain I'd get in trouble or something. I must have done *something* wrong to make this happen. Turns out she had an MI related to an LAD blockage. Not my fault. Thank god.
I was pretty shaken so I took dinner early. Went to the garden near L&D. They have lavender and rosemary growing there. I laid on a bench, listened to some music on my phone, watched the clouds, and tried to will my heart rate to go down below 100.
I can no longer boast about never having a patient code on me. But I no longer have to fear it eventually happening. And that's probably the better of the two options.
She was under 50, but had had a recent stroke. Until a couple days ago, there had been no residual. But then she stopped being able to perform ADLs, and her husband brought her in. Now she was agitated, trying to crawl out of bed, and almost nonverbal. Plus she mostly only spoke a foreign dialect that only one of our CNAs (the one who was supposed to be siting with my ETOH) knew, so he was in there trying to keep her calm.
The offgoing nurse let me know that she'd gotten haldol a couple times his shift, and he saved a X1 ativan for me. A little before 1600, the ANM said that now might be a good time to give the ativan so the CNA could go sit with my other patient. Within 10 minutes she was calm and sleepy, all systems normal.
The MDs were concerned about her having seizures because of the location/type of brain damage she suffered, so we started her on dilantin.
I went to go print my strips. She was normal sinus rhythm. I turned to say hi to a nearby doctor, then turned back to the monitor to finish the strips. All of a sudden, V-Fib. For a split second I thought "This can't be real" so I went to go check on her.
There were 2 nurses outside her door, about to go in and do a skin check (THANK YOU GUYS SO MUCH FOR BEING THERE FOR ME!!! YOU ARE AMAZING NURSES!!!) They saw the look on my face when I went into the room, and followed me.
She was slumped over in the bed. It almost looked like an absence seizure or a stroke. Her tongue was protruding, and she was making blubbing noises. We sat her up a little more, did a shake and shout, sternal rubbing, checked for pulse. I had almost hit the code button when she took a deep gasping breath. We felt a moment of relief before we realized that she was probably not going to be taking another breath.
I hit the code button and we started CPR.
From that point, it's a blur of people and activity. Within 10 seconds there were at least 20 people in the room. It felt completely unreal. Like I was trapped in a TV hospital drama, except this was my patient.
I remember people hooking her up to the defibrillator. She was in Torsades de Pointes. The MD yelling for Mag, which was *not* in the cart where it should have been. Finally they bring another tray and we get the Mag for him.
We stop the dilantin infusion, start NS running full blast. Put a compression sleeve on the bag to make it go faster. Starting a central line. CPR still going, intubation in process. Everyone clear for the defibrillator. Still no pulse, CPR continues. I try to clear debris off the floor so no one slips. There is packaging everywhere. Another shock. I took over for chest compressions for awhile. More feeling of unrealness. Drugs are going in. Triple lumen central line in place in the groin. One of the docs stitching the line down to the thigh. That must hurt, I thought, then remembered my ACLS instructor saying "It doesn't matter what you do in the code. The person is dead and not feeling a whole lot" The MD forgetting to let go of the guide wire before the next shock until another doc told him to drop it. Shock again.
The pulse came back. I go give report to ICU who has a bed for her. She's on the unit even before I finish giving report.
From hitting the button to sending her to ICU was around 30-35 minutes. Part of me feels like it lasted so much longer than that. Part of me feels like it was over so fast. I totally forgot I had other patients. It was probably the most in-the-moment I've ever felt. It was also probably the most disconnected from reality I've ever felt as well.
The ANM congratulated us on doing a good job. I was certain I'd get in trouble or something. I must have done *something* wrong to make this happen. Turns out she had an MI related to an LAD blockage. Not my fault. Thank god.
I was pretty shaken so I took dinner early. Went to the garden near L&D. They have lavender and rosemary growing there. I laid on a bench, listened to some music on my phone, watched the clouds, and tried to will my heart rate to go down below 100.
I can no longer boast about never having a patient code on me. But I no longer have to fear it eventually happening. And that's probably the better of the two options.
Tuesday, November 3, 2009
Sigh. I had hoped she would recover...
I posted about a girl with lung cancer back in June. She and her friends got me dinner from Jack in the Box when I forgot mine. Everything seemed so bright and hopeful when she was finally discharged.
Today while heading out of the break room I noticed a new magnet on the fridge.
"In Loving Memory, P*, *1981-June 14, 2009" with what appeared to be her Senior Photo in the middle.
Really bummed me out on my way home. She was such a sweetheart. And yet the 85 yr old non-compliant CHFers just keep ticking. Stupid world.
Today while heading out of the break room I noticed a new magnet on the fridge.
"In Loving Memory, P*, *1981-June 14, 2009" with what appeared to be her Senior Photo in the middle.
Really bummed me out on my way home. She was such a sweetheart. And yet the 85 yr old non-compliant CHFers just keep ticking. Stupid world.
Tuesday, October 27, 2009
Sunday, October 25, 2009
Man I love children...
At work last week a dad came up to the back station with his two kids (8ish and 12ish?). Their mom was on our unit, and the kids were understandably worried. The dad wanted to help reassure the kids, as well as see how his wife was doing.
He asked if the kids could take a look at the telemetry monitor at the desk. I said sure and brought up the appropriate strip window and turned the screen towards the kids.
It was a picture-perfect sinus rhythm, 60-62. I didn't know the patient, so I don't know if that's on the brady side for her or what, but it looked fine to me. I asked if either of them had seen something like this before, and the older one said it looked like in movies. I said that the heart runs on electricity, like a machine, and the bumps were little jolts of electricity. "When the heart gets shocked, it squeezes up tight, just like when you get a static shock and you feel yourself twitch a little bit" I pointed out the QRS complex: "This point here is what tells the heart to beat. See how everything is very smooth, and the bump (P wave) is nice and round, and the spike (QRS) is thin and pointy? Those are all good signs of a healthy heart."
The kids looked a little relieved, as did the dad, I think. lol I brought up another strip, with had a fairly jagged baseline, the occasional missing P wave, and huge blocky QRSs. I pointed out how different it looked from their mom's. Hers was just plain prettier to look at.
Then I told them about the monitor techs in the cockpit looking after her heart, and the phones we carry calling us automatically if something bad happens "but something bad won't happen" interjected the dad. I hope he's right. The dad thanked me for explaining things to them. I told him it was probably the best thing that happened for me all week.
I really enjoyed the interaction. I miss young people a lot. I miss being able to educate people who have open minds and vivid enough imagination to make sense of what I'm telling them. I need to get the hell out of telemetry.
He asked if the kids could take a look at the telemetry monitor at the desk. I said sure and brought up the appropriate strip window and turned the screen towards the kids.
It was a picture-perfect sinus rhythm, 60-62. I didn't know the patient, so I don't know if that's on the brady side for her or what, but it looked fine to me. I asked if either of them had seen something like this before, and the older one said it looked like in movies. I said that the heart runs on electricity, like a machine, and the bumps were little jolts of electricity. "When the heart gets shocked, it squeezes up tight, just like when you get a static shock and you feel yourself twitch a little bit" I pointed out the QRS complex: "This point here is what tells the heart to beat. See how everything is very smooth, and the bump (P wave) is nice and round, and the spike (QRS) is thin and pointy? Those are all good signs of a healthy heart."
The kids looked a little relieved, as did the dad, I think. lol I brought up another strip, with had a fairly jagged baseline, the occasional missing P wave, and huge blocky QRSs. I pointed out how different it looked from their mom's. Hers was just plain prettier to look at.
Then I told them about the monitor techs in the cockpit looking after her heart, and the phones we carry calling us automatically if something bad happens "but something bad won't happen" interjected the dad. I hope he's right. The dad thanked me for explaining things to them. I told him it was probably the best thing that happened for me all week.
I really enjoyed the interaction. I miss young people a lot. I miss being able to educate people who have open minds and vivid enough imagination to make sense of what I'm telling them. I need to get the hell out of telemetry.
Wednesday, October 21, 2009
Spotted this on Nurse In Australia's blog. Had to share....
Be warned, the injection techniques are somewhat scary. What licensed person would even *think* of doing it like this?
Had an odd, yet very good, shift this evening
When I got my assignment at 1500, I was a little concerned. One of my pts was going to cath, and not coming back. One was to be discharged ASAP, as the family was getting antsy. This would leave me with two spaces for admissions. Wheee!
So I got my two out of there as soon as I could. While I was trying to get ducks in a row for my DC, I get a text from monitor tech saying that one of my pt's leads was off. So I go into the room, and my pt is practically dancing out the door, tele box on the bed. I ask her what's up, and she said "The doctor said I can go home!" "Well that's all well and good, but we prefer if you tell the nurses before you start tearing off equipment." She laughed and apologized, and I went to go see if there was a discharge order. Sure enough, in the space it took me to go see her and get back to the station, there was a new order. Okeydokey, I thought. Why not just let another one go...
Did the DC in record time. I was down to one patient by 1630 or so. And my last patient was a young walky-talky who came in for ACS, and had been chest pain free since the morning. Pretty much just here for Lovenox to thin his blood so they could try to avoid another cath (he'd had one in July).
So I was the best damn nurse I could be to my one patient. I also helped 2 other nurses pass meds. Frankly, I was bored lol. I was told I'd be getting an admission, but by 1830, no one called to give report. The Charge and I did the math, and figured that I could go on committee and give my pt to one of the incoming RNs at 1900.
When on committee, you're supposed to do audits and paperwork. I ended up being more Resource-like (as I always do) because it helps the unit far more than all the paperwork in the world. I got to help orient one of our new traveling RNs, a nurse who'd been on the job since I was in kindergarten. I know it's hard getting used to a new hospital with a new system, but she seemed extra frazzled. I helped her out with the computers, drew some blood for her (she said she wasn't very good at it) and found her brain when it went missing. She gave me a hug and a peppermint candy when I found her brain lol. It was very cute.
When I finally went on dinner around 2015, I decided that today would be the day I EKG myself. I've had a weird arrhythmia for a couple years now. Hard to type out, but it's something like lub-dub, lub-dub, lub-dub, lub......DUBlubdub, lub-dub. Everytime I have one of the weird beats, I imagine it looking like a PVC on an EKG. Not that I think/know that's what it is, but it's what it feels like if that makes any sense.
Alas, plain old normal sinus arrhythmia.
After all that effort to hook myself up (granted I only used 5 leads out of laziness) I hoped at least the mysterious rhythm would be identified. No such luck. Maybe I need to be hooked up for an hour or so, maybe overnight, to give my heart a chance to act up.
I even got the opportunity tonight to make the assignment for the unit at 1900 and 2300. I hope I did it okay, and no one was too mad. I think those assignments are easier than the 0700 one. At 0700, *everyone* leaves and you have to start fresh. At 1900 and 2300, only 2 people left each time, so you just sorta fill in the blanks. It was good experience, though, despite the battle with the copier that followed.
I can only hope for another good night tomorrow, day 5 out of 5 in a row. I can't wait for some days off!!!
So I got my two out of there as soon as I could. While I was trying to get ducks in a row for my DC, I get a text from monitor tech saying that one of my pt's leads was off. So I go into the room, and my pt is practically dancing out the door, tele box on the bed. I ask her what's up, and she said "The doctor said I can go home!" "Well that's all well and good, but we prefer if you tell the nurses before you start tearing off equipment." She laughed and apologized, and I went to go see if there was a discharge order. Sure enough, in the space it took me to go see her and get back to the station, there was a new order. Okeydokey, I thought. Why not just let another one go...
Did the DC in record time. I was down to one patient by 1630 or so. And my last patient was a young walky-talky who came in for ACS, and had been chest pain free since the morning. Pretty much just here for Lovenox to thin his blood so they could try to avoid another cath (he'd had one in July).
So I was the best damn nurse I could be to my one patient. I also helped 2 other nurses pass meds. Frankly, I was bored lol. I was told I'd be getting an admission, but by 1830, no one called to give report. The Charge and I did the math, and figured that I could go on committee and give my pt to one of the incoming RNs at 1900.
When on committee, you're supposed to do audits and paperwork. I ended up being more Resource-like (as I always do) because it helps the unit far more than all the paperwork in the world. I got to help orient one of our new traveling RNs, a nurse who'd been on the job since I was in kindergarten. I know it's hard getting used to a new hospital with a new system, but she seemed extra frazzled. I helped her out with the computers, drew some blood for her (she said she wasn't very good at it) and found her brain when it went missing. She gave me a hug and a peppermint candy when I found her brain lol. It was very cute.
When I finally went on dinner around 2015, I decided that today would be the day I EKG myself. I've had a weird arrhythmia for a couple years now. Hard to type out, but it's something like lub-dub, lub-dub, lub-dub, lub......DUBlubdub, lub-dub. Everytime I have one of the weird beats, I imagine it looking like a PVC on an EKG. Not that I think/know that's what it is, but it's what it feels like if that makes any sense.
Alas, plain old normal sinus arrhythmia.
After all that effort to hook myself up (granted I only used 5 leads out of laziness) I hoped at least the mysterious rhythm would be identified. No such luck. Maybe I need to be hooked up for an hour or so, maybe overnight, to give my heart a chance to act up.
I even got the opportunity tonight to make the assignment for the unit at 1900 and 2300. I hope I did it okay, and no one was too mad. I think those assignments are easier than the 0700 one. At 0700, *everyone* leaves and you have to start fresh. At 1900 and 2300, only 2 people left each time, so you just sorta fill in the blanks. It was good experience, though, despite the battle with the copier that followed.
I can only hope for another good night tomorrow, day 5 out of 5 in a row. I can't wait for some days off!!!
Subscribe to:
Posts (Atom)
