Today was my first full blown code. Young guy had a suspected PE, went into respiratory failure, and shortly after, cardiac arrest. It was horrible. That is all I can say.
The code went smoothly for the most part. Everyone worked very well together. ACLS prepared me for which meds to push, when to push them, when to shock and when not to shock. ACLS prepared me in how to work together with a team, how fast to perform compressions and how to ventilate a person with an ambu bag.
What ACLS did NOT prepare me for was how I would feel during and after the code. ACLS did not prepare me for how physically tiring and hard it was to do effective compressions on a 250lb muscular man for 40 minutes. ACLS did not prepare me for the look of the patients lifeless eyes staring at me from only 2 feet away as I pumped his chest. ACLS did not prepare me for the surreal experience of fighting to save a man's life as a priest performed the Last Rites over the patient. ACLS did not prepare me for the tangible emotion, disbelief, and pain from the family as they watched a short distance away. ACLS did not prepare me for the sorrow I felt when the physician called the code.
It was horrible. That is all I can say.
January 19, 2012
January 12, 2012
12 Hour Shifts....Bleh
These 12 hour shifts are kicking my ass. It's more like 13 actual hours at work. Then add in about 1 1/2 hours drive time round trip. That makes it 14 1/2 -15 hours dedicated to work including travel time. That leaves 9 hours left in my day. 9 hours left to eat, shower, take care of the dog, and sleep. After 3 working days in a row, I'm beat. I'm too tired to do anything anymore.
December 10, 2011
Torture?
There are some days that I feel like I'm working in a torture chamber rather than a hospital. Elderly confused patients who clearly do not want the interventions that are being forced upon them: Are we doing more harm then good?
November 10, 2011
November 06, 2011
"Never trust doctors"
Me: Doctor, my patients heart rate has been consistently greater than 110.
Doctor: Ok, lets try metoprolol 12.5mg IV every 6 hours. We give that, right?
Me: Ummm, yeah? Metoprolol 12.5mg IV every 6 hours, correct?
Doctor: Yes.
Me: Ok, thank you.
*hangs up phone and shows my preceptor the order as I had jotted it down*
Preceptor: OH MY GOD! You can't give this! You'll kill someone!!! Are you sure this is what the doctor ordered??
Me: Yes, I'm sure. I read the order back to him. He asked me if we could give this. I didn't really know without looking it up.
Preceptor: We have to get this changed. Call him back and tell him we can give 5mg IV. 12.5mg is a PO dose.
Me: *feeling very stupid and unsure of myself* Umm, Can you call him please?
*medical director peeks head around from the other side of computer monitor where he was sitting about 4 feet away from me*
Medical Director: *in a kind voice* This is your lesson for the day. Never trust doctors. We depend on you to keep us from killing patients.
I think it's time to be scared now.
Doctor: Ok, lets try metoprolol 12.5mg IV every 6 hours. We give that, right?
Me: Ummm, yeah? Metoprolol 12.5mg IV every 6 hours, correct?
Doctor: Yes.
Me: Ok, thank you.
*hangs up phone and shows my preceptor the order as I had jotted it down*
Preceptor: OH MY GOD! You can't give this! You'll kill someone!!! Are you sure this is what the doctor ordered??
Me: Yes, I'm sure. I read the order back to him. He asked me if we could give this. I didn't really know without looking it up.
Preceptor: We have to get this changed. Call him back and tell him we can give 5mg IV. 12.5mg is a PO dose.
Me: *feeling very stupid and unsure of myself* Umm, Can you call him please?
*medical director peeks head around from the other side of computer monitor where he was sitting about 4 feet away from me*
Medical Director: *in a kind voice* This is your lesson for the day. Never trust doctors. We depend on you to keep us from killing patients.
I think it's time to be scared now.
November 01, 2011
IV Starts
I can change the trachs of 3 month old babies. When I say "change the trach", most people assume that I mean changing the inner cannula. If you are not a pediatric nurse, you may not realize that pediatric trachs don't have an inner cannula. The entire trach is removed and a replaced with a new one approximately once per week. This is scary for pretty much every nurse until you gain confidence in your ability to manage emergencies (such as being unable to insert the new trach). I've had lots of experience. Doing this routine procedure does not bother me in the least.
I can insert foley's and straight cath patients of all ages and sizes. Again, doesn't bother me in the least.
I can give injections. No problem.
I can insert nasogastric tubes. No biggy.
I can pack stage IV decub ulcers down to the bone. I enjoy wound care.
So why in the hell can't I start IVs?!? I get nervous as all get out. I psych myself out before I even start. My hands shake scaring my patient half to death. I know I certainly wouldn't want to see me coming at me with a needle in my state! Why does this seemingly simple procedure get me so nervous? I just don't get it. I've done a lot of things much more difficult than this.
I got to spend a day with the IV nurse doing nothing but IV starts all day. I thought this would cure me. Big Fat NO. Out of about 7 attempts, I managed to get 3 in all by myself. The others I either missed entirely, blew the vein, or had to step aside to allow the IV nurse finish what I started because for some reason that I can't figure out, I couldn't advance the catheter!
It's not the actual IV stick that gets me so worked up. It's the thought of failure. Of missing that IV, of having to tell the patient I need to stick them again, then, when I miss for the second time, of telling the patient that I will get another nurse to try because I'm a big fat failure that has tortured you enough for one day. I get wound up just attempting to look for a suitable vein, especially when I can't seem to find any!
I know I'm psyching myself out. What I need to figure out is how to get outside of my own head.
I can insert foley's and straight cath patients of all ages and sizes. Again, doesn't bother me in the least.
I can give injections. No problem.
I can insert nasogastric tubes. No biggy.
I can pack stage IV decub ulcers down to the bone. I enjoy wound care.
So why in the hell can't I start IVs?!? I get nervous as all get out. I psych myself out before I even start. My hands shake scaring my patient half to death. I know I certainly wouldn't want to see me coming at me with a needle in my state! Why does this seemingly simple procedure get me so nervous? I just don't get it. I've done a lot of things much more difficult than this.
I got to spend a day with the IV nurse doing nothing but IV starts all day. I thought this would cure me. Big Fat NO. Out of about 7 attempts, I managed to get 3 in all by myself. The others I either missed entirely, blew the vein, or had to step aside to allow the IV nurse finish what I started because for some reason that I can't figure out, I couldn't advance the catheter!
It's not the actual IV stick that gets me so worked up. It's the thought of failure. Of missing that IV, of having to tell the patient I need to stick them again, then, when I miss for the second time, of telling the patient that I will get another nurse to try because I'm a big fat failure that has tortured you enough for one day. I get wound up just attempting to look for a suitable vein, especially when I can't seem to find any!
I know I'm psyching myself out. What I need to figure out is how to get outside of my own head.
October 22, 2011
Dr. Dickhead
Background info:
Dr. Dickhead: So, I'm here to see you regarding your sleep apnea. Your sleep apnea would improve if you lost weight.
My Patient: Yes, I know. I've had a rapid weight gain of about 150lbs in the last year or so.
Dr. Dickhead: I see that you have been noncompliant with your diabetes, otherwise you wouldn't be here. (patient's Hemoglobin A1C was on the low normal side)
My Patient: I check my blood sugar a minimum of four times a day. It wasn't until the past week that I couldn't get the levels under control.
Dr. Dickhead: What do you do for a living?
My Patient: Well, I have a Ph.D. and used to be a counselor. Now, I'm a pastor.
Dr. Dickhead: *saracastic tone of voice* Did you used to counsel people on weight loss?
My Patient: Why yes I did.
Me: *picking jaw up off the floor while shooting the "doctor" daggers with my eyeballs*
morbidly obese patient admitted with DKA secondary to major cellulitis infection, consult with pulmonologist
Dr. Dickhead: So, I'm here to see you regarding your sleep apnea. Your sleep apnea would improve if you lost weight.
My Patient: Yes, I know. I've had a rapid weight gain of about 150lbs in the last year or so.
Dr. Dickhead: I see that you have been noncompliant with your diabetes, otherwise you wouldn't be here. (patient's Hemoglobin A1C was on the low normal side)
My Patient: I check my blood sugar a minimum of four times a day. It wasn't until the past week that I couldn't get the levels under control.
Dr. Dickhead: What do you do for a living?
My Patient: Well, I have a Ph.D. and used to be a counselor. Now, I'm a pastor.
Dr. Dickhead: *saracastic tone of voice* Did you used to counsel people on weight loss?
My Patient: Why yes I did.
Me: *picking jaw up off the floor while shooting the "doctor" daggers with my eyeballs*
October 14, 2011
You know you're tired when...
leaving work after a 12 hour shift, you attempt to use your ID badge to "swipe" into your car.
October 10, 2011
Cardioversion
It was a hectic day, but I'm loving learning all I can. Today I got to assist with my first cardioversion. The cardiologist in our unit loves to teach and he has spent many 1/2 hour long teaching sessions with me when the opportunity arises.
Today he asked me to come to the room next door when I was finished with my patient. I walked in and they were getting ready to perform a cardioversion. The patient was in A Flutter. The Life Pak was already hooked up and conscious sedation administered. The cardiologist explained everything to me about the process. Even though the nurse educator had already extensively gone over this with me, it's good to have a reminder when you're nervous.
I operated the Life Pak under the direction of the cardiologist. The patient went into A Fib after I had delivered the first shock. I admit, I jumped a little when the patients body jerked slightly with the shock. When I delivered the second shock, the patient sat straight up and said "Ow" before falling back onto the bed. I jumped again. But he was in sinus brady and all was well.
The cardiologist took the next 15 minutes to explain everything to me, review the meds used for conscious sedation and how the patient won't remember any of it. He even made a point to wake the patient up and ask him if he had felt any it, to which the patient replied "no".
It was a good first experience. The people on my unit are very supportive and understanding with new nurses and are quick to include us when there are good learning experiences. I look forward to the day when I can be that experienced nurse helping the new nurse.
Today he asked me to come to the room next door when I was finished with my patient. I walked in and they were getting ready to perform a cardioversion. The patient was in A Flutter. The Life Pak was already hooked up and conscious sedation administered. The cardiologist explained everything to me about the process. Even though the nurse educator had already extensively gone over this with me, it's good to have a reminder when you're nervous.
I operated the Life Pak under the direction of the cardiologist. The patient went into A Fib after I had delivered the first shock. I admit, I jumped a little when the patients body jerked slightly with the shock. When I delivered the second shock, the patient sat straight up and said "Ow" before falling back onto the bed. I jumped again. But he was in sinus brady and all was well.
The cardiologist took the next 15 minutes to explain everything to me, review the meds used for conscious sedation and how the patient won't remember any of it. He even made a point to wake the patient up and ask him if he had felt any it, to which the patient replied "no".
It was a good first experience. The people on my unit are very supportive and understanding with new nurses and are quick to include us when there are good learning experiences. I look forward to the day when I can be that experienced nurse helping the new nurse.
October 03, 2011
My first code
All I can say is, "What the hell have I gotten myself into?". It was a Sunday and I worked two back to back 12 hour shifts. I had the same 2 patients (who were very stable) as I had on Saturday and thought it was going to be an easy day.
Lesson learned: NEVER even think, "Wow, I'm starting to get this down, I think today is going to go pretty easy". Never.
One of my stable patients was taking a turn for the worse and I watched him go downhill all day while we did various interventions. Approximately one hour before the end of my shift I went in to check on him and recorded his vital signs which were actually starting to improve a bit.
1800: My patient: Hey girlie! How ya doing?
Me: Great thank you! How 'bout you?
My patient: Doin' fine!
1813: My preceptor screaming from the direction of my patients room: I need help in here right now!!
Everyone just stopped to stare for what seemed like way too long before they realized something was wrong and sprung into action. I am pleased with myself that I did react so quickly. I think I plowed down the respiratory therapist as I made a mad dash towards the room. Really, it is all a blur but oddly at the same time it felt like everything was moving in slow motion. I was scared out of my mind, but it's a good sign that I ran towards the room rather than away from it, right?
Anyway, my patient had pulled off his high flow oxygen and quit breathing. He was gray and unresponsive but his heart was still beating. I was amazed at the number of people in the room, all working as fast as possible to get him intubated. It was exactly 12 minutes from the time my preceptor yelled out for help until he was successfully intubated.
I helped where I could, but mostly stood back and observed as instructed to do so by my preceptor. I wonder if I can do this. I KNOW I can, I will learn, but wow, after it was all said and done, I really felt like I didn't know my head from my ass. Is this what it's like to be a new critical care nurse?
Lesson learned: NEVER even think, "Wow, I'm starting to get this down, I think today is going to go pretty easy". Never.
One of my stable patients was taking a turn for the worse and I watched him go downhill all day while we did various interventions. Approximately one hour before the end of my shift I went in to check on him and recorded his vital signs which were actually starting to improve a bit.
1800: My patient: Hey girlie! How ya doing?
Me: Great thank you! How 'bout you?
My patient: Doin' fine!
1813: My preceptor screaming from the direction of my patients room: I need help in here right now!!
Everyone just stopped to stare for what seemed like way too long before they realized something was wrong and sprung into action. I am pleased with myself that I did react so quickly. I think I plowed down the respiratory therapist as I made a mad dash towards the room. Really, it is all a blur but oddly at the same time it felt like everything was moving in slow motion. I was scared out of my mind, but it's a good sign that I ran towards the room rather than away from it, right?
Anyway, my patient had pulled off his high flow oxygen and quit breathing. He was gray and unresponsive but his heart was still beating. I was amazed at the number of people in the room, all working as fast as possible to get him intubated. It was exactly 12 minutes from the time my preceptor yelled out for help until he was successfully intubated.
I helped where I could, but mostly stood back and observed as instructed to do so by my preceptor. I wonder if I can do this. I KNOW I can, I will learn, but wow, after it was all said and done, I really felt like I didn't know my head from my ass. Is this what it's like to be a new critical care nurse?
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