SEDONA

 

This week I ended up with three days off in a row (or so I thought...that's another story) so Spence and I ran away! We got a fabulous deal on a little room  and we spent three days

riding our bikes through vineyard country

hot tubbing

eating McDonald's soft serve icecream

laying out on warm rocks by Crescent Moon Ranch River

enjoying the views...blue, pink, and green everywhere

eating cranberry walnut french toast

enjoying our balcony

house-hunting

talking politics 

talking everything else

soaking in weather below 100 degrees

Thanks Spence

RUPTURED AAA...and my awesome co-workers

Last post expressed my amazement at medicine. Thursday was an epitome of a medical miracle! My patient had a "ruptured AAA," meaning her aorta (the main vessel from the heart running down the abdomen) ripped open. She was taken to immediate surgery, where she lost 5.5 liters of blood (the human body only has about 6). The surgeon opened her up, patched the aorta together, gave a bunch of blood and sent her to us. The next 4 hours we frantically dumped in 31(!) liters of fluid, gave all kinds of medication, ran tests, etc. 2 or 3 times my blood ran cold we almost lost her. But the intensivist kept giving orders and she made it through her first few hours...
The night shift ran all through the night, doing the same. When I came back the next morning, she was basically stable--maintaining blood pressure (with medications' support), looking (almost) pink, perfusing to the point of palpable pulses, and making pee (the things we get excited about as nurses! But that means her kidneys were getting blood). That lasted the whole day. She is not out of the woods, but doing fantastic considering her condition.
I was reading a study (USC center for Vascular Care) that says almost half of patients with ruptured AAAs die before reaching the hospital. Of those who make it to surgery, between 50-70% die. Not surprising, since they open the biggest vessel in their body! So, she is quite a miracle and I'm totally amazed at medicine, again!


**Here I put in a plug for my co-workers. There were 3 other nurses on the unit, each with 2 sick patients of their own. Yet all 3 rushed into my room when the patient arrived to help me get things going. 2 PCTs ran tirelessly: getting supplies, running labs, and making calls. Even my manager popped in (shirt, tie and all) to see if he could help. One nurse stayed with me until the end of shift, hanging blood, checking lines, etc. Another stayed not only until the end of the shift, running tests and helping the doctor insert lines, but he also stayed 2.5 hours(!) after our shift to help me check orders and chart. We finally finished with that patient and he was ready to leave. But, he learned I still had to chart on my other patient and that I was parked 1/2 mile away. He insisted on staying until I finished to ensure I reached my car safely. Wow! I feel spoiled!**

AMAZED

Lately I've been amazed at what medicine can do. And how fast it can work. Here are some of the things I consider medical miracles:

• I had a patient go to surgery and "code" (meaning her heart stopped beating and she lost all perfusion). While doing CPR, they brought the patient to me in the ICU (I was told later I looked the same color as the patient when I saw them coming). We quickly found the patient had a "tension pneumothorax" (pneumothorax is a collapsed lung. It becomes a "tension" pneumothorax when the pressure from the collapsed lung pushes the heart and vessels. Hers was bad enough that they were too far shifted and compressed to pump at all.) A surgeon put a chest tube in to relieve the pressure and walaa! She had a blood pressure, a heart rate, and her color went from dusky to rosy. Within a few minutes she opened her eyes and was trying to talk to us. Wow!
• Another patient went into "a-fib with RVR" (atrial fibrillation with rapid ventricular response. Basically, his heart was beating twice as fast as it should and less than half as efficiently). I called the doctor and got orders for an amiodarone drip (a strong heart medication) within 3 minutes of onset. I let the pharmacy know and within another 3 minutes I was giving it. Another 3 minutes, his heart rate was back within normal range and he had a blood pressure. Again, Wow!
• Still another patient had lost almost all circulation to one foot. It was cold and white as white can be. And she had a sore on her ankle that had been there weeks, unable to heel.  She was taken to surgery. They took a little piece of a healthy vein, hooked it on to the artery and "bypassed" the blockage. She came out of surgery with an incision from her hip to her ankle, but with a pink foot. And she could feel when something touched it--a sensation she claimed to have not had in months. (And this was just for a foot--imagine doing that to the vessels of the heart!)

I could go on for hours. Every time I titrate a "pressor" (medication to improve blood pressure), I'm amazed at the immediate effect. When I watch a patient get electrically shocked out of a dangerous heart rhythm, when I give sedation and suddenly the patient is out cold, when I give a little fluid to a patient whose numbers just aren't right and they suddenly all resolve...it's always amazing to me. (It's daunting, too, as I realize the impact a mistake can have.) But I love having some immediate gratification in my job!