I did chest compressions for approximately 1 hour 15 minutes, with a few breaks, on a poor young soul shot through the chest a few times. He arrived asystolic but was brought back. He coded in the OR, they did open-chest cardiac massage (a.k.a. CPR by squeezing the heart) and direct defibrillation to the heart muscle. Gave who knows how many blood products before being rushed up to our unit with a hemoglobin of 5—so there was still active hemorrhaging—and pulseless again. We gowned, gloved, and donned masks with eye shields as they came up with the patient. They had me start compressions while they set up the rapid transfusion pump, which infuses blood, platelets, and saline almost as fast as a nurse could hang them. They also pushed epinephrine and ran vasopressor drips wide open.
All I can say is it's a good thing I've been exercising.
As I was pushing I kept thinking about all the things I'm learning about hemodynamics and CPR, like: CPR rarely works, you're only pushing 20% the circulation the normal heart can do, most people don't push hard enough or fast enough or let the chest recoil. I didn't sing "Staying Alive" to myself during chest compressions, because that seemed too slow, so I tried to keep a good 150/min tempo on the monitor. That's faster than the 100/min recommended for CPR on the street, but that's how fast I've seen it in ICU codes. I think when you're trying to push meds into veins that have no circulation, you need a faster rate if you're going to move that blood at all.
Eventually I had to kneel on the bed, which meant I was kneeling in blood. During breaks for pulse checks or when I switched out with someone else, I kept throwing towels, blankets, whatever down to cover it, but eventually it soaked through. Searching for the linen room (actually a big complex of rooms) in the basement took me at least 25 minutes. They sent my scrubs to the dry cleaners (I even had to fill out an old-school dry cleaning slip for them) and gave me surgical scrubs.
It's a shame there's so much violence, especially as the Midwest winter breaks and the warm weather arrives. It's like living in a war zone, except it happens on American city blocks not very far from here.
Hey, at least you didn't have to hit the gym afterward.
ReplyDeleteWas that in poor taste?
Violence sucks. Period.
Wow. Just...amazing. What a day. More than that, how amazing that you and your buddies "at the office" worked SO hard to save that person's life. Even if you weren't successful (you didn't say) you were there, giving it your all. Thank you.
ReplyDeletenurseXY--if that was in poor taste, then my LOL probably is too :P
ReplyDeleteAND NOW FOR SOME HEAVY QUESTIONS FOR THE MAN-NURSE.
do you ever pump tons of blood products into someone, who ends up dying, and find yourself thinking "what a waste. these could have been used on someone who needed them"? or worse, on someone who lived, but was shot during gang or drugs sale transactions, and think: great, we just spent a bunch of blood products on someone who is just going to go out and spill it again. or someone else's.
I kind of think when people donate blood, they aren't thinking about the good they're going to do to some young drug dealer some day. but I'm also saying this as someone who has never donated blood. maybe it's a good thing they don't follow up on telling you who ended up with your blood.
I am telling you, I was working ICU this weekened (Nurse Tech) and they called a Code Blue in the CCU, right next door. I went to check it out and it WAS so unorganized. The patient made it, 29 years old, the patient just got there and I didn't get to ask a lot about the patients diagnosis and history. I even had to run to my unit to get a glucometer since their CNA did not update and did no QC tests on theirs. What a mess it was!
ReplyDeletenurseXY - Actually that is what was going through my mind as I went home. I hope that's not too irreverent since CPR really is hard work.
ReplyDeleteAnonymous - unfortunately we don't know what the person's going to do with their future life, so I suppose that's something to think about. More importantly, I think, the hospital isn't the police so we don't know if the person was a criminal or victim (or both) and to what degree. Unfortunately, though, violent people do use up a disproportionately high amount of our banked blood, as well as our tax dollars since they don't exactly buy their own insurance before getting shot. Hmmm, this would make a good subject for a post...
One Family - I've seen my fair share of disorganized codes. I plan to post about that one of these days.