5 West Nursing

Ever wondered why things usually happens in threes?

This was the case on Monday night, January 8, 2007, when we had 3 people transferred to the ICU. Well, almost 3 people… ICU didn’t have any beds available for the 3rd one.

I knew it was going to be that kinda night when after getting report, we had to transfer my first patient to the Unit. “We’ve been waiting for a bed all day and they just only notified us of one available right now… we need to swap one for a tele bed.” Ok (I thought), I’ll do this one and just get it over with.

Within 15 minutes after taking report, this poor lady that apparently was suffering from a suspected brain hemorrhage was on her way to the unit. Off my hands now, I guess it’ll be quiet the rest of the evening. Boy was I wrong.

A couple hours after that, Dan “The Man” calls my attention to one of his. “My patient’s BP is dropping.” Trendelenburg comes to mind. He’s still responsive, however, the machine says 84/53 and going down. “Are you OK sir?” The patient just smiles. Somewhat tachy, we notify the MD. BP on the manual was 90/70. Time for the RRT.

RRT? Yep, the Rapid Response Team.”Hello, rapid response? We need you here… STAT!” (Well not exactly like that, but). Within a few minutes we have an ICU nurse to assist. Boluses of NS does not help… we need dopamine. After a few phone calls with the MD, we get a dopamine and ICU transfer orders. After a few minutes the patient is on his way to the Unit. Relief? We spoke too soon.

Phone rings, monitor tech on the other end. “We have SVT on 59 sustaining at 224″. Is the patient ok? Nurses come trickling in the room. Patient’s in bed, wife at bedside (probably terrified from all the commotion). “Is there anything wrong?” she asks. “Just checking… Are you OK sir?”. He’s fine, just a little bit shaken, otherwise probably nervous from seeing more than a couple of nurses in his room at one time. Lets monitor the patient and call the MD. “SVT sustained at 220″. We need RRT… again!

“Hello you, welcome back!”

“Ok, what do we have?”

“Sustained SVT. Vitals are… waiting for MD to return call.”

After a few minutes of monitoring and various other interventions, we finally got an order for a Cardizem drip…to be titrated.

“But we don’t do drips here”, protests the patient’s nurse, “not with titration!”. Have no fear, Rapid Response Team is here! At this time the ICU charge nurse appears. “We need an ICU bed, MD wants to titrate Cardizem.” “Sorry, no beds available, we’re full and we have ER on the waiting list.” After an assessment of the situation, and with the House Super’s blessing, we come to a concensus that the only way we could help the patient was to go ahead with the drip.

A few hours later we have the SVT under control. Still tachy at 126 but otherwise, not bad. Thanks to Dan “The Man” and the Rapid Response Team, it was smooth sailing by the end of the shift.

Now for the fun part… documenting the whole evening. Too bad we don’t have an RRT for that one!