On a recent transfer, I was taking an elderly pt for a "scheduled" MRI. This was a holiday, and MRI staff were on call only, nothing scheduled. When I showed up, I was informed that the Dr. had called MRI at 0930 so according to her, the MRI had to be completed by 1130. This was her idea of the MRI being scheduled.
The doc told me that the pt was currently receiving solumedrol to help relieve pressure from a possible cord compression. (This was what the pt was going to MRI for.) I took a look at the pt and wouldn't you know it, the pt was not only not recieving the prescribed medication, but there wasn't even an IV started. I tried to get report from the nurse but she said she had just come back from lunch and didn't really know the pt so she began reading from the notes. I can read too you know. After they get an IV, the pt is loaded on the stretcher and we are ready to head out when I looked at the orders sheet. The Dr. had asked for a foley to be placed before transport due to the pts lack of mobility. I brought this up and we had to wheel the pt into an empty room for the nurse to do that.
All in all, we wasted nearly 1/2 hour getting things done that should have been done before we showed up. The call for transport was over an hour before we came and the ED wasn't even that busy. It's just courtesy to get things done before transport so we don't waste time monkeying around when we should be leaving.
Tuesday, February 17, 2009
Long Nights
As most Rt's do shift work, nights are commonplace for us. In doing transports, we have a department in one of the larger hospitals in the city and go out to where we are needed. I don't mind doing nights and often pick up overtime on nights. Several of my collegues have been off on holidays in Jan/Feb so there is plenty of overtime. I'm in the middle of my long stretch. I do 2 days, 4 nights, one day off then 2 days and 7 nights. That's 15 shifts in 16 days. I almost feel more at home at work than in my own home.
Some nights are busy, some are slow. I've had nights where I show up to work and don't have a single trip. One night on this stretch however I left the department at 6:45 pm and returned at 6:15 am with a few pitstops to restock meds and batteries for my monitor. I had 6 trips at an average of 1 1/2 - 2 hours per trip. I'm just hoping to still be sane and recognizable by the end of this tortuous stretch.
Some nights are busy, some are slow. I've had nights where I show up to work and don't have a single trip. One night on this stretch however I left the department at 6:45 pm and returned at 6:15 am with a few pitstops to restock meds and batteries for my monitor. I had 6 trips at an average of 1 1/2 - 2 hours per trip. I'm just hoping to still be sane and recognizable by the end of this tortuous stretch.
Monday, February 2, 2009
Dodged That One
I had a transfer with a pt with upper abdominal pain and hematemesis. We went to consult the GI surgeon who performed a gastroscope. When I got the pt she was unmonitored on the ward. Her vitals were strong and stable and she was quite pleasant to talk to. I left her in the care of the GI team and went to grab a bite before her scheduled trip back to the referring hospital. When I came back to the room, her BP was 56/32 and O2 sats were all over the place. Her LOC had decreased from 15 to around 12. The GI nurses were bolusing with saline and after 1 1/2 litres called for three units of packed cells. There was no active bleeding to be seen on the scope but there was a large ulcer about 4 cm across and a very large clot that the Dr. couldn't see around. This made him uneasy but again, there was no sign of active bleeding.
The decision was made to keep her at the facility and admit her for close monitoring instead of sending her back with me. I dropped her off in the ED until a bed on the ward could be found.
A couple of hours later I brought another pt to the same ED and ran into the same nurse. She told me that less than 10 min after I left the earlier pt there, her LOC went into her boots and she began vomitting lots of frank blood. They called a code blue and rushed her to the OR. Had they not decided to admit her to the hospital, I would have been dealing with this in the back of the ambulance, halfway between hospitals. Like I said, I'm glad I dodged that one.
The decision was made to keep her at the facility and admit her for close monitoring instead of sending her back with me. I dropped her off in the ED until a bed on the ward could be found.
A couple of hours later I brought another pt to the same ED and ran into the same nurse. She told me that less than 10 min after I left the earlier pt there, her LOC went into her boots and she began vomitting lots of frank blood. They called a code blue and rushed her to the OR. Had they not decided to admit her to the hospital, I would have been dealing with this in the back of the ambulance, halfway between hospitals. Like I said, I'm glad I dodged that one.
A Few Ethical Considerations
So I was talking with a collegue after they did a transfer of a pt who was the passenger in a fatal motor vehicle collision. The driver at fault had ETOH on board and there were multiple fatalities in the other vehicle. All the passengers of the drunk drivers vehicle were ok.
As a health care provider, we are obligated to provide equal care. But do we? If this pt were to complain of back pain from the accident, are we a little slow to respond. "You'll have to wait sir, I'm busy with another pt now." Are we a little callous to the pt who failed at the suicidal attempt because they are tying up the system when all they wanted to do was not be here?
Have we ever gone on break knowing there are treatments to do in the ICU to a 'lost cause' pt and justified it saying "All the ventolin in the world won't reverse the anoxic brain injury."
I'm not telling you which ones I'm guilty of, but I've found myself in several moral/ethical decisions many times. We even took a course in school on ethics in health care, so I suppose it's well known that there are these problems out there. I've got some personal growing up to do and it's situations like these that force it upon me. Sometimes I've found it helps to distance myself from my pts. This works in these situations where I don't want my personal disgust for the pt to interfere with the level of care I provide as well as when I am providing care for a pt who is dying.
I'm certainly not in a place of zen at work, far from it but it's a battle I hope I'm winning.
As a health care provider, we are obligated to provide equal care. But do we? If this pt were to complain of back pain from the accident, are we a little slow to respond. "You'll have to wait sir, I'm busy with another pt now." Are we a little callous to the pt who failed at the suicidal attempt because they are tying up the system when all they wanted to do was not be here?
Have we ever gone on break knowing there are treatments to do in the ICU to a 'lost cause' pt and justified it saying "All the ventolin in the world won't reverse the anoxic brain injury."
I'm not telling you which ones I'm guilty of, but I've found myself in several moral/ethical decisions many times. We even took a course in school on ethics in health care, so I suppose it's well known that there are these problems out there. I've got some personal growing up to do and it's situations like these that force it upon me. Sometimes I've found it helps to distance myself from my pts. This works in these situations where I don't want my personal disgust for the pt to interfere with the level of care I provide as well as when I am providing care for a pt who is dying.
I'm certainly not in a place of zen at work, far from it but it's a battle I hope I'm winning.
Wednesday, January 28, 2009
Statistics
So we just got back our statistics for 2008. There are 4 RT's on days and 2 on nights for the critical care transport team. We did over 3300 trips last year. That was down slightly from 2007. Over 350 trips were ventilated. Average trip time (including travel to and from facilities) was about one hour and 45 min. Majority of trips were for pre and post angio procedures as well as CT's. We did over 325 ICU transfers. Most frequent drug administered was fentanyl. I love it by the way, fast acting, relatively short lived and less effect on BP than morphine. Largest number of trips occured between the hours of 1100-1200. There was 4 pages of stats, this is just a sampling. We've been busy and the trend over the past 8 years since we started has only gone up. This is good for job security.
Thursday, January 22, 2009
The Invincibility of Youth
A favorite past time of any young man is adventure. Here in the great white north, this takes shape as motorsports and more particularily, snow mobiling in the winter. My pt was on the wrong end of a snow mobile vs. car and we transported him to the trauma center for a surgery consult and further work up. A couple of days later I ran into the same youth in the CT department. He was being re-scanned to compare to earlier scans. Amazingly, there were no breaks, no internal bleeding, no neural trauma. Just mild cuts abrasions and a few stitches on his head. The best part was that he had already picked out his new snow mobile to replace the destroyed one from the accident. It'll take a few years for his mortality to sink in but until then, enjoy being Superman.
Friday, January 16, 2009
Lip Reading
One of the advantages/disadvantages of an intubated pt is that they are pretty quiet. At least in the sense of talking. That doesn't stop some of the concious, failure to wean pts from banging on something to get your attention. Then when you go to check on them, they start 'talking' and assume you should have no problem understanding what they want. I'm terrible at lip reading though. I don't know how many times my pt has indicated they want something and tried to tell me only for me to have to say "I'm terrible at reading lips. I'll have to get your nurse."
I had one pt who was trached and ventilated who was also very demanding. The nurses 'forgot' to put the pts call bell at the bed side so the pt had learned how to do this weird clicking sound with their tongue to get attention. It seemed the pts main request was ice chips. They would insist on being fed up to a cup worth of ice chips at a time. This was soon ignored so the pt resorted to new tactics. I was at the nurses station when the vent alarms started going. I went in to check on the pt and they had disconnected the vent by pulling on the tubing. I hooked it back up and noticed a major leak. I hunted around trying to figure out where the leak was coming from when I noticed the trach was sticking out slightly. The pt had partially decanulated themselves. I pushed on the trach and after it gave a little 'pop', the trach was back in place.
Despite my efforts, and believe me I've tried, I don't know that my lip reading skills will get any better. I can always use my trusty one liner "I'll go get your nurse."
I had one pt who was trached and ventilated who was also very demanding. The nurses 'forgot' to put the pts call bell at the bed side so the pt had learned how to do this weird clicking sound with their tongue to get attention. It seemed the pts main request was ice chips. They would insist on being fed up to a cup worth of ice chips at a time. This was soon ignored so the pt resorted to new tactics. I was at the nurses station when the vent alarms started going. I went in to check on the pt and they had disconnected the vent by pulling on the tubing. I hooked it back up and noticed a major leak. I hunted around trying to figure out where the leak was coming from when I noticed the trach was sticking out slightly. The pt had partially decanulated themselves. I pushed on the trach and after it gave a little 'pop', the trach was back in place.
Despite my efforts, and believe me I've tried, I don't know that my lip reading skills will get any better. I can always use my trusty one liner "I'll go get your nurse."
Subscribe to:
Posts (Atom)
