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What a day at clinicals

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I had a clinical day that would make my buddy TJ proud. He's the trauma junkie but I don't know if I am yet. I was assigned to the Emergency Department for the day. The day started basically quiet ( a word you never say in an ED) with a few ABG's and neb treatments. Then around 9:45 we got the call for an ABG in room 57. When we arrived we found the doctor, NA, and several RN's in the room. I'm not sure wheat they were doing at the moment. Then someone from inside said that we were gonna intubate the patient. We got prepared and moved the patient to the trauma bay. I bagged the patient during this trip.

The doc said to get the intubation and glidoscope ready. We got everything prepared. One of the new RT's who still needed intubation checkoffs got set up to perform the intubation. She got the tube in with no problem and I grabbed the end tidal CO2 detector. As someone bagged to check for CO2, stomach acid came bubbling up the ET tube. This was something I had never seen. The tube was quickly removed. A physicians assistant who was there quickly jumped in with the glidoscope and attempted the intubation. The rest of us watched on the monitor. The patients tongue was large and the vocal cords were not seen. The doctor took over and successfully intubated the patient. We took the patient back from the trauma bay to his room. End of story, right? Wrong.

I was standing outside of the patients room when my preceptor came out of the room and told me to hurry back in. I looked in and saw a nurse was doing chest compressions. Apparently the patient coded and had no pulse. The doctor was quickly into code mode and started ordering drugs (mainly epinephrine, the drug of choice for Code Blue situations) and I took over the chest compressions. In the code situation the RT usually handles the ambu bag and chest compressions and I got to do plenty of both. After about 15 minutes the patient got stabilized.

We got set up to get an ABG before the patient was to go to the Cardiac Cath lab. We were all having a hard time finding a pulse. We decided to wait and get the blood from the cath lab once they had him. We went with him there and were prepared to hang out and wait for a vial of blood. Once he was on the table the doctor checked for a pulse and found none. He said to call a code and I started compressions. For some reason they were more tiring this time and we rotated out every 2 or 3 minutes. This went on for what seemed like forever but was probably only 10 or 15 minutes. We finally got him stabilized and tried to get an ABG again. Several people tried to no avail and the doctor stepped up and got the blood. We ran it and found a pH of 6.89.

They got him a bed in the CSICU unit. We rushed him for a CT scan and got him settled in his room. That was the last I heard of this patient. So, with one patient I got to bag, do chest compressions, attempt an ABG, and set up a ventilator. What an exciting day. I may just be a trauma junkie after all.

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Diana Lyn said...
January 17, 2009 at 12:33 PM  

Wow...! I have yet to experience a "crazy" day...

Marcus said...
January 17, 2009 at 12:44 PM  

Just wait, I'm sure you will

Trauma Junkie said...
January 17, 2009 at 4:20 PM  

Wow, what a story... That's crazy. It's so strange how a pt can go down so quickly that you don't even have a chance to blink sometimes before you're back on top of them doing compressions.

I don't actually start my clinicals until January 28th and I don't get to go to the big level I trauma center with 900+ beds until around April. It should be a lot of fun though.

Good job at handling the situation, and thanks for the link to my blog.

Glenna said...
January 21, 2009 at 5:37 AM  

Excellent day of clinicals!!! Amazing how fast compressions wear you out. It doesn't seem like much but it really is work...great job!

Marcus--very cool about the CF work you're doing. I'll be back later to donate. I'm very impressed and supportive.

Strong One said...
February 20, 2009 at 6:30 PM  

Oh yes... you sound like an adrenaline junkie like the rest of us.
Glad you got the experience!

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