Shift 54 and 55

Shift 54:

The shift started out good.  It wasn't busy, but not super slow.  Around 11/11:30pm it started picking up and got really busy.  At that time of the night, we only have 1 doctor, so he started getting really backed up.  He finally asked if the charge nurse could call the doctor who is the head doctor (I believe he is the "medical director" of the ER) and ask him to come in. At 1 or 2am he came in to help.  We had every bed filled, and 4 or 5 hallway beds full as well.  The nurses were working together as an amazing team......I never once felt stressed.  We were all helping each other.  However, I didn't leave until nearly 4am (yikes!  I work 2pm to 2am).  I had a patient that came in with shortness of breath- a young girl, I think about 28 or 29.  We hooked her up to the monitor and her heart was beating a little fast, what we call sinus tachycardia, which is 100-150 beats per minute.  She was around 110 or so.  Then, a tech was in the room with her and she said she didn't feel well all of a sudden, and her heart rate went crazy- 250!!! We call that SVT- supraventricular tachycardia, which is from 150 to 300 beats per minute.   The doctor and I went in there, and he had her bear down as if she were having a bowel movement (what we call a vagal maneuver- the bearing down stimulates the vagus nerve, which slows down the heartrate).  Her heart responded and then she went back to sinus tach.  A little later, she went to have a CT.  When she was being rolled back into her room, she didn't look too good, so I told the tech to hurry and get her back on the monitor, and sure enough, she was at 225 beats per minute again.  I told the doctor to come because she was in SVT again and that the vagal maneuver wasn't working. At that point, he said we needed to give her adenosine, which is  a medicine that slows that heart down, and sometimes so much so it may nearly come to a complete stop, so whenever you administer this medication, you must attach defibrillator pads to the patient (some machines have sticky pads that you just stick on, and some machines have actual paddles- we have the pads in our ER). I went to get the meds, a tech went to get the defibrillator.  Then I administered one dose of adenosine and it did not convert her heart rhythm to sinus tach.  It barely did anything to her heart.  I then administered a second dose of adenosine.  Still nothing.  Barely any change.  The doctor then decided we'd try cardizem, which is in a class of medications called Calcium Channel Blockers.  Essentially, they block calcium from entering the heart cells and blood vessels, therefore causing a relaxation effect and widening of the blood vessels and also relaxation of the heart muscle.  This lowers blood pressure and slows down the heart rate.  I gave her some cardizem in her IV and it finally converted her heartrate back down to 130.  I gave her some more a little while later as well, but her heartrate still lingered at 130.  At that point, it was time for me to go home.  When I came in the next day (shift 55), I was thinking about stopping to see her in her room.  She had been really scared the night before, and was crying because she didn't want to die and she really thought she was.  She wanted to call her mom in another state but was debating it because she didn't want her mom to worry, but at the same time she thought if she was dying, she wanted to talk to her mom again.  I comforted her, told her she should call her mom, but to remain calm and just tell her mom she wasn't feeling well and was at the hospital.  I also reassured her that she was in the right place to be sick and that we'd do all that we could to help her get better.  Anyway, I wanted to see how she was doing, and lo and behold, she was still in her room in the ER.  Apparently, she was going to be admitted to ICU, but there were no ICU beds available, so she had to stay down in the ICU (its what we call an ICU hold) and an ICU nurse usually comes to take care of that patient.  The nurse who took over for me when I went home the night before is an ICU nurse, she just floats to the ER to help sometimes, so she took over that patient's care until shift change.  Then another ICU nurse took over.  By the time I came in, the cardiologist had just downgraded her to telemetry, which is a little more acute (sick) than just a medical-surgical floor, and these patients have to be on a cardiac monitor 24/7.  She was actually just getting ready to go up to her room.  I was glad she was doing better and her heartrate was beating in the 70-80 range, which is awesome!  Anyway, that was my exciting experience of the night, my exciting new experience, however, it was unfortunate for the patient.  But I am glad I got to be her nurse to be there for her when she needed someone.  I hope I helped her feel as though  she was taken care of, and taken care of well for that matter. And most of all, I am glad she is doing better.

Shift 55:

Relatively slow day. At one point, we almost had an empty ER.  We had about 5 patients and they were all just waiting to go upstairs (they were already seen, treated and admitted).  We sent 2 nurses and 1 tech home early.  Then around 5pm or so, we started picking up a bit and it lasted until 9:30pm or so.  Then it slowed down again.  I probably would have been able to go home early, except for the fact that there were only 2 nurses who came in at 7pm, so when I left, there would only be 2 nurses left on the floor.  

Shift 56 is Wednesday, and then I am off again for 2 days.  Until then.....