Thursday, August 9, 2012

I worked a lot this past week, having 4 days in a row, and one day off in between the other 2 shifts, so I haven't had much time or energy to post.  But the good news is I did a few really cool/new things.  

Shift 92:
Patient came in complaining of having car battery acid getting into his eye.  The doctor ordered some anesthetic eye drops and something called a Morgan lens to irrigate the eyes.  I had to insert the lens into both eyes and the lens was connected to a liter of normal saline IV fluid, one liter for each eye.  The liter of fluid irrigated the eye through the lens.  Quite interesting.

Shift 95:
Patient came in from fire rescue who was napping and when the family went to wake him up, he just had a blank stare and was having aphasia- trouble communicating.  Doctor came to the bedside to evaluate him and decided to call a stroke alert.  A stroke alert is called overhead throughout the hospital and basically tells the lab to send someone over right away to draw blood, tells the CT department to make sure a machine is clear for the patient to have an immediate CT scan, tells any other staff in the department to come help.  A neurologist is immediately called and usually comes to see the patient within 30 minutes.  The CT scan is used to determine if the stroke was caused by hemorrhage (blood) or ischemia (a clot).  This patient's stroke was ischemia, so the decision was made by the neurologist and family to administer a medication called t-PA (tissue plasminogen activator) which is a highly potent medication used to bust up the clot.  There is a chance of the patient hemorrhaging, so its important to get a good history from the patient's family to see if they are a candidate.  It can also only be given within a 3 hour window of onset of stroke symptoms, and I read somewhere that only 3-5% of patients make it to the hospital in time to received the medication.  However, I don't know how accurate that statistic is since I've seen 3 patients get t-PA in the last couple of weeks.  To give the medication, you give 10% of the total amount, based on the patient's weight in kilograms, during the first minute.  Then you give the other 90% over one hour.  Then the patient has to stay in the ER for 30 minutes to 1 hour after the infusion for evaluation.  Then the patient goes to the ICU.  I'd like to see how his is doing now because he was still very aphasic when he left the ER.  The medicine takes a little time to work, so I am hoping there was some improvement for him.

Shift 96:
Patient comes into ER, around 8pm-ish, complaining of not being able to urinate since 11am.  We inserted a foley catheter into his bladder, but there was no urine.  We tried irrigating it, which means we take a syringe of saline and push it into a part of the catheter and its supposed to break up any clots if there are any.  Still no urine.  Doctor then ordered a bladder irrigation, which is connected to bags of fluid which continuously run into the bladder to help irrigate it.  Still no urine.  The ER doctor then called the patient's urologist who said to stop the irrigation and that he would come in.  He tried a couple of things, which didn't work, but then decided to insert a suprapubic catheter, which means above the pubic area, a hole is basically cut through the skin and a catheter is inserted into the bladder there.  It is stitched into place.  This finally worked for the patient and urine was draining into the foley bag.  I assisted the urologist the whole time, so that was cool.  I even had to run around the hospital at one point to find a bladder scanner, which is like a small ultrasound machine used to see how much fluid is in the bladder. The urologist wanted that prior to inserting the suprapubic catheter.

So thats all my interesting info for now.  I am off for 6 days, so no posting for a while.

Until then......


Anonymous said...

Dad says"Awesome job!"after reading your blog.
Sounded like a rough shift but I know you were a help to the family-they were probably in the middle of that'surreal-time' but I'm sure they knew you were there and sharing their pain.

Copyright (c) 2010 The (mis)Adventures of an ER Nurse. Design by WPThemes Expert

Themes By Buy My Themes and Direct Line Insurance.