Scariest day in ICU
So, it is my first time in ICU. The first few times I was on call were pretty quiet. A few calls about low potassiums and low blood pressures, but nothing really exciting. I kept waiting for the crap to hit the fan. A few days ago it did. Was called to see a man who we had been asked to see earlier in the day. At that time, he didn't "qualify" for the ICU (i.e. didn't need intubation). When I got up there he was acutely distressed, much more tachypneic, diaphoretic, and generally looking SICK. I paged my attending, but it was too late - he coded in front of my eyes. Haven't had a code blue on the ward yet. Different than the ones in the ER. No one seems to know where anything is, and so it takes a LONG time to get anything. Maybe it just seems like a long time when everything is in slow motion. Amazing though, I seemed to know just what to do. This guy needed to be tubed, and now. Finally, after bagging him I got the supplies that I needed and was able to intubate him. The guy was big, so I was worried I might not be able to get the tube in, but no problem.
Then down to the unit for an art line, and a central line. We put in the introducer for the CVL, and initially I had problems with the wire, but eventually got the line into the IJV.
Several hours later I was called about the same man. His sats were dropping, ventilation pressures were increasing, and there was no air entry on the entire right side. Oh crap. The entire lung was collapsed. This guy needed a chest tube, and it was my fault. My beautiful (although lengthy) central line caused a tension pneumothorax. The problem was, I had only ever put in one chest tube. I needed help. My attending told me to "get started" and that he would be right in.
So, I gowned up and got ready. Prepped the patient, put in some freezing and got ready to slice.... Amazing how easy a chest tube is in retrospect. I did have some talking through, but it went smoother than I thought.
Now that I have done everything that I was afraid of in one night in the ICU, I can sleep better at night. Hopefully, the next few nights will be back to the way it was before - quiet. That is how I like it.

0 Comments:
Post a Comment
<< Home