So, back onto a few days. Well, a few days off. Well, two weeks if I’m strictly honest.
Which means I’ve just come off nights.
Some of the worst nights I’ve experienced. The first time I’ve ever been in charge (which was surprisingly okay, if very stressful). The patient volume this week has been incredible. Prolonged cold weather means lots of sickening older people, people with rubbish lungs, or rubbish circulation getting unwell.
The people the GPs and crews were sending/bringing in seemed much sicker than I’m used to, and in some cases really tested my abilities. The department actually ran out of some fairly important drugs, not the hospital, thankfully. But when you’re completely exhausted and you open the drug cupboard and see a space where the antibiotic you need for the septic patient should be, it’s really quite distressing. Thankfully our sister department helped out, and so did ITU, and eventually quite a lot of wards found they were donating drugs to the ED.
And equipment. Our ECG machines, overworked and battered* as they are started to fray – thankfully we got a loaner and with some cunning application of MZ skills one of them was persuaded back into working. Of course, that didn’t help when we ran out of paper.
Incidentally, I hate equipment manufacturers. We don’t, unfortunately, have one standard type of monitor, or one standard type of ECG. Two brands of ECG machine and they have two separate types of paper. Which means that we get through a lot more of the paper for the older machines (reliable, work almost all the time) than for the new machines (flakey as hell, crappier trace). The paper is not interchangeable. Guess what we end up using more when we’re more pushed? Yeah****.
I’ve never been “in charge” of anywhere before. It’s scary. Suddenly the life and death of everyone in the department ultimately resides with you. Where you assign patients to, it matters. You need to think about the skills, the knowledge of the nurse who’s going to admit & care for them, the abilities and familiarity of agency staff with the department. The equipment available in the bay they’ll be going in to. I apologised to ‘my’ resus nurses, because I used them more than I imagine I normally would, just because we had 2 agency staff who I were new to the ED.
I also had one of those phases. For a night and a bit I could not, for the life of me, get a cannula in first time. Quite often I stuffed up the second time as well. It was frustrating, and the more frustrating it got, the more it became a self fulfilling prophecy. Finally, I got my mojo back, and eventually ended up cannulating someone that the doctor’s hadn’t managed. More luck than pride, but it made me feel better, and it meant we could start getting her the fluids she so desperately needed.
But it wasn’t that that made me feel good. One night this week I had a proper sick patient. A complex, difficult to manage, really deeply unwell patient. And the Doctor and I worked as a team, then the specialists came down and we all did the proper team thing.
His blood pressure was a nightmare, we didn’t want it too high – just around 100 systolic – because we didn’t want to make the internal bleeding worse. But at the same time we needed to perfuse his organs. We knew we were diluting down what blood he had, so were trying to be sparing, but he was totally fluid dependent (as soon as we stopped fluids, his blood pressure would drop – stone like)*****. I found out this morning that we did it right. He’s in ITU recovering from a whole slew of procedures in theatre.
And y’know? I feel like I did good :)
* I’ve noticed other departments seem to treat equipment with a lot more respect. We tend to slam ours into doors, floors and walls**.
** Not on purpose, it’s just we’re…well, in a hurry***.
*** Just ask my hand which met, ironically, the helium cylinder for blowing up kids balloons, and now has a big gash in it.
**** And just guess how many different Oxygen sats probes there are, or ECG leads, or even sodding blood pressure cuffs.
***** We were holding off the O-negative (universal donor) blood for the minute, waiting for the crossmatched blood.
