Did I Eat Lunch?

It was just one of those nights at work.  In fact it was a horrible night, one worthy of a full moon, but it was nowhere near a full moon.  The one thing that got me through that night was the knowledge that I did not have to come back for another 12 hour shift and I had a few days off work.  Let me give you a little narrative of my night.

My patient’s blood pressure is 73/46 and she’s screaming in pain.  Due to her surgery, she lost a lot of blood in the OR and the recovery room thought she’d be a good candidate to put back on the floor with the unintelligent “floor nurses”.  Welcome to my work life.  I start a second IV knowing we need some volume resuscitation.

Start blood transfusion in one IV and a fluid bolus in the other IV.  Oh guess what? She starts to have a reaction to the blood.  Stop the blood. Push more fluids. Call the doctor and explain what is happening, with class of course.  Doctor orders labs, no more blood,more fluids and no more pain meds for screaming patient.  Oh this will be fun. 

Remember to take a deep breath.  Drink a little water myself, before someone has to pick my crumpled body off the floor. Take another blood pressure. No change. Take a second deep breath.  IV Benadryl will help.  She’ll finally get some rest.  (It’s for the blood reaction of course, but the sleep is an added benefit).

Three hours later, doctor okays restarting of blood.  Great.  I have an hour to push as much blood into the patient as I can (blood is only good for 4 hours before it becomes filled with bacteria and needs to be thrown out per policy). I get 100mls in patient (trying to be safe due to previous reaction and patient medical history). Patient does fine.

Start second unit of blood. Blood pressure in improving, but not enough for pain meds. 80/50’s isn’t THAT good (pain meds decrease blood pressure).  Finish second unit of blood, patient appears to be improving.  Inform doctor.

Doctor removes JP drains and causes more unrelenting pain.  Patient is pretty sure I’m Satan and thinks she is in hell.  Pain causes blood pressure to increase so much pain meds are now given.  YES!!!! Patient resting better and more stable.  Check in on four other patients.  Time to report off to next shift. 

Drive home, shower, drops into bed.  Falls asleep.  “Oh wait, did I ever eat lunch?”