I arrive and check for my assignment. Today I'll be with a new patient. Our unit huddles at 7 a.m., and we are briefed about staff and patients. My patient is a direct admission from an outside hospital and preliminary diagnoses are sepsis and pneumonia- that’s our specialty. She’s coming by helicopter and they are landing in 10 minutes. I am going to be busy! My room is ready and I grab a couple IV pumps and set up a couple of pressure bags with IV fluids. The report is that the patient’s blood pressure is low, she’s tachycardic, she’s on BiPAP, has a urinary catheter, and she has a couple small gauge peripheral IVs.
The admitted patient arrives, and the medical team swarms the room -- I have lots of help to get her settled in bed and hooked up to the monitor. Blood pressure is still low despite 4 Liters of IV fluids and the patient is breathing too fast and hard with the BiPAP -- she’ll need to be intubated first before a central line can be placed. One of my co-workers has pulled out the medications I’ll need to administer for intubation. The doctor tells me what to give just prior to intubation and after the procedural pause, we begin. Medications are in and the doctor intubates the patient. While the doctor places the central line next, I watch the monitor and report any ectopy.
Whew! The procedures are done and X-rays are ordered to verify placement. Once those are done and placement looks good, I can run the medications to help the patient’s blood pressure through her central line. I have many antibiotics and sedation to administer so the more IV access, the better! My co-workers keep checking on me to see if I need any help. I catch up on charting and signing off orders.
My patient is waking up and getting restless -- time to increase the sedation a little. Is it lunch time already? I report off to the nurse covering me for lunch. Back from lunch and I see there’s an order for a chest CT. I call the respiratory therapist to let him know that we’re going to need to take a trip to radiology. Blood pressures are low again when we get back so I call the physicians to see if they want to give more IV fluids or add another medication.