WOW! I will start off saying that things are as bad as they have been saying. My first assignment was 9B which before all this started was a step down unit and now it has been converted to a high acuity Covid-19 ICU. I will start at the beginning of the shift.. Since there is such a high number of agency nurses, each nurse checks in a the staffing office, there they give you an N95 mask which you reuse for 5 shifts and they give you paper scrubs that go over your normal scrubs, you check in and then based off your specialty they give you your assignment for the day. This is a huge line of nurses waiting for this process. When I arrived to my floor it was pretty chaotic during shift change. I found the charge nurse and she gave me a surgical gown to go over my paper scrubs that were over my normal scrubs. I made a paper hat out of the covering of the surgical gown. I was then assigned 3 patients. 2 were vented and both on several pressors and sedatives and the other was on a non-rebreather at 15L with o2 sats of 88%. On the unit there were 23 patients, 14 which were vented. Each nurse was 3:1. Like I mentioned yesterday, the drips and med managment can be done from outside the room, which was nice, because everytime I needed to actually go in the room to perform a task (blood work, patient positioning, ect) I would have to put on a plastic gown that covers the surgical gown that covers the paper scrubs that covers my real scrubs. So you could imagine how hot and sweaty that gets. Also a note, the n95 was so painful on my nose after just a few hours, I would have to take a bathroom break just to take it off and give my nose a break.
My one patient that was not intubated was a Spanish speaking gal, so my Spanish skills came in handy. When I started speaking with her the resident and aid that were assigned to her care were so ecstatic. I also noted her widening QRS complex which wasn't on a previous EKG which impressed the attending and helped me gain the trust of my team. It was a good confidence booster to start off my 4 weeks. As the night went along my intubated patient that was sharing a room with my non-intubated patient went asystole and here there is no "working a code". She was already maxed out on norepinephrine and vasopressor. So I got help from another nurse and we removed and clamped all her chest tubes, foley, OG tube, IV's and we cleaned her off with wipes and put her in a body bag. She sat there the rest of the night while the other patient just could see her. It was so crazy for me to think this poor lady has to see this body while she continues to fight for her life. My other patient didn't code but I would be surprised if he was still alive when I return tonight. His HR was 140, o2 sats 74% vented with 20 of PEEP and his two pressors already maxed out. The nurse that I was working with says she has not had 1 intubated patient get extubated and discharged home yet during this crisis. I also watched 2 doctors yell and fight about intubating or not intubating another patient because it is almost like just giving up knowing they will probably die.
I also thought it was interesting how the triage and give patients to certain ICU's. The sickest patients that don't have a good change of survival get sent to an ICU that was made from a clinic. There are no vents or central monitoring stations and the basically just try to keep them alive until the die from respiratory failure. 9B where I was is where they send the sick patients that need intubation but will probably not make it. The original ICU sounds like they get the most stable intubated patients that have the highest chance of survival.
IV pump and tubing going through the wall to my patient that had recently deceased. The drips that were running were Propofol, Norepi, vasopressin, Fentanyl and Versed. And you can also see the feeding tube and solution above the top pump.
End of my shift. I was tired and my nose hurt!
Half way through the shift and just taking a breather...
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