So I was assigned back up to 9B. When I got there the same charge nurse was in charge and she stated that she requested me to stay on her floor which made me feel good. I failed to mention yesterday that I am blown away with the attitudes of these NY nurses. The are so cool and helpful. They have been dealing with this for a couple months now and they are still just fighting hard everyday. I was nervous that there would be frustration with me because I am not a traditional ICU nurse, but they have all been so understanding and helpful.
So I was assigned the same two patients that I had yesterday. The 42 YOF Spanish speaking lady and the other guy that was deteriorating on my last shift that was still alive (suprisingly). When I took a report the nurse told me that the Spanish gal was starting to show more signs of distress and was worried that she was going to need to be intubated. So I went to check on her and sure enough she was sitting upright in straight panic with a pending doom in her voice and on her face. WIth only being able to get one or two words out at a time she told me she was done breathing and we had to breath for her, I ran and told the doc and he came in to check on her and we intubated her right there. I had literally been there for 10 minutes. Sedation took several hours to dial in. After a few hours she was finally resting with a propol, versed and fentanyl drip. Throughout the night she started to lose her BP and I had to start a levophed drip to maintain her MAP above 65. A frustrating thing that is happening is sedation drug supply is running low, so instead of having 200mL propofol containers we only have 50mL which means I have to switch her drip every hour and her drip was bedside because she was too far away from the hole in the wall to hang drips outside the room.
At about 2am I got another patient from the ER that was short of breath but maintaining o2 sats with 15L of NRB mask. well 30 minutes of having him he got to tired to breath and almost word for word like the other patient he stated he wanted us to breath for him because he was done breathing. So almost the exact same sequence of events happened with him and I was dealing with sedation and intubation with him. At this point all three of my patients are Vented and on the exact same drips of Prop, fent, versed and Levo.
At 715 I was changing all my drips so that they would be full for the on coming crew and my patient that was already deteriorating before I got him, well he literally died when I went to check on him. His rate was 30 in a idioventricular rhythm and then went asystole. I DC'd all of the lines, but the charge said the day shift would put him in the body bag.
Notes for the shift for the unit... We started with 6 patients that weren't intubated, we ended with 1. 4 people on our floor died during the shift. As I go back tonight I hope to have the same spanish gal. I would love to see her recover. It's unlikley but I feel invested in her care.