For some reason I was more tired during my shift last night than I have been the rest of my time here. I'm sure I'll be getting a second wind here shortly.. I had three vented patients again last night. Two of them were patients that I had the previous shift. All three of the patients were stable during my entire shift and I barely had to titrate any drips. In fact, One of my patients became alert!! She was nonverbal and was extremely confused, but it is the most progress I have seen in a patient that was intubated since I've been here. We tried to see how she would handle moving off the vent and she couldn't really tolerate it, but there is still hope that she could breath on her own over the next day or so. I would say the hardest part about having 3 vented patients is keeping up on replacing all the drips. Each patient is on at least 4 different drips and they each end or run out at different times. It feels like I am just running room to room replacing a drug just to find another drug I need to run and replace.
I wanted to talk about what it is like working in a healthcare system that is totally overwhelmed. Obviously this is the main reason I am here. Before coming, I imagined what an overwhelmed healthcare system was and how it would be. A lot of what I thought is true, however there are other things that I didn't anticipate. We heard so much about ventilators and staff shortages.. So that I knew what I was getting into. Each patient is on a different kind of vent, so I need to learn how to adjust setting or at least how to use certain functions for several different kinds of vents. My ICU only has 1 Respiratory therapist on the floor at night and we have about 15-20 vented patients. The most patients I have had since being here is 3, but before I got here it wasn't uncommon for ICU nurses to have 6. This is a crazy amount of high acuity patients for 1 nurse to deal with.
What I didn't really expect and maybe should have, is the shortage in basic supplies that you don't realize are so important. It seems like every night we are out of a certain product/supply and then it gets replaced for the next shift and we are completely out of something else. COMPLETELY OUT... meaning I can go on a scavenger hunt through the hospital and not find any. These things are 10cc flushes, alcohol wipes, Normal Saline bags, hypodermic needles, suction catheters. There was a night we didn't have ANY IV tubing for the IV pumps. This is a huge deal when you are titrating pressors. When you are dealing with the tiniest amounts of fluid that can affect the body, the last thing you want to do is try to count drips in a drip chamber. IV pumps are one item that we run out of every night. Luckily I have been able to find a couple on hospital wide scavenger hunts. We also run out of Propofol almost every night. (the main drug for sedation) and we have been using the small vial (50mL) instead of the normal 100 mL's because the hospital is completely out of them. This is a big deal because I will burn through a 50mL vial is 45 minutes which means I will have to switch that bottle 16 times in my 12 hour shift. Which means if the pumps are inside the patients rooms I have to expose myself that many more times.
I know PPE issues have been publicized like crazy. It has been without a question an issue, however I do feel it is in a better place now than when the crisis first started. When I first arrived I had to make my N95 last 5 shifts, but now I can get a new one every other shift. I have to make 1 gown last 12 hours, so I can use plastic gowns to protect that gown, but we run out of plastic gowns early in the night.