Monday, May 4, 2009

Tales from Behind The Mist....Of Albuterol

From the "Are You Serious?!" File....

Some true stories from work this weekend.

Phone rings and it is Nurse X: "Andrea, can you come and give the patient in room XXX a breathing treatment?"

Me: "Sure. Whats going on with the patient?"

Nurse X: "I don't know. He wants a Coke. Can you just give him a treatment so he will shut up about the Coke?"

Phone rings and it is Nurse Y: "Andrea, my patient's sat is 85 on 2 liters. Can you come see him?"

Me: "Did you turn up his oxygen?"

Nurse Y: "Yep. To 5 liters." (sounding very proud of herself)

Me: "What's his sat on 5 liters?"

Nurse Y: "I don't know. I left to call you."

Me: "Well, I am in the ER with a full arrest. Go and see what his sat is, and if it still low, put him on a venturi mask at 50% and 15 liters, and I will be there as soon as I can. Do you know how to do that?"

5 minutes later the phone rings. Nurse Y again: "Andrea, I think I broke the venturi mask."

Me: "Get another one and try again. I am still bagging this patient in the ER."

2 minutes later, Nurse Y, again.: "I don't think 50% is going to fix this. We need to go up on his oxygen, not down."

A few minutes later, I head to the room. The patient's sat was 100%. His heartrate was 85. I put him back on his 2 liters and went back to the critically ill patient I left in the ER to deal with this.

Later that night, a full arrest in the ER. We are intubating the patient and I have the nurse behind me at the crash cart hand me an en-tidal CO2 detector to verify proper tube placement.

Doctor X: "That won't work on this patient."
Me: "Well it is habit, so just humor me."
After a few breaths, we get the color change that shows the tube is indeed in the lungs and not the esophagus.
Me: "See, it worked."

After the code, Doctor X comes up to me, and in a gentle voice asks me if I understood why it would not work for that patient.
Me: "Well, it did work. Plus, It is an ACLS standard that tube placement be verified with an end-tidal CO2 detector, and therefore it is the policy of this hospital that we use it after an intubation."

Doctor X: "Well ACLS is wrong. I'm going to write them about that."

Seriously, people. Seriously.

No comments: