It’s your first shift of four-in-a-row and little do you know that you are in for a tough stretch! Your shift starts out calmly enough, but at 0200 you take report on a 23-yr old post-surgical trauma patient who came in through the ED due to a pedestrian vs auto incident. The patient was crossing the road on a dark, rainy night when she was struck by a vehicle at approximately 30 mph. Her injuries are:
Taking care of patients with neurological injury means managing their intracranial pressure, or as it’s commonly called, ICP. And when we say neurological injury, keep in mind that we’re not just talking about people getting bonked on the head with a 2 x 4. We’re talking about space-occupying lesions, hydrocephalus, intracranial hemorrhage, subdural/epidural hematoma, even severe hyponatremia…basically anything that’s a key player in (drum roll please….) the Monro-Kellie doctrine.
The phrase you will hear most often in your nursing school career isn’t, “This is on the test” or “Choose the members for your group project” or even “Get comfy for six hours of lecture.” Nope…the most common phrase (and probably the most important one) is “What are you going to do about it?” It’s also the most common thought running through your head once you’re out there doing your thang as an RN! Here’s what I mean by that…
Ah, the kidneys…who doesn’t love ‘em? These two little bean-shaped organs will come into play with just about every single patient you deal with. In some cases it will be a chronic and devastating case of renal failure, (such as those patients requiring dialysis), but in most cases it will be moderate and more subtle. In all cases, renal function will tell you volumes about the patient’s fluid balance, electrolytes, blood pressure, infection and perfusion. Keeping an eye on renal function is a basic skill you’ll use every day as a beside RN…so let’s get to it!
Compartment syndrome, in the clinical setting, is considered an emergent situation that requires immediate treatment. Note we’ll be talking about acute compartment syndrome here, and not the chronic variety which is usually caused by muscular exertion. What we’re talking about here is a limb-threatening condition that, if left untreated, could result in loss of the affected body part, kidney failure and even death.
A few years ago a local radio station had a contest…Hold Your Wee for a Wii. The contest rules dictated that the contestants would drink copious amounts of water and whoever could hold their pee the longest, won a Wii game console. Despite numerous physicians and nurses calling in to the switchboard to tell them how dangerous this was, their pleas were ignored. They undoubtedly thought…”It’s water…what’s the big deal?” Well, the big deal was that the winning contestant went to bed that afternoon and never woke up. It was an enormous tragedy and absolutely beyond heartbreaking. I can’t imagine what her loved ones went through to have someone close to them die from such an avoidable event. Hyponatremia is deadly serious…and here’s what we’re going to do about it.
I first encountered Heliox when working in ICU and assuming care of a patient with severe asthma. As the team brought her up from the emergency room, I saw the respiratory therapists pushing a huge cart with what looked like gigantic oxygen tanks. The patient was wearing an oxygen mask hooked up to these tanks via long tubing and working hard to breathe. As I would learn later, she was on Heliox and it made the difference between ending up on ventilator or improving enough to downgrade to telemetry the next day. Which she did. Go us!
Today we have another fabulous guest post from Courtney over at From New to ICU. In this post, she talks about a topic that comes up A LOT in the clinical setting…sepsis. So, without further ado…here’s Courtney!
Knowing when you need to intubate a patient in respiratory distress is a key skill you will use regularly as a nurse. This skill applies across the board…not just ED or ICU. Nurses in all settings come into contact with patients who decompensate, and knowing when you need to intubate can mean the difference between life and death.