So in true MICU fashion, we went for a while with nothing exciting to getting a few interesting calls in a row recently. As the title of this post suggests, we took care of a complicated NSTEMI. It is not too often that we take people out of the ICU at our base hospital. Especially on beautiful days with almost no clouds in the sky and minimal wind. Basically this patient should have received a scenic tour to the downtown super hospital via an EC145 or whatever the airframe of the aeromedical provider is utilizing that day. However, we made it happen.
Our patient decided to start having extreme difficulty breathing up there in ICU land and actually had to be intubated. He also decided to say "screw you guys, I'm going into cardiogenic shock"! I'm sure a few of you read that in Cartman's voice. lol. At any rate, this patient who had received a PVC challenge with out paralytics was fighting the tube and required both chemical and physical restraints. Good times.
As it turns out, this pt was having a rather large and complicated cardiac event that required pressors, vasodialators, sedation, pain management, continuous bladder irrigation (CBI), and ultimately a cardiac cath. It was a bit of an ordeal just getting this pt transferred to our equipment and gurney. So much in fact that we had to call for an extra set of hands to drive us priority one to the super hospital where the cath team was waiting.
As my partner starts swapping things over to our equipment, I start asking the friendly neighborhood RN what the story was with this pt. I get a jumbled and some what inadequate report and had to piece the rest together from the chart and the Doc. Oh and we are still trying to get everything swapped.
Just as we are finishing up getting pumps and vents set up and swapped over, our back up arrives. Oh good, we can go now! As we are getting the pt over to the gurney and swapping vents, our "Frankenstein vent" as my partner likes to call it, dies. Great. Not to worry though, the crew that showed up for man power also happened to be a MICU crew that had a vent. So we just borrowed theirs.
Now that we are out of the ICU and what felt like transfer purgatory, we still had a 35-40 minute drive to the cath lab at the super hospital. It's ok. It will just be a bit bumpy until we hit the interstate. Vitals q 5 min and watching the vent should be an easy task. After all, the transfer from the bed to the gurney was the hard part...right? Well I guess we were wrong on that one.
Remember how I said it was a complicated NSTEMI? Well the pt decides to dump their pressure enroute and brady down a bit. Not cool, intubated sick guy! The bradycardia was probably due to the A1 drug we had running but the hypotension wasn't. However, a fluid bolus did help get the pt back on track.Simple solutions for what seems like a complicated problem. Side note ***next time you listen to heart tones, try doing so with either a radio playing or someone yelling in your ear. Just to make it challenging. Because we had lights, sirens, horns, and bumping equipment to contend with. Should be interesting.*** At least no one was shooting at us.
So after our little bout of hypotension, we notice our pt needed the CBI bag changed. Doing so without getting fruit punch colored urine on your clothing is one thing. Doing the same thing down a highway that is in need of repair was nothing short of a miracle. Thankfully I will be able to wear that uniform again for another day. lol.
As we approach our destination, my partner calls report while trying to adjust a problem pump. He ended up putting the lab on speaker phone. I was monitoring the vent and the monitor at this point when suddenly under the chaos of traffic and the notice that is being put out by our ambulance, I hear crappy elevator hold music. The first thing that comes through my mind is "really?". I look at my partner and go "Are we really on hold right now?", to which he just rolls his eyes and hits end call. He gets the pump issue resolved and ends up calling report about 5 minutes out.
Upon our arrival to the facility, we move through the ER dodging IV poles, linen hampers, and the nursing staff. All that was said by all parties was "CATH LAB"! Once we get to the lab, my partner and I give report and get everything all transferred and swapped. Then I get the task of playing ventilator while we wait for respiratory to arrive. It only took about 10 minuets. It was probably a good thing. It gave me time to let my endogenous catecholamines wear off so I could return to my normal sinus brady.
Is it odd that I would rather have complicated MICU calls all day and loath boring (but easy) priority 3 transfers? The jury is still out on that one. lol.
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