Every once in a while I have nights at work that remind me why I became an ER nurse. Despite dealing with the drunks, the drug seekers, the psychs, and the idiots of society people really do need emergency care help. Last night I had that reminder.
The shift started out like every other shift--coming into chaos and helping to sort it out. Around 1900 we get a call from American Fork they have a patient coming as a traumatic arrest. These are never good. The patient had been stuck in between two tractors crushing his chest and abdomen. They estimated he had been coding for 20min before medical help could even get there. He arrived with heart around 30bpm and a thready pulse. From there we got to work. Poor guy had bruising all over the place and a swollen belly. We dumped 5 units of blood and 4 units of FFP into him as soon as we can. To help paint the picture of the controlled chaos here is the basic process. On a nasty case like this we have 2 nurses, 2 techs, the respiratory therapist, the ER Doctor, the trauma nurse practitioner, and the trauma surgeon. In addition to x-ray, ultrasound, and CT techs. Lots of people and lots of things done REALLY fast. Luckily, we have someone there to write it all down. We ran him to CT scan and when we got him back his Blood pressure started to fall. Becky and I had 3 different doctors yelling 3 different orders at us. After drugs we hung, and fluids pushed in, he started to stablize. During this time the family came in. For me this is the hardest part. While I'm running around trying to do my job, the son kept saying "come on dad you can pull through, you can do it." The wife at the head of the bed just crying. We got him up to the ICU, stable and in one piece. After finishing our charting, Becky and I walked downstairs to hear the radio go off again. Provo was out on a motorcycle accident where the patient hit a sign full on with her body. Their call was basically she's alive here we come. Frantically, we restocked the drugs, supplies and cleaned what we could before they rolled in.
They rolled her in, she was still talking and crying in pain. Strapped to a backboard we moved her over onto our bed. After a quick assessment she screamed when she was touched here and pushed there, we intubated. I pushed the drugs and my doctor tubed her. IV's were started, fluid and once again blood was pushed in as fast as we could. Drugs were pushed and we ran to scanner. Her injuries were astounding. The pelvis was in 4 pieces, a broken femur, and a tear in the aorta. Overall, NOT GOOD! We rolled back into the trauma room and thought we were in the clear. Watching the monitors, pushing blood, and starting the drips to help her stay stable. She did not stay that way. Shortly after she tanks on us. More Doctors come in to decide what to do. While they discuss we are trading off with chest compressions, drug pushing, and blood squeezing trying to keep her heart alive. The cardio/thorasic surgeon (yeah it was that bad) had the chest cracking tray open and put in a chest tube. Blood went everywhere. Within seconds almost a liter of blood flooded out. By then there wasn't any hope. Her heart came in and out with a beat. At that point there was nothing more we could do. The monitors were turned off and she was covered up as we let the family into say goodbye.
Needless to say it was an emotional rollarcoaster that night. One of the honors I have as well as one of the hardest things I do is clean up the body of a patient that has passed away. The family asked to have all the tubes removed. I went in and pulled out all the tubes, ivs, and tape. For a secong I thought about asking her to lift her arm up so I could wrap up the IV site. I shed a tear after that. The sister looked at me and asked how I did my job. I do it to give a person a fighting chance to live. To give the family a chance to say goodbye. Its hard but rewarding. I do it because I have some amazing people to work with. After 6 hours of adrenaline rushing running, I was tired but still had to go out and take care of patients--our waiting room was still full. But I was exhausted the rest of the night, as was everyone else!
So how do I cope with this kinda of situation? Tears are shed of course. I allow myself 24 hours to process it. I'm often blah for that time. But I also remind myself of why I do my job and the good things I have. My testimony is a great source of strength. Today, I played with my nephew so my sister could sleep and hung out with my friends. Weston is a crazy 2 year old who gets so excited over blue cars, the sky, and running outside. Simple things. But they make him happy. His new favorite word is, "okay." Makes me laugh every time he says it too. Summer rain storms are one of my favorite things. Today, the rain poured--the smell came through the window and the rainbow was bright. A Tender Mercy just for me. Letting me cope with my job so I can go back and do it again tomorrow.
The shift started out like every other shift--coming into chaos and helping to sort it out. Around 1900 we get a call from American Fork they have a patient coming as a traumatic arrest. These are never good. The patient had been stuck in between two tractors crushing his chest and abdomen. They estimated he had been coding for 20min before medical help could even get there. He arrived with heart around 30bpm and a thready pulse. From there we got to work. Poor guy had bruising all over the place and a swollen belly. We dumped 5 units of blood and 4 units of FFP into him as soon as we can. To help paint the picture of the controlled chaos here is the basic process. On a nasty case like this we have 2 nurses, 2 techs, the respiratory therapist, the ER Doctor, the trauma nurse practitioner, and the trauma surgeon. In addition to x-ray, ultrasound, and CT techs. Lots of people and lots of things done REALLY fast. Luckily, we have someone there to write it all down. We ran him to CT scan and when we got him back his Blood pressure started to fall. Becky and I had 3 different doctors yelling 3 different orders at us. After drugs we hung, and fluids pushed in, he started to stablize. During this time the family came in. For me this is the hardest part. While I'm running around trying to do my job, the son kept saying "come on dad you can pull through, you can do it." The wife at the head of the bed just crying. We got him up to the ICU, stable and in one piece. After finishing our charting, Becky and I walked downstairs to hear the radio go off again. Provo was out on a motorcycle accident where the patient hit a sign full on with her body. Their call was basically she's alive here we come. Frantically, we restocked the drugs, supplies and cleaned what we could before they rolled in.
They rolled her in, she was still talking and crying in pain. Strapped to a backboard we moved her over onto our bed. After a quick assessment she screamed when she was touched here and pushed there, we intubated. I pushed the drugs and my doctor tubed her. IV's were started, fluid and once again blood was pushed in as fast as we could. Drugs were pushed and we ran to scanner. Her injuries were astounding. The pelvis was in 4 pieces, a broken femur, and a tear in the aorta. Overall, NOT GOOD! We rolled back into the trauma room and thought we were in the clear. Watching the monitors, pushing blood, and starting the drips to help her stay stable. She did not stay that way. Shortly after she tanks on us. More Doctors come in to decide what to do. While they discuss we are trading off with chest compressions, drug pushing, and blood squeezing trying to keep her heart alive. The cardio/thorasic surgeon (yeah it was that bad) had the chest cracking tray open and put in a chest tube. Blood went everywhere. Within seconds almost a liter of blood flooded out. By then there wasn't any hope. Her heart came in and out with a beat. At that point there was nothing more we could do. The monitors were turned off and she was covered up as we let the family into say goodbye.
Needless to say it was an emotional rollarcoaster that night. One of the honors I have as well as one of the hardest things I do is clean up the body of a patient that has passed away. The family asked to have all the tubes removed. I went in and pulled out all the tubes, ivs, and tape. For a secong I thought about asking her to lift her arm up so I could wrap up the IV site. I shed a tear after that. The sister looked at me and asked how I did my job. I do it to give a person a fighting chance to live. To give the family a chance to say goodbye. Its hard but rewarding. I do it because I have some amazing people to work with. After 6 hours of adrenaline rushing running, I was tired but still had to go out and take care of patients--our waiting room was still full. But I was exhausted the rest of the night, as was everyone else!
So how do I cope with this kinda of situation? Tears are shed of course. I allow myself 24 hours to process it. I'm often blah for that time. But I also remind myself of why I do my job and the good things I have. My testimony is a great source of strength. Today, I played with my nephew so my sister could sleep and hung out with my friends. Weston is a crazy 2 year old who gets so excited over blue cars, the sky, and running outside. Simple things. But they make him happy. His new favorite word is, "okay." Makes me laugh every time he says it too. Summer rain storms are one of my favorite things. Today, the rain poured--the smell came through the window and the rainbow was bright. A Tender Mercy just for me. Letting me cope with my job so I can go back and do it again tomorrow.
Holy Cow!
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