Post by groo on Apr 17, 2024 4:42:34 GMT -5
Fun ICU story. One of the many very bad things that can happen after coronary artery bypass grafts is “losing a clip”. This means one of the fasteners securing the grafts dislodges after the surgery is finished and the graft starts free bleeding into the pericardium after the chest is closed. It is rare. Never happens with the great surgeons but I saw it a couple of times over a decade.
But we keep a three big ass surgical trolley’s prepped and checked twice a day - just in case.
The worst possible time this can happen is between Midnight and 6am. You’re in the ICRN’s hands then until we can get an Intensivist and Cardiac surgeon back in - it only takes 15-20 minutes but that’s a long time when you’re bleeding out. 10-15 years ago some ICRNs were trained to reopen the chest and just try and control the bleeding. I was taught it by one of the best surgeons in Australia. As I was taught I remember thinking oh HELL no! But eventually the training just takes over. It’s not trained anymore. Less liability for hospitals to just let the patient die.
It’s 5:45am. The unit is quiet. I’m float (senior extra pair of hands) - I’ve been watching large drain output on a fresh heart - it was sitting just below the start panicking level since admission. The Registrar had been throwing packed red cells and clotting factors at it all night. It was seriously borderline. I’m at the other end of the unit and I hear the Clinical Nurse in charge yelling. “Get a fucking surgeon or this guys is gonna die!” We don’t normally roll that way in ICU want to see calm in a crisis? Visit an ICU.
I take off running to get the first trolley, collaring 2 junior RNs as I sprint down the ward to move the other trolleys. Trying to run the re-open procedure in my mind.
Cue heavenly music, the best cardio-thoracic surgeon in Australia strolls through the unit doors - doing an early round. Not his patient - but absolutely the guy I wanted to see. A re-open is about the only time an Intensivist ever defers to another Dr.
Surgeon is all over it immediately. But ICRNs are not surgical nurses. I’m running the haemodynamics and thanking god I’m not doing the re-open. Shit is flying everywhere as the team rips open the sterile packaging and the surgeon gowns, sterile gloves without scrubbing - there is no time.
I’m frantically stripping everything but sedation and vasopressors out of the IV pumps and replacing it with blood volume expanders. Surgeon is yelling just let it run (as in not put it through a pump) I’m yelling these pumps are faster and slapping lines into the pumps at 999ml/hour - much faster than than using pressure bags. These were new tech and theatres didn’t have them yet. Surgeon is elbows deep in this guys chest, and pulls out a double handful of clot and shouts “bowl” but the trolleys look like they have exploded and there is packaging everywhere. So the surgeon just drops it on the floor and goes back in to get control of the bleeding. Intensivist arrives - just stands watching - there is nothing he can do. The emergency surgery team rolls in and they roll the patient out with the surgeon holding the clamped artery running next to the bed. They leave a trail of blood and sterile packaging as they rush the patient back to surgery.
The Intensivist grins and looks me up and down. I’m covered in blood and probably looking a bit shell shocked.
He says “Tough night?”
Longest 12 minutes of my life and not what you need at the end of a 12 hour night shift.
Guy survived. And that kiddies is why we call it walking with the gods.
6:09 PM · Apr 17, 2024
·
328
Views
But we keep a three big ass surgical trolley’s prepped and checked twice a day - just in case.
The worst possible time this can happen is between Midnight and 6am. You’re in the ICRN’s hands then until we can get an Intensivist and Cardiac surgeon back in - it only takes 15-20 minutes but that’s a long time when you’re bleeding out. 10-15 years ago some ICRNs were trained to reopen the chest and just try and control the bleeding. I was taught it by one of the best surgeons in Australia. As I was taught I remember thinking oh HELL no! But eventually the training just takes over. It’s not trained anymore. Less liability for hospitals to just let the patient die.
It’s 5:45am. The unit is quiet. I’m float (senior extra pair of hands) - I’ve been watching large drain output on a fresh heart - it was sitting just below the start panicking level since admission. The Registrar had been throwing packed red cells and clotting factors at it all night. It was seriously borderline. I’m at the other end of the unit and I hear the Clinical Nurse in charge yelling. “Get a fucking surgeon or this guys is gonna die!” We don’t normally roll that way in ICU want to see calm in a crisis? Visit an ICU.
I take off running to get the first trolley, collaring 2 junior RNs as I sprint down the ward to move the other trolleys. Trying to run the re-open procedure in my mind.
Cue heavenly music, the best cardio-thoracic surgeon in Australia strolls through the unit doors - doing an early round. Not his patient - but absolutely the guy I wanted to see. A re-open is about the only time an Intensivist ever defers to another Dr.
Surgeon is all over it immediately. But ICRNs are not surgical nurses. I’m running the haemodynamics and thanking god I’m not doing the re-open. Shit is flying everywhere as the team rips open the sterile packaging and the surgeon gowns, sterile gloves without scrubbing - there is no time.
I’m frantically stripping everything but sedation and vasopressors out of the IV pumps and replacing it with blood volume expanders. Surgeon is yelling just let it run (as in not put it through a pump) I’m yelling these pumps are faster and slapping lines into the pumps at 999ml/hour - much faster than than using pressure bags. These were new tech and theatres didn’t have them yet. Surgeon is elbows deep in this guys chest, and pulls out a double handful of clot and shouts “bowl” but the trolleys look like they have exploded and there is packaging everywhere. So the surgeon just drops it on the floor and goes back in to get control of the bleeding. Intensivist arrives - just stands watching - there is nothing he can do. The emergency surgery team rolls in and they roll the patient out with the surgeon holding the clamped artery running next to the bed. They leave a trail of blood and sterile packaging as they rush the patient back to surgery.
The Intensivist grins and looks me up and down. I’m covered in blood and probably looking a bit shell shocked.
He says “Tough night?”
Longest 12 minutes of my life and not what you need at the end of a 12 hour night shift.
Guy survived. And that kiddies is why we call it walking with the gods.
6:09 PM · Apr 17, 2024
·
328
Views
