when the moon is full....

so i was put on call this morning. (yes, i did the happy dance at 5 am lol). this is only because i was off this weekend and am off the next 2 days as well. BUT i had to go in to work at 3 pm. it was the middle of the day... but i could already tell the moon was going to be full tonight. as i am sure that most people understand, the full moon brings out the best in people. right?? :)

first off, the first patient i go to see has like an airway obstruction. sats are 82% on 3L. yay! HR 155. beautiful! temp 102.2. getting better? ng tube with tube feeding. so in the middle of all of this... i put him up to 4L.. sats only go up to 86% even after he coughs up some of the yummiest sputum out there. seriously. the respiratory tech and i argue about whether or not it was tube feeding. i stand my ground.. it was much too yellow to be tube feeding. yes, tube feeding is a shade of yellow/brown, but this just looked purulent and not like any other aspirated tube feeding that i have ever seen. his lungs were full of rhonchi down to the bases.. which is another reason i didn't think it was aspiration. anyhow.. sats weren't better, so i preoxygenated him with 6L of O2 and then suctioned the mess out of him. sats instantly to the mid 90s (yay!) and put him back down on 3.5L where he stayed well oxygenated. Now the doozy.. during this time, the man is calm, has some chills, but is alert and oriented and not a problem. once i got the sats up.. he was plain nutty! usually, it is the other way around! not today :) gotta be the moon.

so once he is fixed.. emergency in the dialysis room. pt is bleeding out of the graft site. plts are 18. doesn't take a neurosurgeon to figure out that one. but the surgeon that responded to sew up the graft site wasn't too thrilled about it. luckily i got to monitor the rhythms and the phones during all of that. i have already seen one person bleed out in real life.. i really prefer not to see anymore. this person in dialysis was stablized but she is a dnr and probably won't make it through the night or much longer than that if she does. because i know her well as a patient.. she will really be in a much better place than where she is right now. because right now she is miserable and there is nothing that we can do to prevent it. not even treat it.

and i cannot forget about my country patient. alcoholic.. lethargic... just a plain mess. he was actually better back on friday when i had him. he had woken up some then.. was more alert. today.. hallucinating, lethargic, weak, speech so slurred that you couldn't understand a word he said. hardly a response to pain unless you count that evil glare he gave me with deep nail bed pressure. he sure didn't move his leg back in response to it. i can't imagine that he is going to pull out of this anytime soon. he must certainly be visiting liver land or something to that effect because he is well past the time to go through dt's. either that or it's just the moon. heh.

and now i am off for a couple more days. hopefully by the time i get back to work.. the moon will wax or wane itself away, and we on the floor can get back to the normalcy of our pleasantly confused patients without the added effect of the moon.