I've started to realize that I lose my filter in conversation as the day progresses. Chalk it up to being extraordinarily over worked, mental Olympics to get report ready, or that one last stat abg on the floor that winds up with critical results on every. single. line. So games are always fun, so here's a multiple choice pop quiz because I know a lot of you guys are students.
1. In a 12 bed MICU, what should be the maximum amount of vented patients ONE therapist should be assigned?
a. Four
b. Two, as well as other admits/breathing treatments and maybe a floor
c. Six
d. Ten, plus a floor with tons of frequent fliers with flu/wheezes.
e. N/A because your hospital has fantastic staffing (*envious*)
2. When you have an emergent intubation on a patient that has an unknown metabolic acidosis, would you put them on normal "nbrc" modes (rate of 10 or 12) of ventilation to begin with?
a. True
b. False
c. It doesn't matter because the NP has no clue what he/she's doing and he/she will not listen to what you have to say.
3. Who should ultimately be held accountable for a patient?
a. The attending
b. The admitting surgeon
c. The RN/RT
d. The resident
e. What does that word mean? aaaaah count ahhhh bility?
4. What is the fastest way to anger a mid-level (PA/NP)?
a. Ask how long they worked bedside before getting their licence
b. Tell them that the changes they want you to make are dumb
c. Go call the attending with questions instead of asking them what they would like to do
d. All of the above
just for fun one more
5. Why does PACU suck for me so much?
a. Finding supplies is absolutely impossible
b. Anesthesia trying to tell me to put a patient on 10cc's/kg because "that's what they need"
c. I have no clue what the patient had done in surgery or what the nurses name is
d. No therapist is actually assigned to that mess and I frequently have to deal with it
e. Being paged for a "wake up vent" in bay three because anesthesia wants to go home early
"Answers" per me.
1. b. I don't think one RT should have to round on more than four vents in an ICU. That takes in consideration getting the Q3 vent checks in as well as all the little abg/vbg/mvo2/mini bal/coding patients/new admits going crazy that pop up like they do. I once had an ICU that started with 3 vents, and then ended up with 9 at the end of my shift. Can we say tbh, fml. Oh, and a floor added on to all that nonsense. This is a staffing issue. There are 8 therapists on the shift, one supervisor, and 8 ICUs. Let's not even get into the floors/ER that have to be tacked onto the assignments. I'd be interested to hear how other hospitals are staffed, so if you feel strongly about therapist to vented patient ratios, leave me a comment.
2 b. False. I'm a fan of lower tidal volumes and higher rates, so I set the rate high to blow off CO2 to compensate for a low bicarb. No one knew where the acidosis came from, but yet the NP wanted to start weaning the rate on a perfect gas before we even knew where the met acidosis came from. Why would you start weaning the minute volume before addressing WHAT KIND OF ACIDOSIS IT IS/FIXING THAT FIRST?! Once the acidosis is starting to be resolved, I'm perfectly fine with weaning rates, but not when the bicarb on the patient is SIX. Ok, rant is mostly over.
3. E. Very rarely will someone step up and be accountable for a mistake. The other day I saw a cardio-thoracic surgeon causing a huge scene in the ICU because a resident didn't order a mixed venous on his patient who was in heart failure. Well, mister CT surgeon, you can yell and scream all you want at us about accountability, but you were the one that did a mitral valve repair and coronary arterial bypass graft x2 open heart on pump on a ninety-something year old with multiple comorbidities.
4. d. all of the above. heh.
5. Every single bit. a b c d. But answer E really ruffles my feathers because these patients are on one of our vents for MAYBE one hour, and are charged about 3k because someone's feeling lazy. Sigh, oh the issues with healthcare.
Anyway. Quiz time is over for now. Just another way to skillfully organize my complaints over the last few weeks.
I think I've touched on this subject before, but I'm going to go here again anyway. I believe in hospice 100% for end of life care. I also believe that having a solid plan put together for a senior citizen would save a whole hell of a lot of money for the patients, hospitals and the government. But shhhh. No one likes to talk about death, and how most people face their last day on earth as torture with tubes in every orifice. The old and dying population account for 80% of healthcare costs, but yet family members still want everything done to their 92 year old grandma that is constantly aspirating her tube feeds and has basically no sedation because the PA wants to be "progressive" and not use continuous drips of seditives. Next stop for grandma is trach and peg land, and then get ready for some faaaantastic nursing home care that will include huge decubitus ulcers, and some kind of new antibiotic resistant super bug that's been going around in that facility. But the last stop is back to the hospital and into the ICU/ED where we will still try and keep her alive by shoving needles in her for central lines, a-lines, and doing cpr that will most undoubtedly crack a few of her frail ribs. All of that, or, grandma gets to be in her warm bed at home with fido curled up by her side, all of her loved ones next to her, and the hospice nurse dosing her up on morphine to help ease the pain and work of breathing from her heart slowly giving out.
I just don't think the general public is aware of this. I wish that weren't the case, I honestly do.
