Saturday, July 13, 2019

Fresh feelings

Part of being a nurse for ten (10!) years is that the mundane, ridiculous stuff no longer warrants a blog post. I have seen a lot, been called a lot of names, and witnessed such a wide variety of foreign bodies in rectums that I no longer rush home to write about all these events. The shit that I used to write about four times a week is still happening, but there's only so many times I can reword the same feelings into fresh posts.

But this week, I experienced a patient that truly made me want to come home and write about it. So here I am!


The highest potassium I had ever seen before, up until this week, was 8.3 - I thought that would be a record to stand for a long while. But a few days ago we pulled a patient out of a car who was pulseless, gray, and apneic. I jumped onto compressions and we got started with the usual code process.

When the labs came back a few minutes later, the potassium was 8.9...EIGHT POINT NINE. You didn't read that wrong.

We gave more calcium, bicarb, insulin, and dextrose that I've ever given to someone before. After 45 minutes and the third round of CPR with subsequent ROSC, a coworker called out to the doctor that the patient had opened his eyes. I thought that surely she was imagining things but when I went over to the patient and asked him to squeeze my hand he promptly followed that command.

I went up to visit him in the ICU the next day. He's awake and though still critically ill, intubated, and on pressors is following all commands.

As any of you ER people know, this is the rarest of occasions. We don't usually get wins like this. Normally the okay people stay okay, the really sick ones we often prevent from getting sicker, and the dead ones stay dead. There's only been a few times in my career where I can look back and say definitively that I and my coworkers took a dead person and made them alive again. This week it happened, and I am still so happy I was a part of his care.


If there's anyone out there still reading this blog, thank you for caring about what I have to say!


Pat Bowne said...

I'm reading, and I'll refer my students to this post when I teach potassium balance next semester! They can explain the rationale for all the treatments to me. :)
I've really been enjoying your posts.

Kitsuri02 said...

I love all the things you have to say. Your adventures are fun to read. :)

Oldfoolrn said...

I love reading your posts. I'm so glad your patient had a good outcome. It's so easy to remember only the bad stuff (for me anyway...It seems like there is a graveyard in the back of my head sometimes.)

Back in the day elevated K levels were met with an onslaught of Kayexelate gastric lavages and retention enemas. Hospital beds resembled playground seesaws. Reverse Trendelenberg for the lavage and Trendelenberg for the backside buffoonery. I would have never believe a patient could survive a > 8 level. We started going crazy at 6 mEq.