I’ve managed not to kill anyone!

The most apt way to describe my first two weeks in Intensive Care is “overwhelming”. I’ve been slapped in the face - and slapped hard - with a steep learning curve; and am trying to fully assess and actually understand what is happening to my patients. Ventilators, art lines, ABGs, CVP monitoring, alarm after alarm, and a truckload of new infusions are things that I’m still struggling to come to grips with.

I have come to the realisation that when I thought I was used to looking after really sick patients in a neuro HDU, that the term “really sick” is unbelievably relative. Given that my new unit looks after some of the most critically ill patients in the state, it has become obvious that if someone is sick enough to be in ICU, then they are sicker than anyone I’ve looked after in my three years of surgical/high-dependency nursing. Now gone is the once-comforting thought of knowing that if my patients drops their bundle, they can always go up to ICU. Now that I’m in ICU, there is nowhere-else for my patient to go if they get sicker (other than the morgue). I’m playing with the big boys now; and have to bring my A-game each shift.

So far, I’ve looked after patients with the following problems:

• MVA resulting in massive chest trauma
• Cardiogenic shock
• Cardiogenic shock/sepsis/MOF
• Post-op cardiac surgery
• Subdural haematoma/failed extubation/ventilator dependence
• High spinal injury/ventilator dependence

As intimidating as all of this has been, it has been an awesome learning experience - one that once the initial shock wore off, I have really enjoyed. I’ve gone from being a teacher to being a student - from the proverbial big fish to a little fish in a really big pond. Thankfully, I’ve passed my first load of assessment and have now been entrusted with my own patients, without someone holding my hand.

So far, I’ve survived two shifts unsupervised, without killing anyone. On the couple of occasions where it appeared to have gone momentarily pear-shaped, I’ve been fortunate to have the support of the ICU nurses and doctors that really know their craft, and who are more than willing to share their knowledge. Awesome.

When all else fails, I just remember two important bits of advice:

Stop.
Breathe.
Think.
Act.

And probably the best bit of advice ever (cheers to Ian at ImpactED Nurse for this one):

Air goes in and out.
Blood goes round and round.
Oxygen is good.

It looks like its going to be an adventure.

Life is good.

One more sleep

Tomorrow will be a big day.

Tomorrow, I start in ICU.

Tomorrow, I go from being a big fish in a smallish pond to being a small fish, etc, etc…

I’ve never noticed it until now, but the word “tomorrow” really is a stupid-looking word. But back on topic - one more sleep until the big change. I often wonder about those people that say that a change is as good as a holiday. I don’t ever recall feeling this nervous before a holiday.

Personally, I think they’re full of crap.

Image of the month

Have always loved the creative grafitti on this street sign.