The patient survived untill D3….His MAP was around 55 mmHg at a medium dose of dopamine…. There were 2 incidences which irritated me …
On D2 the patient’s condition was still bad – MAP ~ 0-30mmHg and tachycardic…
The patient sustained an open fracture over his left hand, the surgeons had planned to repair it after the laparotomy but it was not perform as the patient’s condition was too ill. On D2, while I was doing rounds in the ICU, I had seen him and asked the orthopedic surgeon to see him and at least do a simple debridement at the bedside. While the surgeon was preparing to do so…. The nursing specialist of the surgeon walked in to the ICU and advised the surgeon in a high tone –“ No need to do so, just wash up, the patient is going to die anytime today…” I almost lost control and wanted to walk toward her and give her a good slam…well, she is really an aXXhXle as far as I concerned. Her boss had covered her well, she is a dare daring person, she is always late on our case conference. She buy her lunch at 11:45am at the food store. You could hear her grumbled how busy she was when she had only almost handful of patients under their service.…She hardly renewed order for their ICU patient , you could see patient with order that dated 10 days ago(order should be renewed at least once per week )…. Arrogant and knowledge poor person who keep writing patient had bad digestion and poor bowel movement but never bother to manage the patient’s hypokalemia….
3 hrs later after the irritating words, I got a call again from the ICU…. The patient had removed his endotracheal tube. “WTF,” I mumbled on my way to the ICU. I saw the patient again struggling under restrain at a MAP of 10 mmHg. I asked the nurses what happened, and the nurse told me that the patient had removed his endotracheal tube while they were performing the rolling over position change. I asked,” Wasn’t the patient under restrain ?” the nurse in charge told met that they thought the patient was “flaccid” as the BP was so low…. “Flaccid” my aXs, never violate the SOP(standard operating procedure) was the rule of engagement working. I shook my head and ordered some propofol while taking my position. The intubation was smooth and I waited for the mouth bite while the nurses were trying to fix the ETT. I asked for the bite but no one had seem to care about my pledge. And during my 3rd request, the nurse in charge told me in a high tone(in a sense of telling me the TRUTH) that the patient is suffering from air hunger and don’t need a bite as he was opening his mouth all the time gasping for air…I almost roar but tell them in a very serious tone – “ then no bite for him and THERE WILL BE NO BITE for this patient FOR THE REST OF HIS STAY….”
The next day, someone told me that the patient was given 2 bites as he started to bite the ETT hours later….
This nursing department is SICKED as far as I concerned… the nurses had dared to violate the SOP under their discretion(which proved to be fatal in some of the situation…), I had prayed well for the patients.....what the heck happened ? simple we had a nursing director who was so “Lemah Lembut”(weak and soft) that no nurses would be punished /demoted for their fault… the head nurse of ICU had gone for a long leave and the acting head nurse is a BIG(in size I mean ) BULLY who is another arrogant lady who was .,..
PS: pt was transferred on D3 and died in another hospital - he did not make it for his second ops...
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