night 7, made it to the end of another set of nights!

again, not much to do except babysit. just as well, as i think im coming down with this bug that everyones got. loads of the anaesthetic regs were away from theatre earlier in the week. guess ive got it now. feeling distinctly sore in the throat, feverish and sniffling... still, im now off for four weeks, so shouldnt complain. managed to get down a full lunch tonight, despite feeling shit.

food of the night:

cantonese roast duck and rice, three pots of tea (may need more...)

tried to drown out this stupid virus with fluid. usually works. anyhow, shift over, nights over, feeling shit, but now off for a long time... woohoo i guess. =|

posted by Chas at 10:10
go ahead, roll the donut!

 
night 6, fairly quiet yet again.

not much to say really. spent a lot of time in the staff room watching videos on some crappy cable music channel. "stacys mom" by fountains of wayne is one hilariously awesome track. her mom is rachel hunter right?

food of the night:

egg fried rice. too much salt. ugh...

posted by Chas at 08:28
go ahead, roll the donut!

 
night 5, continuing the current series of peaceful night shifts... just a couple of things of interest tonight...

aortic root replacement man extubated himself for the third time. often needing propofol overnight, he spoofed out his nurse tonight by making a sudden move for his tube... had to reintubate fairly quickish cuz he was desaturating. guess hell have to go for tracheostomy now...

ran around a bit with data collection and blood sampling from todays mvr* with high pa* pressure on iv sildenafil trial.

otherwise, just some standard babysitting really.

i see that those 5 dodgy british geezers from guantanamo bay have arrived back in britain. raf northolt to paddington green police station for 4 of them. wonder what the verdict will be...

food of the night:

shredded pork fried noodles

----
* mvr = mitral valve replacement, pa = pulmonary artery

posted by Chas at 07:48
go ahead, roll the donut!

 
night 4, yet another peaceful one...

aneurysm lady went for her planned pack removal and formal closure during the day, made it back from theatre amazingly a second time, not that acidotic either! even more amazingly, i managed to get her off dopexamine a few hours ago, cuz her indices were getting a bit too good (cardiac index over 4 with resistance around 600)! if she maintains this kinda progress, should be able to get her off her noradrenaline too later today and head towards extubation...

got another rsi* under my belt tonight... an elderly dude producing copious amounts of pleural and peritoneal effusions over the last few months, cause for which still unknown, possible neoplastic, tb or some other shit, the only positive finding so far being benign mesothelial cells in his ascites. underwent elective unilateral pleurodesis on this admission, but then went into ventilatory failure afterwards requiring intubation, extubated onto bipap*, held at this level for several days on the unit, but suddenly and unexpectedly deteriorated during the day, with him tiring and his carbon dioxide reaching 11 soon after i came on shift tonight. nice grade 1 tube. carbon dioxide came back down to around 8, oxygenation never a problem.

no news of note for yet another night. the world is so boring this week.

food of the night:

shepherds pie, deli crumbed ham, muller fruit corner strawberry, crisps x2 again, tea

----
* rsi = rapid sequence induction, bipap = biphasic positive airways pressure

posted by Chas at 07:57
go ahead, roll the donut!

 
night 3, another peaceful one...

no new admissions, almost took another for general icu, avoided with some smart bed managing by our charge nurse, even though it shouldnt have been his job to do so.

all 6 on the unit behaved themselves mostly. resited an arterial line that had mysteriously "fallen out" in the middle of the night, as they do...

aneurysm lady actually deteriorated during the day, with acute renal failure developing and a base excess of -12 again handed back to me on my arrival tonight. stuck in a haemofiltration cathether and started her on cvvhf*. also sited a pulmonary artery catheter too, just to see what her heart was actually doing. wouldnt wedge properly, even sent her into a short run of vt* while i was in her rv*! ended up just pulling it back. she could do without cardiac numbers for a couple of hours, having stabilised out on higher dopexamine. vascular want to take her back to theatre in the morning for pack removal and formal closure. she might just make it off the table. we shall see... =(

niven will be on his own today, no second person on duty with him, happens sometimes. better make the handover as slick as possible to keep his workload down.

food of the night:

braised pork, broccoli, rice

----
* cvvhf = continuous venovenous haemofiltration, vt = ventricular tachycardia, rv = right ventricle

posted by Chas at 07:43
go ahead, roll the donut!

 
night 2, very peaceful...

only 8 patients to babysit tonight. discharged 2 back to the ward to make space available for general icu overspill. as usual, general icu were full and were in a panic, looking for another bed, in case of another new admission. my boss agreed to letting them use one of ours overnight. as it turned out, they found one for us. grr...

78 yearold lady presented to the ed with back/bilateral loin pain, worse over the course of the day, 7cm aaa* on palpation, confirmed on ct scan, maintaining a systolic around 100. went straight to theatre to be repaired with a graft, then to us after. came off the table on just a bit of adrenaline, not much else required. for the rest of the night, made a remarkable recovery, even if i do say so myself...

from a -17 base excess out of theatre, i handed her over to the daytime crew with her base excess at -5. good or what! plus she was actually peeing around 30 an hour too! *proud*

other than that, all the others were quite stable. managed to watch both shows that i had planned for around 4am, an episode of "off centre" and an episode of "jack & jill". both were repeats that id seen before, and it wasnt my fav episode with the chau project (1.15 "faking the band"), but hey, i love these shows, so...

food of the night:

pork and veg dumplings, dozen, crisps, 2 packs, banana

----
* aaa = abdominal aortic aneurysm

posted by Chas at 11:53
go ahead, roll the donut!

 
ok, so here i am, back on nights again...

been really bad about updating the donut. busier at work last couple months. also got burgled, so lacked puter capability for a while. insurance company got me a new laptop, so back online again, but still only managing to update with night stories...

night 1, not too bad...

got lumbered with 3 new cases to admit that the daytime guys didnt have time to sort out. happens that way sometimes with these elective cases. they come out of theatre late in the day and recovery hang onto them until almost handover time... then they all pile into the unit at the same time, just as the day guys are about to leave... *sigh*

otherwise, not much happened really. not even much news going on in the world to report either.

food of the night:

chicken fried rice. pretty good it was too. =)

posted by Chas at 06:34
go ahead, roll the donut!