Spiga


Trau·ma  Junk· ie  ( 'trau-m&  'j&[ng]-kE) n. Slang
  1. One who has an insatiable interest, devotion or addiction to responding and assisting people with serious injury or shock to the body, as from violence or an accident.

I may just be a student, but...

Dear ICU nurse,

You're right about one thing-- I am a student. You're wrong about the other-- this doesn't mean I don't know what I'm talking about when it comes to the respiratory care of a patient (I mean, there is a reason we're called RESPIRATORY therapists, respiratory therapy students).

When I told you that increasing the FIO2 on your long-time COPDer in bed 7 would knock out her drive to breathe, I'm sorry you weren't satisfied with my knowledge. I am just a student, but not only have I read about, I've seen it happen. 88% is, in fact, an acceptable to SpO2 for this patient, and as she wasn't in distress and her blood gases were within normal limits for the typical COPD patient, there was no reason for alarm.

But I'm just a student. You didn't buy what I had to say.

When I told you I didn't think it was a good idea, in my opinion, to increase her FIO2, you did it anyway. You were shocked when her sats dropped from 88% to 82% and her respiratory rate slowed severely. Again, calmly and professionally, I tried to explain this to you.

Finally, it reached a point where it was time to do something before your patient coded. You started screaming for BiPAP. I explained that since her respiratory drive was no longer stable, she wasn't a candidate for BiPAP, coupled with the fact that she had *severe* anxiety and was extremely claustrophobic.

I suggested we intubate your patient, instead, before matters became worse. You know, give her a break, allow her to resume a normal breathing pattern. I'm ALL for BiPAP to avoid intubation, but BiPAP wasn't indicated anymore.

Well, you went ahead and did it anyway. You called the hospitalist, instead of the pulmonary doctor, and got an order and placed the patient on BiPAP. She crashed harder. She damn near coded. A few minutes later, here comes the pulmonologist with the intubation kit.

Your patient is now intubated. Her gases are awful. I'm just a student, but she will have to be tubed for a lot longer than she would have if you could have had a little faith in me.

I don't try to piddle in nursing things. Don't piddle with respiratory.

Kthxbai.

Much Love,

TJ

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