Friday, March 11, 2011

First Week of Clinicals


Ya'll....can I just tell you how much of a whirlwind the past two days have been? Seriously. I feel as if I have barely slept since Wednesday...mostly because I have barely slept since Wednesday.

My senior level clinicals started this week. And when I tell you it started out with a bang, that might be just the *tiniest* bit of an understatement.

On Thursday morning, I arrived at the hospital cafe to meet up with my clinical mates and our instructor. We headed to the hospital's medical library where we talked about past clinical experiences as well as what we all hoped to learn this go around.
The professor had several other students in the hospital at the time doing make-up clinical so she left us to a writing assignment while she went to check on them. After about 15 minutes of writing and listening to one of my clinical mates talk about her experiences as a paramedic (including telling us a story about a situation with a family in New Orleans that included the kidnapping of an 17 year old by his mother, a high speed car chase, and several of the male family members taking off their pants in the middle of the interstate [in order to keep them from falling off while they fought? No idea.]), the instructor walked in and asked a loaded question.

"So which of you has never seen a code before?"

Me, having no idea what I was getting myself into, jumped at the chance and said that I had never seen one.
She grabbed me and 3 of the other students and told us to follow her. This little woman can move fast! We ran up a flight of stairs to the medical acute care unit (MACU) where one of my other classmates was doing her make-up clinical one. From what I gathered later, while she was doing her morning assessment, her patient had started to have trouble breathing. She sat the bed up at a higher angle (to facilitate lung expansion) and increased the amount of O2 being given (don't worry...there was a doctor's order for it...because *technically* oxygen is considered a medication which nurses cannot give without an order) and the primary nurse called the medical response team (sometimes called the rapid response or emergency response team). By the time they arrived, the patient's heart had stopped beating.
When we arrived, the team was doing chest compressions, pushing epinephrine and breathing for her via an ambu-bag.
The cardiac monitor showed ventricular tachycardia but the patient didn't have a pulse.
With massive amounts of epinephrine pumping through her veins, the patient finally regained a pulse but it was weak and unstable.

It was an intense scene.

The team called for a room to be prepped in the ICU and within a few minutes we were on the way. My fellow nursing students and I followed the team and the patient into the unit and watched what can only be described as a tragic symphony. It was amazing to watch because it was just so coordinated.
Everyone knew what they were suppose to be doing and they acted like if they had done it half a million times before. One person put in a NG tube while another inserted a foley catheter. Someone was inserting another peripheral IV while a tech came in to do a 12lead EKG. The doctor was checking for a response to painful stimuli (which the patient DID NOT respond to). It all happened so fast.
When the team said they needed to place a central line, we left the room. It is the policy of the unit to lock the door once the procedure starts. No one gets in or out during it in order to reduce the risk of infection to the patient. And for those of you who are curious, a central line is a form of vascular access [like an IV] but instead of going into a small vein, it goes into a major one so it can be placed for long term access whereas an IV has to be changed every 2 to 3 days. It can be placed in the subclavian or jugular veins or it can be a PICC line [a peripheral inserted central catheter] which is placed in the arm but the catheter is very long and stops in the superior vena cava.
[and for any of you who were wondering, the next day when my classmate and I floated back up to the ICU, the patient was still alive and was more responsive.]

At this point our instructor had left us in the capable hands of the ICU nurses (and I must say, some of those chicks are freaky smart and ridiculously scary/intimidating).
But anyway, something was going on in the room next door, so we wandered over there.
They were preparing to preform a tracheostomy on a patient. O_o
One of the doctors had put in an ET tube and was using a laryngoscope to view the patient's trachea. Once both doctors were ready, one began to clean and prep the patient's skin with a ChloraPrep applicator. I was watching the monitor as the doctor took the scalpel and cut into the patient's throat. Seeing the scalpel pierce the trachea was surreal and I believe that I was the only one in the room to gasp [ hopefully no one noticed :-/ ].

And did I mention this was all before 11am? On our first day? Even before we had a chance to orient to our medsurg unit or take our calculations exam or do our trach care/central line care practicums?

Welcome to senior semester clinicals, darlings. It is going to be a wild ride. ;-)


CaLLie.ANN said...

SO jealous that you got to see all of that. A M A Z I N G!

Zazzy Episodes said...

How very exciting for you! Are interested in that specialty?