Saturday, 25 April 2009

Penultimate Shift

It was two days ago. I'm late, so sue me.

And due to a toothache I'm not feeling recovered at all. But I'll trundle on.

It was a good shift. A shift which started with one Level 2 patient and ended with a different 2/3 patient. The story of the latter was somewhat sad, although I'll find out tomorrow just how sad it turned out.

The patient had a medical history as long as my arm, for starters, and was no spring chicken. These two things set off warning bells, in my head, at least. This patient was brought into A&E and then into ICU due to a quite tenacious case of community-acquired pneumonia. Placed on CPAP for a long, long time. CPAP basically comprises of a spaceman-style facemask. Something you are basically strapped into. You might get a break once every four hours, if your oxygen levels are up to it, but generally you're stuck in it. And it's like hanging your head out of a car window at 70MPH (although without the risk of it being knocked off comically by a signpost). Trapped in, blown at. And you can't drink, eat or talk to any useful degree. Not pleasant.

On the plus side, it is very, very effective. The patient was improving. There had been fears the patient would have to be sedated and intubated if their condition worsened, which was entirely possible. The doctors were optimistic (this is, as previously mentioned, rare). The nursing day was going well. We were on top of things, would you believe! And then, of course, something happened.

After having a few visitors, the patient decided they'd had enough of the mask. We spent a little while trying to convince this patient that keeping the mask on, as difficult and awful as it can be for the whole day, would be the best thing to do. As a compromise, my mentor decided to step him down to a normal face mask on high, high flow oxygen.

And we watched. The patient seemed happier, the family were a lot more worried, but the consultant said we'd see how it went. And within a half hour their saturations were holding well, blood gases weren't terrible. My shift ended then and so I'll see, on Sunday, how it panned out. Well, it goes without saying, I hope.

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