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May 18, 2021 4:19 AM
Leareth is a terrible ICU patient. Does this thread need to exist: no! but who can stop me
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"Yes, yes, I know..." And it's a good reminder to do slightly more troubleshooting, e.g. making a stop by the clean supply room and cramming a lot of possibly-necessary materials into her scrubs pockets. She doesn't know where to find anything in the emergency room, and radiology won't have half of what she needs short of ripping open a crash cart, so best to be prepared. 

Last stop, the break room, to stick her phone in her bra - you never know, she might have a long boring scan wait to check Facebook - and grab some change for the coffeeshop. 

There is, in fact, a wonderful shortage of line, and within sixty seconds of walking up, she has a grande Starbucks light roast and is forging onward. 

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There is not, at a first glance, anyone visibly available to talk to in the emergency room! It's shift change, and short-staffed; nearly everyone is pulled aside for reports.

In the trauma bay, one bed has the curtains pulled and someone inside - maybe several people - are audibly sobbing and wailing. Another has all of the lights on and about a dozen people crammed around, so that she can't actually see what's happening. 

The third looks a little like a hurricane just passed nearby it and left various excess packaging from supplies all over the floor. A couple of paramedics are using the top of the crash cart as a desk for paperwork, and a concerningly young - resident? medical student? - role unclear but definitely young, is hovering by the bed. 

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Marian spends a minute glaring dubiously at the heart monitor from a distance, and then pushes through the inevitable feeling of social awkwardness, and marches up closer. "Uhhh, I'm looking for - what's-her-name, the nurse - is he the admit for ICU, can someone give me a report or something....?"

She will also try to figure out whatever she can by just looking at the patient, whose code-name she's already managed to forget; she can't easily find it on her clipboard right now because her other hand is full of coffee, which she takes another scorching gulp of. 

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The patient does not notice or care about her appraisal! He's unconscious, strapped firmly to a backboard which is now sort of plopped onto the gurney, with his head immobilized between foam blocks; some of his dark hair, still soaking-wet, is stuck in the Velcro straps, which makes Marian wince. His clothes have been peeled off from the waist up, with one of the paramedics' horribly crinkly-scratchy blankets sort of flung over him. It's also wet at the edges. 

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Nobody has answered her question yet, so Marian keeps looking. 

Airway and breathing: he's already on a ventilator, check, though the monitor is failing to pick up a reliable oxygen saturation curve and is currently reading 68% with a question mark and beeping plaintively, and she can't read the settings because it's the stupid ED ventilator model with the unreadable-at-a-distance screen.

There's a blood pressure up on the monitor but she has no idea how long it's been there. She whacks the button again. His heart rate is steady at about 120, which is...fine...though not entirely reassuring if that's a real blood pressure number. 

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Footsteps. "Oh, phew, you're here. Can I give you report." The nurse finishes shedding her isolation gown and crams it into the nearest dirty-linens bucket. 

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"That would be great! Are you Lina?" Marian fumbles with her coffee and clipboard, trying to find a way to hold both and also a pen; after a couple of seconds she gives up and sets the coffee down under the patient's gurney, trying to make a firm mental note to definitely pick it up before wheeling him anywhere. 

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She gets a report! 

It is not the world's most helpful report! Police responded to reports of an explosion, found the man unconscious in the shallow water near the edge of the river. 

"Breathing and had a pulse when the paramedics got to him, but sats were in the low nineties when he got here on a hundred percent O2, and he was unresponsive, so we intubated him then. Vital signs otherwise decent -" 

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Marian is looking suspiciously at the monitor again. "When's the last time you got a decent sat reading? I bet it's because he's cold - here, I brought one of the stick-on kind for infants, I'll try it on his ear, sometimes that's better..." She grabs for the hand sanitizer and goes in to do this. "Uh, what's his temperature...?" 

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"Couldn't get a reading on it with ours, it just said 'low', but it's finicky below ninety-five. Ventilator settings, one sec..." Lina unrolls a crumpled scrap of paper. "Sorry, we've been running all night, I wish I had a better report for you." 

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"I get it." Marian scribbles down numbers. "IV lines, just the one it looks like - just saline, he doesn't have anything for sedation?"

She'll make a note to try to call Alice and get her to set up the thingy for warming IV fluids, if he's already hypothermic they shouldn't be dumping more cold fluids into him. 

The patient's hand is in fact very cold, nailbeds purplish and mottled from it; no wonder she can't get a pulse waveform there. When she tries moving it, though, it does eventually stabilize, the wave matching his heart rate and the number steadying out at 95%.

"There, that's better. Though if he's on seventy percent O2 it's not great. Apparently I'm supposed to detour by CT after this - can I steal your ventilator for it if I promise to bring it back right after?" She didn't think to grab the transport one, which incidentally she hates.

The blood pressure dings and provides a fresh number of 108/72. Marian squints at it with suspicion but writes it down. 

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"Sure, whatever." 

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"Is there anyone who can give me orders for sedation, if he wakes up in CT I'm going to be having a bad day." And also Alice will give her an 'I told you so'. 

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"Can you?" Lina says to the presumably-a-resident, then digs in her front pocket. "Oh, and I've got some propofol left over in here - it's technically from the lady next door but that was like twenty minutes ago." She offers Marian a ten-cc syringe and the half-empty vial. 

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...She has probably ever done something at work that felt sketchier than 'accepting a syringe of unlabeled drugs from a random ED nurse on faith' but Marian isn't sure what. 

"Uh, thank you? Can I have an IV pump anyway though. Just in case." There isn't one on the pole right now. She peers around.  

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"...Oh, they must all be in bed one, she spent half the night coding on us, but the family's in there now." 

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Marian grits her teeth, weighing out the stress of 'dragging a patient to CT by herself with literally no way to run IV drugs except by gravity', versus the agonizing social awkwardness of barging in on a family grieving their loved one in order to steal equipment from the dead body. 

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Lina sighs. "I'll go find you one. Emma, can you do the orders?" 

     "- Oh, right, sure." The resident heads for the nearest computer-on-wheels - or COW, as they're universally referred to by the staff. 

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Marian grits her teeth. Mortifying or not, she is not delighted at the current plan. "Uh, are you busy? Is there any way you could come to the scan with me, in case I– in case something comes up?" 

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The young woman lets out her breath. "I'm supposed to talk to the family in bed one after this," she says morosely. "You know what, sure, I can come with you. You're worried?" 

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"...I don't know if I am." The problem, Marian reflects, is that she knows about two point five things about this patient. I hate shift change admits. 

She tries to go down the mental list of things Alice nagged her about, and then the separate mental list of 'things she really ought to figure out for herself'. There used to be a checklist at the back of her clipboard but last week she somehow managed to let her patient pee on it and she hasn't been organized enough to print it out again. 

...Coffee retrieved, check, that'll help with thinking. "Right. Uh, Emma, any chance you know where they keep the soft restraints here? I know he's not awake now but I'm kind of paranoid about leaving intubated patients in scanners without that." 

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"Oh, that's a good point. Sorry, I don't know where anything is yet." 

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Great. That makes two of us, Marian thinks, gulping more coffee. It's finally cool enough not to scorch. 

She checks her watch. It's somehow already almost seven-fifteen, and this isn't even her patient. At least Leg Lifts Lady is boringly stable and doesn't have any scheduled meds before nine. 

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Just as Lina is getting back with an IV pump and more drugs, the intercom crackles to life.

"Code blue, ICU–"

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Marian endures a second of chest-thumping panic that her patient in 112 wasn't sufficiently restrained and has now pulled out her trach and gone into cardiac arrest as a result, but then the announcement finishes with 'room 110' instead and she relaxes fractionally. That's the patient with the misbehaving dialysis machine. ....Which sort of throws a wrench in calling Alice for help prepping the stupid room for Alice's stupid patient, but at least it can't possibly be her fault. 

....What else, come on, think. At this point Marian is definitely stalling, and it's because she hates transporting patients. She likes her patients to be in rooms where she knows where everything is, and where there's a crash cart right there and a supply room within twenty steps. She does not like to have patients in, say, elevators. Or CT scanners while she's evicted to the other room. 

She manages to stall for another two or three minutes, grabbing warm blankets from the blanket-warmer and piling them on Alice's soon-to-be-patient, then checking the IV pump and the oxygen tank under the gurney, and listening to the patient's lungs herself - definitely quieter-than-normal on the left side, which isn't especially surprising if he almost drowned but she's ticked off that she didn't get it in report. 

Lina gets the patient transferred onto the portable monitor. Marian frowns on it and then sets the blood pressure to cycle every five minutes instead of the default 'every hour'. And fiddles with the alarm settings so it stops pinging constantly for a heart rate above 100.

It's somehow 7:25 am. If she spends any longer delaying then she's going to run into the day shift scheduled CTs and have to WAIT which would be terrible. 

"Let's go," she says to Emma-the-resident, whose hospital nametag she can't read because it's flipped backward. She chugs the last of her coffee, balances her clipboard on the gurney beside the patient, they forge out into the hallway, Marian trying her absolute best not to swerve the gurney into any walls by mistake. The hallway is ALSO terrible but the sooner she starts the sooner it'll be over. 

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