#respiratory therapist | Explore Tumblr Posts and Blogs

skyloftian-nutcase · 2 years

Text

Giving Report with the Healthcare Boys (LU in Healthcare snippets)

What patient handoff and/or shift change looks like for some of the boys!

Wild stretched as he entered the staff lounge and caught sight of a coworker getting on shift. His feet were sore and he had a headache, but overall he felt pretty good despite the chaotic day.

"How was today?" his coworker asked.

Wild shrugged. "Busy."

His coworker smirked. "Well at least you're actually mostly in uniform today."

Wild looked down at his black scrub bottoms (that he absolutely didn't steal from Twilight), light blue polo, and sleeveless black jacket. "Yeah, I guess so."

"What kind of adventures did you have today?"

Wild laughed. "Only one, thanks. We eventually found MRI."

"How long did it take for you and your patient to find MRI?"

"Um," Wild shifted awkwardly. "Maybe twenty minutes? Didn't mess up her appointment, so it was fine. Besides, she got to see the ambulance bay and a friend of mine showed her the back of the ambulance, which she thought was really cool."

"That sounds like way more than twenty minutes!" his coworker laughed.

"We had fun and got there eventually," Wild shrugged as he crossed his arms. "That's all that matters."

When his coworker continued to guffaw at the entire situation, Wild rolled his eyes exasperatedly and clocked out. He was ready to have some of the dinner that he'd made for himself yesterday, and he was excited to get home and relax.

XXX

"I just fueled her up, she should be set to fly for you tonight," Sky said as he pat his hand against the helicopter with a warm smile. "The only thing I can think of is that you need to watch the cyclic; it's a little jerky if you adjust it too fast. I was going to see if maybe I could look it over but we kept getting calls."

Belari nodded. "Got it! I'll take a look at it with the shift checks. Sorry you were flying all night, though."

Sky shrugged. "It wasn't too terrible. But I'm definitely ready to go to bed."

Belari laughed at that. "Sky, you're always ready to go to bed."

XXX

Twilight grabbed a clipboard and his finger slid down across different names of patients. "So these two are the ones who have been the biggest ones to look out for. Airway issues for this kid, and the parents aren't in there, so just keep an ear out, especially if her nurse is busy. The other is on seizure precautions, everything's set up but he's already had one seizure today."

The tech he was handing off to sighed. "Poor kid. I thought they'd gotten that under control."

"Yeah, we all thought that," Twilight remarked sadly before continuing with his report. "This one here is a standby with one assist, usually uses a bedside commode for toileting. This one in room 12 needs a sitter, you might get stuck there a bit. He's not really bad, just developmentally delayed and likes to throw things. He's nonverbal, but he understands more than you think, so just redirect him. Loves to listen to Barney, so I've literally just been playing it on repeat all day. Kept him pretty preoccupied. Rooms 1, 3, 4, and 5 are night baths. The 24 hour QCs have been done, I think you'll just have to do the EKG machines."

"Is the lift still broken?" his coworker asked with dread.

Twilight grimaced. "Uh, yeah. But the only one you'd need it for is room 8, and she's pretty light."

His coworker crossed her arms. "Yeah, light to you, Mr. I-Can-Bench-Press-the-Planet."

Twilight couldn't help the laugh that escaped him, and then he spluttered to try and compensate when she waved him off.

"Get out of here, Twi," she said exasperatedly. "It's gonna be a long night and you don't need to be here for it."

XXX

Wind settled beside his preceptor as the night shift respiratory therapist pulled up a chair. He shifted nervously, knowing that Daphnes had said he would be giving report for one of the patients; this was Wind's first time even attempting to give report.

"All right, go for it," his preceptor's relief said, ready for report.

Wind swallowed and nodded. "Okay, so room 12 is a 54-year-old female, post-op day 1 for a CABGx3. She's still intubated because they can't get a good neuro on her, I think? Like for us she's been fine, breathing spontaneously on the vent, but they're afraid she can't protect her airway if we extubate."

Daphnes held out a small piece of paper to Wind, who jumped, realizing what he'd forgotten. "Oh! Right, her last gas looked good, but her lactate was high so that's another issue she's got going on. She's got a 7.5 ETT, 23 at the lips, cuff's fully inflated and intact. She's on 30% FiO2, PEEP of 8, pressure support."

"Tolerating the vent? Suctioning, any secretions you're getting out?"

Wind's heart skipped another beat as he felt like he was messing everything up. "She's tolerating it, yeah. Hasn't really bucked it all. Because, you know, no neuro and the like. She isn't following commands or anything. They're not sure what's wrong. She doesn't have a lot of secretions, last time I went in she was good. Lung sounds are clear, a little diminished in the bases."

The respiratory therapist finished scribbling notes and then nodded. "Okay, sounds good."

Wind leaned back heavily in his seat as his preceptor gave report on the other two patients they'd been caring for. When he was finished, Daphnes put a hand on Wind's shoulder.

"Good job on report," he said with a smile.

Wind watched him uncertainly. "I thought it sucked."

Daphnes laughed. "It's your first report. You went over the broad strokes. You'll get there, Wind. Good work today."

Smiling, Wind perked up and nodded. "Thanks."

XXX

Hyrule tried not to feel overwhelmed when he brought the stretcher into the large room filled with people waiting for him. He could do his job and take care of the patient, but giving report always made him nervous.

He caught sight of Legend in the corner, who gave him a smile and a nod.

Taking a deep breath, Hyrule stood beside the stretcher alongside a tech while Mo and another nurse moved to the other side of the hospital bed where they'd lined up with the stretcher, grabbing the sheet under the patient.

On three, the four slid the patient from the stretcher to the bed, and people swarmed around her as Hyrule stepped back.

"71-year-old female, stroke alert, last known normal was two hours ago at 1945," Hyrule started loudly so both Legend and the physician could hear him as they worked. "She's got right sided facial droop and arm weakness, as well as aphasia. No neglect or vision changes to my knowledge. She hasn't changed for us over transport, she's just been like this since we got on scene. She can follow commands, can't really say anything but she'll track your movement. Vitals have been stable throughout transport, glucose was 112. I've got bilateral 18s in both ACs, one's saline locked and the other's KVO. Sinus rhythm on the monitor. History of TIA and hypertension. Any questions?"

"Does she have family coming?" Legend asked as he labeled blood samples pulled from one of her IVs.

Hyrule nodded. "Daughter's on her way."

The charge nurse walked in. "CT 3 is ready for you guys."

Legend nodded. "Thanks, Roolie. We'll see you later."

With that, Hyrule stepped out of the room as Legend and a few others guided the patient's bed out of the room and headed off to get a head CT. He blew out a deep breath of relief and made his way to his partner, who was cleaning the stretcher.

"Well that was exciting," Mo commented.

Hyrule had to laugh. "Yeah, no kidding. Maybe we can sleep the rest of the night."

"You really think so?"

"...No."

"Me neither."

XXX

"Well you took your sweet time," Legend grumbled as Warriors plopped into a seat beside him.

"I can't help that morning huddle took an eternity," Warrior fired back, rolling his eyes. "I'm not charge today, and the one who is just stood there for like a solid five minutes figuring out where everyone should go. So what do you have for me?"

"In the twenty years it took you to get here, I discharged one of the patients," Legend explained, getting a good-natured chuckle out of his friend. He pulled up the other patients' charts. "You only have two to worry about. Room 28 is a 24-year-old female, A/Ox4, stable, she's here for generalized body aches, they're doing a flu workup for her so she's on droplet precautions. She's been stable, no known medical history, she's fine in there. I took care of all the orders for her, we're literally just waiting for results."

Warriors nodded, reviewing the chart briefly before Legend moved on to the next patient. "Okay, this other one is the issue. Roolie brought him in about an hour ago, respiratory distress CHF patient, was on CPAP with Roolie and then we intubated him here; he's on propofol for the sedation. He's gotten 60 of IV Lasix and 2 inches of nitro paste, got a Foley in and it's put out like 150 so far, so mostly responsive to the Lasix. But they did an echo on him and his EF is absolute garbage, so even though we're getting fluid off it isn't doing much. They're talking about putting him on a milrinone drip, I've got the tubing and stuff ready if they decide to do it. Big surprise, he's been consistently hypertensive for me, started out at 220/136 now his systolics are lingering in the 160s. He was tachycardic and I think the nitro didn't do him any favors for that, but the good thing about milrinone is that you got reflex bradycardia with it, so hurray."

Rubbing a hand over his face, Warriors grumbled, "You always manage to bring me such great patients, don't you?"

"Hey, I got rid of a stroke patient earlier, you should thank your lucky stars," Legend retorted. "Stroke alerted her and she went straight to surgery. These two are all you got. They're working on getting this one up to the ICU as soon as possible. You've got an 18 in the left AC and a 20 in the right upper arm. Your propofol is going at 30 in the AC. The tube is a 7.0 and it's 21 at the lips. They're alive. End of story."

"Well, that's all that matters, anyway," Warriors muttered, perusing the patient's chart before glancing at his friend. "You okay?"

Legend huffed. "Am I okay? Yeah, sure, we got our asses kicked last night. But it's over. Just going to stay a bit to catch up on charting and then I'm getting the hell out of this nightmare."

"Charting," Warriors said with as much disgust as he could muster. "I hate charting."

"You and me both. Good luck, Wars."

XXX

In the ICU it was typical to have only one to two patients. On a day like this, where staffing was short, however, it was surprising and rarely a good sign when one was lucky enough to be singled with a patient.

It usually meant the patient was a mess.

Four sighed as he grabbed his report sheet and his multicolored pens and sat down beside the nurse who he would be receiving report from. After pulling up the patient's chart, he gave his coworker an affirmative nod that he was ready.

"This is a John Doe, just got up to the unit at 1545 from the OR. He is approximately somewhere in his 30s. Involved in a motor vehicle crash, vehicle versus a tractor. He got extricated and flown here. He was awake and lethargic on scene, apparently, got RSI'd in the field when he couldn't really protect his airway from bleeding with facial trauma. Got 2 units of RBCs in the air, another in the ED, and another in the OR. CT showed right femur fracture, skull fracture with intracranial hemorrhage, multiple facial fractures, rib fractures, and cardiac contusion with tamponade. They placed a bolt in the OR, he v-fib arrested and they shocked him twice. We've given 1L crystalloid for more fluid resuscitation and 1 unit FFP. He's kind of vasoplegic but not by much, still he's on epi at 3 and Levo at 5. Still getting a fluid bolus right now. Ready for systems?"

Four scribbled feverishly, and then he paused. "Wait, who was the surgeon?"

"Time."

Four smiled. Good. That meant the team would be keeping a close eye on the situation. "Okay, I'm ready for systems."

"Neuro, he's a RASS -3 with a goal of -4. He's no longer paralyzed, it was reversed at 1600. He's got the bolt, it's subarachnoid. His ICP has been steady in the..."

The longer the nurse talked, the more Four realized this was going to be a long shift. But he'd get through it. They went through neurological, respiratory, cardiac, gastrointestinal, genioturinary, musculoskeletal, and skin individually before reviewing lab work, and then Four wrote down what points of access he had, including a central line, an arterial line, and three peripheral lines, as well as all the different medications going in through them. After finishing handoff with the other nurse, Four sat in his chair for a moment and just took a deep breath.

Time to get to work.

#I have no idea what kind of handoff pilots do with each other #so I just figured it would be maintenance related lol #at first I was like 'I should make this simple because non-medical audience'#and then I was like 'screw it let's have fun'#so then we just got increasingly more complicated with reports because this is what the boys would be doing for work anyway #so this one's for all the medical nerds #as a general rule ER is more concerned about what's going to immediately kill you while ICU needs to know everything about you #hence the difference in reports #respiratory therapists are concerned about respiratory stuff so they're very focused #techs care for a lot of patients on the unit and have specific things they look out for to assist the nurses and help the patients #I didn't even attempt to do Time's report because I know too little about surgical notes to fake one lol #maybe someday XD #lu in healthcare #writing

38 notes · View notes