Acid Base Disorders.
aka one of my weaknesses.
Today my preceptor and I got assigned to rooms 1a/b, 3 and 5.. and our wonderful combination included: ICU admit for Acid Base Disorders, M/S admit for abd pain, Psych on restraints and one up for D/C.
We looked at each other with a “bring it on” vibe.
To our luck: 1b got admitted shortly after shift report and 5 was d/c’d before we even got to bedside report. This left us with 1a and 3, and to be honest, we didn’t get to 3.. the pt got reassigned because 1a became our pt for 8 of the 12 hours, and we did a lot of trying to stabilize.
I realized today that I am truly lacking in my Acid Base Disorders chapter.
NTS: study this. asap.
Our tx today included a lot of Sodium Bicarb, liters of NS, Kayexalate, Calcium Gluconate, Dextrose.. Levaphed.. along with Vanco, Zosyn and one other abx that slips my mind at the moment. Oh! Levaquin. There was a bipap machine, coude cath turned foley, a PICC line insertion and a Quentin cath insertion.
I. was. overwhelmed.
The BPs were fluctuating from systolics of 50s to 110s, with diastolics of 15s to 60s. I could not wrap my mind around how low the bps were, and was nervous to even titrate the Levaphed to maintain a MAP of 65.. raising it by 2mcg/min from the initial 0.01-3 mcg/kg/min.
Where was ICU? Why didn’t they have a room ready yet?
But we managed.. and eventually I got to start up on a few patients of my own from triage to discharge for the day. But it definitely got me realizing that I still have so much to learn!
we had a young adult whom had a seizure after three beers. a polysubstance abuse dx who originally came in for cold/flu-like sx. an incomplete miscarriage needing blood transfusions. and ended the day with a lower abd burning pain radiating to the mid-sternal chest pain with a prior visit dx of gall stones.