Grace under pressure?

So, I went to work, and when I got there, the nurse that was taking care of my patient was in his room. Pumps were beeping, the monitor alarms were going off...the crash cart was in front of his room, so I knew I was in for a tough night.

The nurse, M, wasn't really talking a lot and when I looked there were two bags of Neosynephrine hanging, and both the pumps were paused (hence, the beeping) and my patient's MAP (mean arterial pressure) was 41 (very, very bad...you want it up at least around 65.) So I ran to the med-room, mixed up some levophed, which he had an order for, and set the pump at dose mode and calculated the mcg/minute dosing, and set him up at max. Two pressors running at max.

She couldn't get anything beyond "this is...this is....this is..." out of her mouth.
To make matters worse, the patient next door was doing the same thing, but with arryhythmias, and we were getting a patient from the OR that had coded on the operating table. They had called in another nurse for the night. Also, M is a diabetic, and as it turns out, she was hypoglycemic and her blood sugar was down to 30 when someone caught her and sat her in a chair and eventually she was sent to the ER.

I wouldn't have minded so much if she had done anything since 7 pm. I guess the night had started off crazy, so none of her orders were taken off, not much had been done in the way of labs, and I had to go backwards and recreate the day from when I left yesterday morning. To make matters worse, she hadn't charted much, and had not given me report.

Eventually, she came back upstairs at 4 am and gave me report, but it was more about what she could remember at that point.

All night, I ran back and forth between either my own patient's needs, or helping W, M--a different M, or L the other nurses with their highly accute patients. I was mixing drips, and running glucose checks, and titrating drips all night. I had my patient's feet up in the air, his head and torso flat, and his pressors all the way at max, so I was glad to be able to titrate them down at all, and not shut off all perfusion to his extremities (Did I ever tell you about the lady in NY who had had so many pressors that her fingers became necrotic and had to be amputated? Fingers and toes, ALL gone, and all because there were too many pressors on board.)

Anyway, last night was like I remember an ICU being--crazy, nonstop and acute. As I was taking over with little direction or help, I was realizing: I AM ready to go back to NYC...maybe I don't know a few things yet, but I think this is what they wanted us to be able to do--handle a crisis.

I did that, and then some, I think.
I got my charting done, and left only 15 minutes late.
Who knew...I actually CAN do this!
:)