My First Time Alone in ICU

Well, my first shift in ICU was not too bad. I was in charge of 11 patients, which is supposedly a low number for our ICU, but good for me at least for my first night all alone in there. Let’s see, what did I have? A Great Dane who had a GDV (twisted stomach)-surgery had been performed earlier in the morning and he was in recovery. Had trouble with his blood pressure, it was consistently high, but he didn’t seem painful and really had no other reason for it to be, he was just a really anxious dog—once he settled down we finally started getting some normal readings. I almost Ace’d him (gave him some tranquilizer) to see if it would help, but he then settled down on his own and I didn’t need to. My other patient was a pancreatitis case – the one I had talked about earlier – she is still here – still jaundiced – not doing well, so they went to exploratory surgery – found masses in the spleen so did a splenectomy and removed it, liver was also grey and streaked (not normal liver color!) so that was biopsied, pancreas was very thickened (likely result of chronic pancreatitis), and the gall bladder was distended and there were multiple adhesions of omentum and mesentery to the common bile duct (that lets bile go from the gall bladder into intestine), so the common bile duct was cannulated and a stent placed (to keep it patent), a feeding tube was also placed into her jejunum (small intestine)-because in pancreatitis you want to bypass the pancreas when re-feeding them. She had a rough recovery, she is a very nervous dog any way and she kept thrashing around, so I turned down her Fentanyl CRI (pain) at first because she was very dysphoric and I thought maybe it was because of that, it didn’t help so I finally gave her some Acepromazine (tranquilizer/sedative) and she finally calmed down. Started her on feedings through both her nasogastric tube and jejunostomy tube and that was about when my shift ended. I will get her back again tonight so we will see how she is doing, hopefully better. Then had a vomiting cat with pancreatitis that had been doing very well here in the clinic with an NG tube (nasogastric) in and not had any vomiting in days…so he was set to go home, pulled NG tube and he starts vomiting all over-crap!!! So gave him a SQ injection on anzemet (dolasetron) an anti-emetic and seemed to stop it, sent him home, didn’t hear back so I hope he does well. Next step for him is an esophagostomy tube for tube feedings if he won’t eat or continues to vomit. Has an old German Shepherd with a tail mass that was removed, he did fine. Just added some pain meds no and he was ready to get discharged this morning. Had an English Setter with Parvovirus (vomiting and diarrhea) who had very low albumin (1.1) (a blood protein), we do not like to see it get under 2.0 because then you start to see effects like edema and all this nasty stuff. So, got her set up to receive a human albumin transfusion – she was still receiving that as I signed off shift…I am sure I will get her back today…hopefully the albumin helped and then hopefully she starts eating because that will both help her get albumin and will help her GI tract enterocytes to repair themselves so she is not losing the proteins through her gut (we call it protein losing enteropathy when they lose through the gut, it is because of the diarrhea and the normal GI cells get sloughed and then they start leaking good stuff out ). Had another young German Shepherd who came in with acute neurological signs, couldn’t walk in hindlimbs then couldn’t walk in front limbs. Normal cranial nerves, absent CP and reflexes both fore and hind limbs. She was very anxious also—because she keeps trying to walk and can’t. Have her on Doxycycline in case of a tick disease, also thinking coonhound paralysis (what Michelle and Dan’s first Jake dog had). So monitored her breathing really well overnight to make sure she didn’t need a ventilator if her diaphragm because paralyzed. She didn’t ever on my shift, we will see where she is tonight. I also mentioned running a tensilon test to check for Myasthenia gravis—she doesn’t have typical presentation and doesn’t have a fatigable palpebral response, but it is a cheap thing to try and rule out. Then I woke up this morning and thought..god I hope that dog doesn’t have rabies!! Other thought,,,botulism,,,kinda a stretch, but we will see how she is doing tonight. Had my hit by car in the head dog back again last night. She waxes and wanes in her mental acuity, sometimes she is up and aware and able to walk, othertimes she seems non-responsive to humans. And she has developed a wide circling to the right pattern when she walks. She finally had her CT scan yesterday of the head, good new no hemorrhage or swelling (but could have been and now went away b/c she is about 5 day s out), but multiple left maxillary (jaw) fractures, left frontal sinus fractures, left periorbital fractures (around eye). So the hard thing with her is listening when she moves her jaw, all you hear is this gross crunching sound!!! Poor girl, so she is getting a surgical consult on Thursday…but the mental aspect of her…not sure how long that will take or if it will ever fully come back. Had three post-op surgical dogs that did fine. Had to replace bandages on them a couple times. Placed two on Domitor CRI (sedatives) because they were anxious and whining and Ace did nothing for them…so that kept them nice and quiet the entire night. They will get transferred back to surgery this morning. Then at the end of the night my ternmate Katie turfed me a renal cat…possible oliguric renal failure—not good—or pyelonephritis…owners didn’t want to do much diagnostics, just wanted support and were planning to transfer to rDVM this am. Should at least do an ultrasound of the urinary tract and kidney though because one disease can be cured and the other holds a very grave prognosis!! And rDVM will just send them back to us for ultrasound anyhow!! So, that was my night. I am hoping for another slower night…as least while I am getting used to things. I am also mad because they were very slow on the floor all night…Katie was the 2p-2a person and she actually left the clinic at 1:45a…that never happens to me,,,she always lucks out with slow shifts….why can’t I ever get that? I have bad luck..I always get slammed!! Ok,,well I am going to go and work out a bit and then study some before heading back to that place.