Where do I start?
I think I could have done better last night, but I was so tired of night shift. 😔
So my neuro patient has been off sedation for more than 48hrs, best GCS is M5 with me, and she can get quite strong and restless every now and then.
Anyway, the first incident is that I found his chooks was detached from the CVL, cuz I found my sheet is a bit wet. Because of this, we are not sure how much morning Panadol and KCL actually gone into the patient. After I realised the line was detached, I quickly cleaned the CVL, aspirate and flush, and put new chooks and IV line on.
Second thing is his high temperature, I was told we are not worried till it's 38.5, and it comes up to 38.5 around 4am, so we did a full septice screen, and I noticed the urine was a bit cloudy in the beginning of the shift, which I should probably raised earlier and maybe changed it earlier. Anyway I found the temp cable was a bit loose, so I tightened it, then temperature jump straight to 40 degrees....😭
But because we don't want to sedate him, so we can't really use the active cooking machine, so my access helped me to put multiple ice packs and cold towel around the patient, also around that time, I notice the CVL center is a bit red, which I didn't notice earlier, and I felt bad about it.
Anyway we decided to change the IDC as well, and weirdly, the IDC went in ok, but very little urine come out, or it became bypassing afterwards. We ended up had the SR to do it, he also didn't get much urine out, but he aspirate and flush the IDC with saline, and apparently fixed it. Something I could probably try to use to troubleshoot next time.
The SR was pretty rude at the time, after he put the IDC in, he asked in a demanding way "Who's changing catheter in the middle of the night?" Well I don't back off neither, I said " because the patient has high temperature and the urine looks cloudy, so it's a very good reasons to change the catheter in case it's the source of infection. I thought we would want to eliminate the source of infection as soon as possible." Then he went silent and didn't argue back, I was proud of myself at the time.
Overall it was a messy morning, just little pieces I wish I have found or escalated earlier, not until temperature is super high.
Good thing is his B/C came back negative, and WBC actually coming down, so the high temp could also be neurogenic related.
What a night and I will definitely be more vigilant next time!!
No comments:
Post a Comment