"The Story of the Bleeding Trache"

….eeriee…

The story goes this way…

DAY 1: 

It was my second week of training…and i was assigned to this particular ward where it caters mostly to VA patients..anyway, as i was going about my business of preparing the medications for my 23 patients(that was my census at that time)…our charge nurse got a call from the ER saying that they have a patient with Severe Head Injuries caused by a vehicular accident..and that they are going to bring it up to our ward for treatment and management. When the patient arrived, he didn’t look so good. He had an endotracheal tube attached to an ambubag, a prominent head injury which was already stitched, swollen eyes, very restless, and with multiple bruises all over the body. He also had several IV fluids attached to him and his clothes were soaked in blood ( sometimes patients are transported to the wards with their street clothes still on….or am i just the one noticing this?…geez…ER people wake up.) I’d like to call him Mr. D. 

Ok..so there he was…all bloody and gasping for breath…then out of the blue, the wife appeared…crying, and near hysterical…she was raving something about him being so careless, so stupid, and how his mom just recently died and crashing his motorcycle to a concrete wall won’t bring her back( although its gonna make him see her again actually…don’t you think?..hmm)..and that they still have an 8-month old son to raise…and so on…and so forth…..i was so close to injecting her with an anxiolytic just to shut her up…sory.

After everything was done to make him comfortable and stable…the wife finally came to her senses and  calmed down. So we proceeded to go about our work for that day and finished the shift in 8 hours.

DAY 2:

The next day, my census went up to 25 patients. I was charge nurse that day so i was in charge of documentation, carrying out doctor’s orders, and making sure all procedures were done. Before starting our shift, we have to go around and make bedside endorsements. On that day, i noticed Mr. D was quite stable in the ICU section of the ward. He was a Post Craniectomy and Post Tracheostomy case and recovering steadily. He was hooked now to a mechanical ventilator making him breathe easier. He was still restless though.

I smiled to his wife and she smiled back…she was nice after all. 

The thing about ET tubes and T-Tubes is that you have to suction them regularly for secretions to avoid clogging them. That way, you’ll be able to maintain the patency andclearance of the patient’s airways. It is a not so complicated procedure yet still requires the expertise of trained personnels. Sad to say though, that due to the scarcity of hospital staff, procedures like this are sometimes delegated to the watchers of the patients(whatt???!!…yes..).

As i was teaching Mr. D’s wife how to suction his tubes, i could sense her apprehension and hesitancy in doing the the procedure. But i told her that its important that she learns to do this because his husband’s life depended on it( ok, that’s frightening…let me rephrase that)…i told her he could breathe easier if his tubes were clear (better?…good). So every now and then, i checked on her to see if she was doing it right, and she did…although there were a couple of times wherein her husband would cough and gag, i told her everything was going well….until the next day.

NEXT DAY:

Census: 26; Admission: 2; Death: 1

Where’s Mr. D?….dead.

Cause?….Cardiac Arrest.

Real Cause?…..severe hemorrhage due to improper insertion and placement of the tracheostomy tube.

FACT: The main risks associated with tracheostomy occur during surgery, or soon after. They include:the voice box or oesophagus becoming damaged during surgery, injury to a high innominate artery, jugular veins or thyroid gland. Severe bleeding may occur if the tracheostomy tube erodes through the anterior wall of the trachea into the arteries that lie there or into the thyroid gland. The bleeding may be life threatening and needs emergency surgery to control it. 

Wife?….blamed herself because she believes she suctioned him to death.

What inspired me to write this article?….we had 2 previous cases of bleeding trachs in the ward in a span of two weeks…and nobody would want to comment on it. 

..Back from the Grave…

…HI GUYS!….

…i can’t believe a hadn’t written a single entry in four months ….whew!….did you miss me?…i hope so…

anyway,…am back from the depths of the grave from which i’ve buried myelf into for the last few months…why?…i don’t know…i guess i have just been preoccupied with a lot of things…things to do, things i shouldn’t do, things am forced to do…and i guess that also includes things am not supposed to do ever but did it anyway….hehehe…i really wouldn’t want to elaborate more on that..

well, the last topic we talked about was my hospital training i did earlier this year….actually it started late last year…November exactly….and so it was…

Starting my training was a bit difficult…mainly because it was my first time ever to actually work in a tertiary hospital with a couple of thousand  bed capacity…(ok, just kidding…actually its only an 800 bed capacity hospital BUTTT….you’ll be amazed at how the hospital staff can transform it into  3x more the maximum capacity…..miracle?…nope,just plain insanity)….i remember i had this exciting-bordering-on-fear-that-i-might-kill-someone-on-my-first-day kind of emotions…but i had no choice..i had to start someplace right?….right.

Our program started with a 3 day orientation seminar…giving us a bird’s eyeview of the entire hospital set-up…rules,regulations,who’s in charge, who’s not in charge…etcetera2x…the Speakers were extra careful not to scare us  with their true to life clinical experiences but failed miserably..i remember thinking am going to hand out my resignation letter the next day…

But i didn’t of course,…i mean..who the hell gives up on the first day???!!!…certainly not me…am going to war…might as well enjoy it….so i did…and more.

 After the orientation, we proceeded to the actual clinical area….that meant real procedures, actual patients, active diseases, and not so charming doctors….we had to do everything on our own without clinical instructors to give us grades or evaluation reports(although we are evaluated at some point by the head nurses of our area)…still we had to basically perform everything on our own. 

To sum it up….it was fun…and i have a couple of interesting stories to tell…some may shock you…some maybe quite repulsive if not totally and blatantly horrific…some are unethical…some stories are inspiring(well,it inspired me)…and some can move you in more ways than one.