Saturday the 14th

Before I begin this post, please remember I am an ICU nurse and without sick patients I cannot hone my skills.  I don't wish anyone ill, it's just the job. 

Today started out a little slow.  We had six patients, two of which would transfer to the ward after rounds and two in the CCATT bay (this is where we keep our injured Americans and coalition forces).  After rounds, my patient transferred and Tovar's went to the OR.  Around 1200, I got word we were getting a patient from the ward.  This patient had a dissecting aortic aneurysm, from the right carotid to the left iliac artery (picture a beauty queen's sash)!

We got the patient and hooked him up the monitors.  His systolic pressure was over 200 (this is VERY bad) and his heart rate was in the 80 (not good).  As we were getting him going, I started to feel like I was in my element again.  I told the docs we needed an art line, central line and told my tech to get a foley in the patient.  The patient asked if he could go to the bathroom and I said "You are not to get out of bed, we will get you a bed pan."  His next question was "Is it really that bad?"  How could I tell him he's a ticking time bomb just waiting to go off!  My response was a simple "Yes."

After we got him hooked up, I started getting the meds ready to titrate.  They were hanging on the other side of the docs, who were sterile.  So I did the only thing I could do, crawled underneath and between their legs.  Yes, I'm sure it was quite the site. 

I got the meds going and started to titrate, I don't think I've ever run esmolol and nipride at such high rates before but after about an hour, we got his pressure down but not the heart rate.  This patient was so critical we had to air evac him out of the country like yesterday.  Our flight med folks were working on the flight, one was generated to leave in four hours.

When the CCATT team showed up, my patient's mental status started to diminish (again, not good).  The team intubated him right there in the bay and then had to go to the next patient to put in a chest tube...it was CRAZY busy!

I think what upsets me most is the fact this person knew he had this condition before he deployed and his civilian doctor (from the information I am gathering) knew he had it and cleared him to be deployed.  This guy is not out of the woods.  If his aneurysm completely dissects, it doesn't matter where he is all you can do is watch them die.  My big question is was it worth it...my answer is NO.  We'll have to see what happens, he's in the air and for his sake I hope he makes it.