Gotta Dance

Worked today. Seems like I've been blogging a lot about work lately, but it's just been really interesting of late.

Today I started off with one of those chronic kids ... fully accessorized with a trach, gastrostomy tube, etc. However, the real excitement was that ML was coming in to get transitioned from flolan to remodulin ... our first ever case! AgreeableJ was the transplant specialist on. And when she and the transplant coordinators came with the calcs, I was ready to roll. We had the remodulin all primed and ready, with the drip sheet set for her initial weight (when she started flolan therapy so many years ago), a one liter bag of saline primed, oxygen via a face mask, and all the other monitoring stuff all set up. We went over everything, and rehearsed, and then we were ready to go. First, through her PIV, we gave 100cc of NS over 15 minutes, then another 250cc over 45 minutes. We started the face mask at eight liters of flow. Then, we removed her flolan drip, wasted 4cc of blood, flushed her broviac with 30cc of NS, then connected the remodulin and started it at twice the desired end rate. This took about 45 seconds. Then we waited for 0.5cc of the remodulin to infuse, which was the volume of the catheter. This took about 10 minutes. An agonizing 10 minutes, as ML started getting symptomatic ... decreased and erratic heart rate, decreased blood pressure, and abdominal pain. After the catheter volume had infused, we changed the rate to half of the initial rate. It took about an hour and a half for ML to feel better, and for her heart rate and blood pressure to stabilize out. By 1700, ML was eating like a champ, was on only two liters oxygen via a nasal cannula, and feeling back to normal.

I was done with report by 1930, and getting ready to leave when MM started to code. TallB started squeezing in NS, LL started priming the rapid infuser with saline, and I called the blood ban to hurry up with the rbc's, FFP and platelets. Some other nurses got the code cart out and started drawing up meds, and another called the mother from the parent room. We got the bagged blood products, primed some lines, and started infusing. By 2000, there was such a crowd in the room that I took at step back. By 2010 I was out of the unit.

Changed in the hall bathroom, and drove up to Pasadena for some dancing therapy. It'd been so long since I'd been to LG that I guess lots of people missed me. Danced all night. Loved it. It's such a release ... a way to utilize my pent up energy to create something beautiful (or at least fun), and connect with another person, if only for the duration of a song.

Stayed longer than I shold have, especially since I haven't packed for my trip to SLC. Oh well, I can sleep on the plane ...