Preparing for COVID and helping non-ICU staff in our units

Posted over 5 years ago by Elizabeth Cogan

 I thought about how blessed we are in the Reno-Tahoe area to have the time to prepare compared to our brothers and sisters in places like NYC and Saint Louis. But how are our colleagues who must prepare to be floated into ICU? It's not their world, it's our world, and our world scares them.

I was working with one such staff member today, who was terrified of potentially taught her what she needed no calmed her fears. Maybe it’s because I grew up during a shortage so bad I sometimes had to work with just 2 RNs for 12 pediatric ICU cases (more than ½ on vents and the other ½ undergoing intense hour-by-hour chemotherapy). But even though I have been away from the bedside for 9 years, I immediately gave her my less than 5-minute in-service on vented patients. She became amazingly calm, even laughed and said she could do it.

In case things get to where you need to work in ICU with non-ICU peeps, here’s my in-service:

  1. First, mostly ignore the vent. You can see by the monitor and by looking at your patient when they are in trouble. Call for help.
  2. Lungs are likely to sound crappy. Expect that. Turning and suctioning help.
  3. Next, know which alarms mean what. Start with finding the Silence Alarm button because alarms are annoying.
  4. Which alarm is it, and how do you work with it?
  5. High pressure: either the patient is biting the ETT, in which case sedate them, or the tube is obstructed, in which case, suction them. Easy-peasy.
  6. Low pressure: either the tube is disconnected from the vent circuit (easy to fix- just put it back together) or it is not sensing a return of the volume given (which requires an RT who may need to check the cuff and re-inflate, or maybe there’s an air leak and we need a bigger tube, to come off the vent… lots of RT-based options; just call for help).
  7. Know where the “give a 100% breath” button is – THAT one is your friend.
  8. If several alarms are sounding, call for help, disconnect the vent circuit, and hand-bag the patient. Watch out for ARDS patients, as hand-bagging them is a workout like using the pec deck at the gym.
  9. If you are EVER unsure, ask for help.
  10. Show them how to perform in-line suctioning.
  11. Remind them: sedation is your friend.

I know that may sound glib, or dismissive of the work we do, but breaking it down into manageable action items with a little humor really does help non-ICU staff feel capable of holding down the fort. Check on these guys frequently. Who knows? After it’s all said and done, maybe you will get a transfer into your ICU because you helped them feel confident. It often worked for me. We got out the best new staff after crazy nights being short-staffed (EEK! I said the S word!)

If anyone wants to start a message feed please do. If you need to say it, someone probably needs to hear it.

Stay safe out there.

Liz


Comments


Only active members can comment on this announcement.

Learn more about membership