You're in the bay. Once you get over to the bed,
we'll give you the story. Everything's going
to happen super fast. Welcome to the emergency
room. Alright guys, so another crazy story this
one happened, I would say probably two months
ago, three months ago, something like that. So
if you guys have been in nursing school, I don't
know what nursing program you are in. I have
listeners like literally all over the globe.
And that's pretty cool. But recently, the Netherlands
Hey, hey Netherlands, what's going on guys? But
Yeah, I've had a lot of Have listeners basically
all over all over the globe all around the world
and so I don't know what nursing program you
guys are in but in my particular nursing program
They made it sound like or seem like Like I wouldn't
take care of a lot of LVADs. And so if you're
not familiar with what an LVAD is an LVAD is
a left ventricular assistive device. My hospital
we take care of a ton of LVADs. It is the complete
opposite of what they told us in nursing school.
They made it sound like I might not ever see
one in my entire nursing career. And I see at
least two or three a week and I only work two
days three days a week. Okay, so at least once
a day and so If you're not familiar with what
I know that is because you haven't made it that
far into your program yet What it is is that
for our particular hospital in our at our facility?
an LVAD criteria patient is a patient with significant
heart failure with an injection fraction of less
than 20%. Now, a healthy ejection fraction is
over 50%. That is where you're supposed to be
is anywhere over 50. The better. So If I'm not
mistaken, I'm not in cardiology. I'm an ER nurse,
but if I'm not mistaken, I believe you're diagnosed
with heart failure. If your ejection fraction,
your EF is below 30. If I'm not mistaken, if
you're in cards, please, you know, leave a comment
or something for the correction there. But or
if you know what it is, but if I'm not mistaken,
I believe it's below 30. And so it then you qualify
for like again at my hospital if your ejection
fraction is below 20. Now, the significance of
that is because if your ejection fraction is
low, then whenever you put your heart under stress,
your body is not going to be able to handle it
because your blood is not your heart is not able
to pump the blood to meet the demands of that
particular activity. And so it can lead to a
sinkable episode. Now, if you are just listening
to this, just listen to it, you know, because
of whatever the reason and you're not in the
medical field. If you by chance at any point
in your life was like running or walking or just
walking up a flight of stairs or a hill and you
just passed out for an unknown reason, you need
that checked out. Because you're not supposed
to have a Syncopal episode, which is just passing
out. You're not supposed to be passing out just
doing ADLs your active daily living type stuff
so That right there is it so the LVAD what it
does on the rough end of stuff again I'm not
a cardiologist and I'm not a CV nurse Basically
what it is is that the LVAD will take over for
the LV part of the LVAD the left ventricle the
left ventricle. So like it'll just kind of like
bypass the left ventricle in the machine will
pump it directly into the aorta to kind of perfuse
the rest of the body. Okay. And so on paper,
it sounds legit, right? It sounds pretty cool.
And so But when you start looking at some of
the pathologies that kind of go on, you know,
with the heart here, it kind of like defies the
pathologies of a lot of stuff. And so. Like.
The story is that I was walking down this hallway
and one of my friends, his name is Kevin. He
like pulls me off to the side because he was
an LVN at one point that worked in this ER. He
got his RN and BSN. And so he kind of like helps
mentor, you know, the LVNs, you know, into becoming
a better nurse. So he pulls me off to the side.
He's like, Hey, man, come check this out. Because
again, we are in the med center. And we see a
bunch of crazy shit, right? We see a bunch of
crazy traumas. And so in the Med Center in Houston,
it is the largest medical center of like a conglomerate
of hospitals that officially, unofficially, officially
have like a specialty. And so, like, for instance,
you have in the Med Center, we have I want to
say it's common spirit St. Luke's now previously
known as St. Luke's or CHI St. Luke's, previously
known as just St. Luke's Medical Center. And
so fun fact that hospital a few years back is
the reason why a lot of blood protocols got changed
as of recently within the last five, 10 years
or so. because they had a sentinel event regarding
blood products. And so regardless, I divert.
But they are known for their incredible transplant
program. And they are also home to the Texas
Heart Institute, THI. And so they are leading
medicine in the ways of transplantation and cardiology
for like THI stuff, right? They also have an
extremely robust oncology program. Now talking
about oncology. Where the the med center really
kind of shines is if you're going to get sick
in anywhere in the world You're more than likely
going to want to come to the med center because
we have MD Anderson Now MD Anderson's rival is
going to be Johns Hopkins University like they
are direct competitors, you know when it comes
to stuff and so Common spirit st. Luke's they
are right behind MD Anderson and their oncology
program like their rank number two, or something
like that, when it comes to cancer. And so that's
their specialty. So now, in if you're sick, and
you have a heart problem, you can go to CA or
not CHI common spirit, St. Luke's. And if you
have cancer, you can either go to St. Luke's
or you can go to MD Anderson. Now we're going
to kind of keep moving along the spectrum. If
you are a high risk pregnancy, okay. Whether
you have pre eclampsia, eclampsia, placental
or credo that has invaded other organs or Or
you have like a complete placental previa, or
maybe even just like a complete placental abruption,
a molar pregnancy, all this stuff that you learn
about in nursing school that you're like, never
heard of it. If you have like a high risk pregnancy,
where your resting blood pressure is 190 over
110, then you're going to want to go to the Texas
Women's Hospital of Texas or the women the Women's
Hospital of Texas. And they, you know, can handle
your high risk pregnancy because they are what
we would call a level four maternity center.
And so like your level four, you know, pregnancies
will get shuttled to, you know, the Women's Hospital
of Texas. If you have a baby or a very, very
sick child that is not cancer related, then you
can also go to the Women's Hospital of Texas
because they have a level four NICU. And if I'm
not mistaken, they might be one of two or just
the only one in the med center with a level four
NICU. Maybe Texas children's will get to them
in a second. They might be they might be level
four as well. And then if you have a sick child,
and you the mom are not sick, you know, you can
either choose to go to the Women's Hospital of
Texas or you can go to Texas Children's Hospital.
And they have a level one pediatric trauma program
and they have either a level four or level three.
Nick, you I don't know. I don't work there and
I don't want to. So you have those. OK, now,
if you are hit in a car, you know, and you have
like a really, really bad car accident, your
shot, your stab, whatever, and you. you need
emergency services that's where you you'll go
to Herman Hospital Texas Medical Center. Herman
Texas Medical Center is the busiest level one
trauma center in the United States and is the
only the only hospital in the Texas Medical Center
With a level one pediatric emergency services
and a level one pediatric level one adult trauma
services and so Morial Herman prides themselves
on the ability to if a Pregnant mother gets into
a car accident that is bad enough to be classified
as a level one They pride themselves on the ability
to be able to keep mom and baby together the
same hospital because if you If you get taken
somewhere else, let's say if you got a level
one trauma for a mother Then the baby is going
to go and they they take you to Texas Children's
The baby will stay at Texas Children's and the
mother will get some sense somewhere else over
If you get taken to Ben Taub Hospital, which
is also a level one hospital that's funded by
the county You will sit there and the mom will
stay at Ben Taub and then the baby will get sent
to Texas Children's or Memorial Hermann. But
if you are a mother that gets injured in a car
accident, that is a level one classification
and you get taken to Memorial Hermann. You and
baby will stay together throughout the entire
stay of your state, right? The entire time of
your state. event you have Those are kind of
like the major kind of services, right? and so
You have like I said you have if you're a child
and you're super sick you go to Texas Children's
or you can go to the Women's Hospital of Texas
If you have cancer you have two options. You
can either go to common spirit st. Luke's or
MD Anderson And then if you are injured in a
really bad accident or you fall from a ladder
or a building or something like that, then you
can go to one of two adult level trauma centers.
And one is going to be Harris Health Ben Taub
Medical Center. Or you can go to Memorial Herman
Texas Medical Center. So so what that entails
is that we see a lot of weird stuff. Stuff that
you only read about in textbooks one of the weirdest
cases that I have It's not medical or anything.
It's not life threatening is a sickle cell sickle
cell as you guys know predominantly effects,
you know the black community and But there's
like a 1 % chance of it affecting people from
the Middle East And I shit you not I have taken
care of a patient with sickle cell that was from
Saudi Arabia and that was Like one of the kind
of like the coolest things I've ever done, you
know, it's sad for him but cool for me Was that
he was a Middle Eastern guy that had sickle cell
and I was like man I never thought I would ever
take care of you know, like that 1 % in the world
and that's the craziest thing so back to the
original story Kevin pulls me aside to look at
this guy, and the monitor is going crazy. The
guy is in ventricular fibrillation. Now, if you're
not a CLS certified vfib is a unsustainable rhythm
because the ventricles are literally just quivering.
And so they're not contracting, they're not pumping.
But because the guy has an L pad, His body is
getting perfused while his heart is literally
dying, right? And so he was awake. He was talking
to the nurses. He was making jokes He was having
himself a grand old time He was technically dead
He was technically classified as being dead,
but because he had this LVAD in place It was
literally keeping him alive and he was awake
And I think he might have been there Because
his driveline got infected or something like
that, which is very common for L that patients
is for the driveline to kind of get infected.
So, but yeah, crazy story, right? A guy on an
L that in ventricular fibrillation, awake walking,
you know, could walk if you wanted to. Talking,
laughing, joking with nursing staff and the doctors
while he while he's technically dead and he said,
So yeah, all right. There's one of the crazy
craziest stories. I think I'll ever encounter
in my life Sorry about that tangent about the
med center But yeah guys, so that right there
is another crazy story. Just a guy that's dead
on vfib What is all that just chilling in the
bay? All right, you guys peace out Me and the
nurse For the RN Me and the nurse that were in
the room. We had already done everything So the
only thing that needed to be done was rock and
atomic date and then like kind of get the monitor
set up that way we can go to scanner and The
pelvic fracture was so bad that the trauma attending
like walks in as we have the monitor and brain
on the monitor ready to go to scanner he was
like you guys are going straight to the OR shit
okay so um like if you work in the OR go to hell
okay and that's all i'm going to say about that
because the story kind of continues this that
that mentality so we got this dude like he's
literally bleeding everywhere at this point you
know he's not in DIC but he just has open holes
everywhere blood it's just kind of pouring onto
the stretcher, you know, and like we got blood
going and we got fluids going and like we're
hitting them all different types of liquid stuff
to kind of prop up that volume. And so we get
up the ORs for us are like one or two floors
up and we have a special elevator dead designated
for those types of events where we could just
hit it hit a button and it goes straight to the
ORs and that's where we're at. So we get we get
on the elevator we get to the OR and they see
they see you guys at work in the OR you see us
Walk in with this dude that has all this stuff,
you know, because it's like an entourage of us
Coming into the OR and you guys want to sit there
try to hold us up because we don't have a little
hat thing on a little bouffant and we don't have
little booties on and we're walking into your
O .R. like, dude, we are literally keeping this
dude alive with. All right, we have literally
lactate ringers and blood keeping this dude alive
and you're going to sit there and tell us you
need to grab a bouffant. Get the fuck out of
my way, dude. So we we get in there the whole
or team is trying to throw a fit and the surgeons
like yo We need to get him over and we need to
get going quit worrying about what they're wearing
We'll worry about that with some vancomycin and
I'm like, thank you Thank you, you know, like
you're gonna throw antibiotics at this dude.
Anyways, so just throw some more antibiotics
at him Don't worry about what the hell we got
going on because he's laying in rocks and grass
You know the stretcher has literal rocks and
grass on the sheet so So that that right there
is the story right and The anticipatory stuff
of hey when you have something like that that
shows up it shows up in in whatever you got going
on That's where the nurse anticipates this I
was anticipating Two large bore IVs. I was anticipating
fluids. I was anticipating blood and I was anticipating
on Closing this pelvic this pelvis long enough
for us to get to the OR those were the anticipatory
things that The doc didn't need to say now that
right there is where that stuff comes into play
in real life It's not you know A stupid question
always like the nurse is going to anticipate,
you know, ambulating the patient to the bathroom
like it's not it's not always going to be stupid
shit like that. You know, it's going to be, you
know, it can be not going to be, but it can be.
Hey, you know, you got this patient, they got
hit by a car going 30 miles an hour and he was
drug 100 feet. What are you anticipating? It's
going to be stuff like that. You know, so I just
wanted to hop on and kind of talk about that
real quick, you know, because yesterday, like
our our cohort, we had a really rough pediatric
pediatric OB exam. We had a really tough OB exam,
and we all kind of like walked out of there mad
as hell. So it just brought up like, man, this
anticipatory stuff like I know it's applicable,
but the way that they're using it is not. So
I just wanted to talk about that as a story and
there's like a meaning behind it. So there you
go. All right, guys. Thank you for listening
and keep enjoying the educational material.