What Was That Noise?

So in lieu of my last post on Wallpaper, I thought I’d throw another log on the fire and continue talking about noises and/or alarms on the nursing floor.

The other day I was tending to one of my patients. A fellow co-worker walked by and asked if I need any help, and I kindly declined. (At that time I was ACTUALLY caught up with all my work)

My co-worker disappears only to return shortly asking me if ‘that noise’ coming from your other patients room is ‘normal’.

Side note : The word ‘normal’ is a term used very, very loosely amongst fellow nurses. You’d be surprised what we consider to be normal.

So I of course saunter on over to my other patients room to listen in on the curious ‘noise’.

Background : This particular patient was a trauma pt who had multiple respiratory challenges during his stay. Everything from getting a tracheostomy tube, multiple chest tubes (with one still in place, multiple separate bronchoscopy’s, as well as battling pneumonia. On this particular day he was recovering nicely. He was on a 50% Aerosol Tracheostomy Mask. He had been producing excessive amounts of secretions from his trach site, so his coughing was ‘normal’. He also had a slight case of tracheitis. To add insult to injury the mental state and compliance of the patient was also a challenge. He required high doses of sedative medication to keep the patient safe from self harm.

I enter the room to the sound of seals barking. Thinking

Every time my patient coughs there is this audible ‘barking’ noise?

Now throughout my shift this patient would produce a croup-like sound when the patient had a hard coughing jag, but nothing like this sound.

So (for all my student nurses and new grad nurses) here’s where those ‘critical thinking skills’ come into play.

The patient is now in increasing respiratory distress. You have the audible sound that shouldn’t belong. And now his oxygen saturation is starting to decline. All other trouble shooting checks have been made, and have been cleared. (trach cuff is inflated, pt is getting same amount of oxygen as before, no new bodily fluids or blood present, vital signs, etc, etc)

THINK…

THINK…

THINK…

Idea

Uhh.. he still has a chest tube. How about we check that?

Glory BE!

The patient, during the horrendous coughing jag, somehow managed to yank at their chest tube while batting their hands on the bed so hard that their chest tube was dangling at the skin.

Enter – TORNADO EFFECT

In one fail swoop, the Trauma Docs are called. And yes the chest tube was out.

We go through the gamut –>

– Doc pulls out chest tube that’s hanging on by a thread

– Doc gets gowned up for new chest tube insertion

– Pt has sucking chest wound while sterilizing site

-New chest tube inserted

Now from the time I stepped into the ‘seal barking’ noise to the new chest tube insertion… I think a total of 10 minutes might have lapsed. And the longest portion of the whole scenario was the sterilization and gowning up to place the chest tube. (The patient had already spiked another fever, so we needed to keep things as sterile as possible)

So the lesson learned….?

Not all noises are Wallpaper.

Carpe Diem

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