14+ units and counting

 It's hard to believe that amount of blood one has inside the body.... unit it starts to be expelled from the body.

I had a pt who had a GI bleed... and anyone in healthcare will know the smell that the breakdown of blood creates.... the smell of melena stool.

I was lucky enough that my pt was expelling things fast enough that it wasn't smelling like that. When I got the pt, he had had several procedures in an attempt to stop the bleeding internally. We thought it successful.... during my shift he only had two BMs - and it didn't have the clots and bulk that it did before. I thought I was pretty fortunate. I also thought the procedure successful.

Until the next shift when I ended up cleaning up six BMs. Again, no real melena smell. I figure where they thought that they had an issue and thought that they had fixed was what would stop the bleeding. Clearly though they did not... based on what the stool looked like, I imagine it to be small bowel, but close to the large bowel. Because it's not like it was bright frank blood but it was broken down some - but clearly it wasn't in his bowels long enough for the blood to be broken down to the point where the enzymes interacted with it and caused the typical melena smell.

Another scope another time. Hopefully this time it was successful.

For all the bleeding this poor soul has undertaken, he ended up with 14+ units of PRBCs.... his blood volume replaced twice+ over. Hard to believe, but hey, the human body is miraculous.

Full of bullshit

 We're almost at a point in our ICU that we can't accept any other patients. COVID's second wave is starting to take over our ICU. At last point we had 5 pts in our ICU and another 7 pts on the wards. And of course our numbers in the province are only getting larger not smaller so it's inevitable before we get inundated with COVID pts.

I previously asked our manager what the plan was for non-COVID ICU pts when our ICU is COVID pts - the powers that be indicated that they would cross that bridge when they come to it.

The last wave had some of our staff in the unit above with COVID ICU pts - a dangerous endeavor as the monitors for the pts were all inside the rooms, so it made it difficult to monitor pts accordingly. I'm sure they will be doing the same thing very soon.

Being that I have a workplace accommodation that I don't have to work with these pts, I've asked what they plan to do with ICU-trained staff who all have accommodations.... there's always going to be ICU pts that still need assistance.... until such a time when our hospital is overtaken with COVID pts. I'm sure that it will happen, look and see what's happening in the large cities in the US. Guaranteed that's what's going to happen here in Canada.

Hell, it happened with the first wave and everyone is saying that this wave is going to be worse. So I can't see us not getting hit this time around. We were actually quite fortunate that we weren't inundated with COVID pts the first wave. Sure we had our fair share, but at least it was manageable. I have no idea what they're going to do this time around.

I also think that the powers that be need to sort their shit out on who they provide resources to. I mean, intubating a 90yr old (IMO) is just a waste of resources when the second wave is just beginning. It's not likely that they're going to survive COVID, so why not just attempt to make their death as comfortable as can be?!