I need a Dulcolax suppository, stat!

So... last night, I had to call a rapid response team on a patient. This patient had coronary bypass nearly a month ago, and he is just not progressing well. He has had post-op respiratory failure, among other complications.

I heard a call for help and walked into his room to find his oxygen on his cheek. It should be in his nose. While I hear O2 is great for the skin, it really doesn't do much good for the lungs unless it's actually IN his nose! His saturation (sat), as I put the O2 back in his nose, was 66%. This is Decidedly Not Good. I crank the O2 up and encourage lots of deep breathing. His sat only goes up to 86% - better, but still Not Good. Call respiratory therapy, who draws arterial blood gases (ABGs), and we put him on a non-rebreather. His sats come up beautiful - 100%... on 100% O2. I listen to his lungs, and they're just full of fluid (mind you, 3 hours earlier, this wasn't the case).

We call a rapid response team upon seeing the ABGs, and I get on the phone with the surgeon. I get an order for Lasix, the ABGs we'd already gotten and chest x-ray in the morning. I give the Lasix, fluid starts coming off of him and, long story short... his respiratory status improves. We're going to have to do a lot of work today to continue to piece together what else is going on with him, but I'm wondering if I'll come in tonight to find a Lasix drip on him ... hopefully he won't be back in the ICU.

It's 6:45 AM and I'm giving report to one of the day nurses, who really is a lovely person. But, well, she's tall, blonde and gorgeous and occasionally not the brightest bulb in the box (but I adore her regardless). We'll call her Barbie. I'm explaining the patient's post-op course to her, and the respiratory failure after surgery and rapid response team that evening.

Barbie looks at me, and asks, "When was the last time he moved his bowels?"

...

Sigh.