develop or progress, and the patient’s health status is adversely affected—a phenomenon described as “failure to rescue” (see Chapter 1) (Silber et al., 1992).

As the case example in Box 3-1 shows and as physicians in the American College of Critical Care Medicine note:

Critical care nurses do the majority of patient assessment, evaluation, and care in the ICU … critical care nursing staff … spend several hours per patient per shift collecting and integrating information and incorporating it into meaningful patient care. Through their caring practices, they improve the ICU experi-

and the chest tube drainings, I could see that her heart was OK. The pericardium was not filling up with blood and there were no signs of tamponade….

A short time later, while I was out of the room at the nurses desk, the ventilator alarm began to sound. I reached her bedside immediately and could see that all that was calm moments ago was in chaos now. “What’s going on?” I thought. “Is she seizing?” Her head was lifted off the pillow with convulsive coughing. The needle on the pressure gauge was hitting the red zone and the high-pressure valve was venting with loud hiss with each breath the ventilator tried to give. But the motions were not really seizure-like. My mind was racing…. Is the ET tube blocked? No. Has the ET tube moved? Can’t tell. What do the lungs sound like? Right side OK, LEFT SIDE NOTHING!! What’s going on here?” … As I was taking her off the vent and connecting the Ambu bag I’m thinking, “No breath sounds on the left … could be the ET tube is in the right main stem.” … It took both hands on the Ambu bag to force a breath through the ET tube. Rita was dusky and tachycardic and her neck looked funny. I reached over and palpated, her trachea was shifted way over to the right….

I gave the Ambu bag to a respiratory therapist that had come in and said, “Anna … go get a Pleur-Evac, a couple of sizes of chest tubes, and a bottle of sterile water.” I beeped … the resident on call. “Come to ICU stat.” Dr T. called me back…. I said, “Get down here now. This lady with stab wound through her heart has no breath sounds on the left, we can hardly bag her, her trachea is deviated to the right, she’s turning blue….”

Dr T. arrived and … took the 18 gauge needle and stuck it in Rita’s chest wall…The Pleur-Evac was ready and Dr. T put the chest tube in. I listened to her lungs, “breath sounds both sides now.” Rita’s breathing was calmer, and we could put her back on the vent…. Things went smoothly for the rest of the evening.


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