Inside a COVID-19 ICU: ‘I’m Terrified’

Inside a COVID-19 ICU: ‘I’m Terrified’

What your doctor is reading on Medscape.com:

APRIL 06, 2020 — Nothing in her nearly 30-year nursing career prepared Gina for what she’s gone through in the past few weeks — not even the dawn of the HIV epidemic, when the fear of AIDS prompted most healthcare providers to back away.

COVID-19, she says, is different. “I’m terrified.”

Gina (a pseudonym) worries about how much worse things at her hospital will become. Mentally and emotionally exhausted, she tamps down her panic while at work. But when she gets home, she can cry in the shower without anyone hearing. “I don’t want anyone to know what it’s doing to me,” she said.

Gina is a long-time critical care nurse working in a 200-plus bed community hospital that’s part of a multi-hospital system in the northeastern United States. She spoke with Medscape Medical News on condition of anonymity and asked that her hospital not be identified.

With little warning, the hospital’s 12-bed intensive care unit (ICU) grew to 28 beds. It now houses 21 COVID-19 patients on mechanical ventilators.

To ramp up nurse staffing, what used to be taught in a 3-month clinical training program was condensed into an 8-hour crash course in critical care nursing.

Overnight, step-down nurses became ICU nurses who are expected to take care of the hospital’s sickest patients. Some had been nurses for less than a year.

As an experienced ICU nurse, Gina is assigned to three COVID-19 patients, a patient load that’s likely to increase as the crisis worsens. It’s physically demanding work. “I’m lucky if I get to pee once in a 12-hour shift,” she said.

Patients with COVID-19 are intubated, paralyzed, and sedated. They receive central venous catheters, arterial lines, nasogastric tubes, and urinary catheters. Most are on one or more vasopressor drips. Oxygenation, pulmonary function, and cardiovascular status are continuously monitored. The nurse titrates and adjusts drug infusions in response to changes in these parameters, drawing labs periodically to monitor a host of other body functions.

The newly trained nurses need a lot of support. They are still learning about mechanical ventilation strategies, endotracheal tubes, neuromuscular blockade, sedation, pronation, and the hemodynamic consequences of COVID-19 and its treatment. Gina spends a lot of time teaching, advising, and reassuring them, as well as stepping in to help when their patients aren’t doing well.

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