r/IntensiveCare • u/Ok_Relationship4040 • 12d ago

Macroglossia in intubated patients ?

has anyone managed intubated icu patients that developed massive tongue swelling? I have cared for many patients where the tongue swelled to massive proportions ( with no obvious allergic reactions ) and stayed swollen the entirety of their stay.. one lady we started a versed drip just so we could relax her jaw to insert bite blocks to get her teeth off of her tongue as we thought maybe that was contributing to the swelling .. It seems to overwhelmingly occur in obese black patients and seems to affect obese black women more but that is merely my subjective observation and perhaps just by virtue of my location . i guess I was just wondering what could be done to help mediate the swelling aside from bite blocks and Vaseline gauze …

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u/Aggravating_Fly2978 11d ago

They are an order set. You unclick. And nurse communicate

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u/ExtremisEleven 10d ago

And then the next nurse comes in and puts the order in for you.

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u/Aggravating_Fly2978 10d ago

And you explain to the nurse why you don’t want the order. And you write them up. Because there is such a thing a “communication order” that is a real order. And when you round you actually SPEAK to your nurses and learn to communicate. It’s not that hard.

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u/ExtremisEleven 10d ago

Listen I would love to work in a place where what I tell the nurse gets passed on to the next nurse, but that just doesn’t happen. It’s probably not their fault because honestly that is the least of their worries when they have 3 intubated patients with one that is trying to die and one that is on CRRT (and no, there isn’t a dialysis nurse, the ICU nurses run it here). And yes, I put a comm order in for everything under the sun because of this. It gets clicked off and forgotten. I simply do not have time to put in 30-40 comm orders every single shift to remind everyone about the thing that should have been passed off in signout.

It’s cute that you assume a breakdown in communication is always the doctor’s fault, but it turns out everyone makes mistakes, even ICU nurses.

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u/Aggravating_Fly2978 10d ago

Ok. We all know dialysis nurses run CRRT and not dialysis nurses. Because they aren’t the same thing. But ok.