One of the hardest (emotionally and intellectually) lessons to learn in nursing…is that sometimes when things go bad…nothing you do is going to make it any better. This evening was particularly frustrating because certain things were not being done as they should have been. There was a shortage of people who were actually working and that was leading to some overworked, and very busy nurses and techs. Since our side of the floor seemed to have fewer patients then the other unit, the other nurse and I were taking turns going over to the other unit and helping them stay caught up. In one of my many trips over to the other unit, I heard a nurse talking to her patient with a sense of panic in her voice (Nothing ever good comes from that much panic in a voice). I ran to the room, and saw the nurse and one of the techs from my unit trying to hold a 400 pound man from falling out of the bed (This nurse and tech are both only like 100 pounds themselves so it was easy to see that they needed some help). As I finished running into the room, someone had managed to pull the code light. So I did the only thing I could…I jumped right into help.
Now usually the way a code happens is, the nurses will begin CPR and ambu bagging if needed while the techs are grabbing the code cart and clearing out the room of any excess furniture or people. The nurses will also be getting the zoll pads on the patient and an EKG strip ran so when the doctors get up to the room everything is ready for what they need to do….now notice I use the word USUALLY…
This night things didn’t go exactly the way they should have…a little background information…this patient was a large patient who needed to be on oxygen at all times. The nurse had been helping him sit up so that he could get out of bed to ambulate to the bathroom. As the nurse was preparing to have the patient stand up, the patient stopped breathing and began to fall out of bed forward. The nurse was doing everything she could to keep him from falling face first off the bed.
As I entered the room, I was followed by about 5 or 6 people in the room, we all started to help get the patient laid back onto the bed, so that compressions and abmu bagging could be started. As we laid him down, there was so much force that he rolled onto his side, which pretty much made compressions impossible. As the rest was trying to turn him, I began to ambu bag him. All of a sudden I felt my scrub pant legs and shoes get soaked. I looked down and felt like puking. The patient had fluid coming from every orifice on his face (eyes, ears, and nose). Another nurse began suctioning to try to get all that fluid out. Rapid response and the doctors arrived in the room at pretty much the same time. From there it became a little chaotic, and there were enough people in the room to help, I left and went back to my unit. Unfortunately after 45 minutes of CPR, the patient was not revived and he was officially declared dead.
As I was walking past one of my patient’s room, I noticed his continuous pulse ox machine was beeping…Now there are many reasons a pulse ox machine might beep. 1) The Pt’s oxygen level is below 90 (which was the normal reason it beeped for this pt) 2)the heart rate may be increased/decreased or 3) last but most common, the sensor may not be working or not reading correctly.
I poked my head into his room to check on him...at this point I wasn't that concerned since as i said before it was usually his oxygen deceasing a little because he would forget to breathe through his nose where the nasal cannula was. I started to remind him to take some deep breathes through his nose, when I just happened to glance at his pulse ox machine. His heart rate was freaking 190. Now that is not a good thing any time, but especially when he is on a Med-Surg floor with no telemetry or monitoring. Now here’s another case of why tonight was not a normal night…Normally I would call the doctor and rapid response and they would be up to look at the patient in a matter of minutes…but as I was calling the doctor I remembered that the doctor and rapid response was over on the other unit in the midst of the code. I went ahead and paged both but knew it was going to be awhile till I heard from either of them…
I went back to my patient’s room to keep an eye on him…he denied having any chest pain or trouble breathing (he was complaining of severe abdominal pain). About 30 minutes later, the doctor returned my page and came to access the patient…she ordered an EKG and a ½ Liter Normal Saline Bolus (she then rushed off to go to another code and said she would return).
The EKG showed (no surprise) ventricular tachycardia and SVTs. The doctor returned and ordered another ½ liter Normal Saline. Rapid response was finally able to come assess the patient. They talked to the doctor and decided it would be best to move him to a progressive bed. Before rapid could move him, they had to cardioconvert his heart (push an IV medication that stopped it from beating for a few seconds, so that when it restarted it would hopefully be in a better rhythm. After four hours I was able to move the patient to a different floor.
Believe me when I say that it was not a very good night for me at all.
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