Two in One Night...Oh Come On!!!!

There are bad nights in the hospital, and then there are really bad nights.  Last night was a really bad night.  As I walked into the hospital and made it to the floor I work on, I heard over the loud speaker “Code Blue, Code Blue”.  This is not a good thing at all.  In fact it means that a patient is coding somewhere.  As I rounded the corner I found the excitement.  I jumped in with chest compressions and helping out wherever I could.  Unfortunately, the patient was too far gone and was not able to be saved.  Not a great way to start a shift.  This was going to be a very long night. 

As I was making my rounds, one of the nurses informed me of one of her patients that was not doing very well.  In the few minutes we had been there she had started to take a turn for the worse.  Her oxygen requirement had increased and she had to be placed on supplemental oxygen.  Her breathing had also increased and she was having trouble catching her breath.  We paged the doctor who ordered a chest X-ray and some medication, Lasix, to help pull any fluid off of her lungs.  However, he was not extremely worried about the patient’s condition. 

However as the night progressed, the patient respiratory status continued to decrease.  Her oxygen was increased again and again until she was requiring the highest amount of oxygen therapy we were able to provide on the floor.  She was still having trouble catching her breath, and after every breath she was having a weak cough.  In fact just by looking at the patient it was obvious she was exhausted and her energy to even take a breath was wearing out quickly. 

We re-paged the doctor, who came to the bedside to assess the patient.  He continued in his assumption that there was nothing wrong with the patient and he did not want to do anything at this time.  We paged Rapid Response and they came to access the patient and immediately knew something was wrong.  They managed to push the order through to get the patient moved to progressive care, however as our luck would have it there was no beds available at the time and it would be awhile before the patient could be transferred.  This turned out to be a very dangerous situation, because the patient was quickly approaching a point where she was not going to be able to breath at all on her own, which means we would have to call a code and the likelihood of reviving the patient would be slim.  However, if we could find a progressive bed for her they could move her and intubate her before it reached the point of a code.  Two hours later, a bed finally became available.  As Rapid Response began to move the bed to transfer the patient, she stopped breathing and they ended up taking her to the progressive floor doing chest compressions.  When they reached the new bed, they intubated the patient and she was able to get the oxygen her body demanded.  This was one work night I wished I would have called in for.