The worst code you've seen? - Page 3

Where do I start?? Too Many...

This one though has stuck with me for awhile (wasn't my pt thank God) Transferred a pt to our unit at 2300 from small outlier hosp with initial unstable angina, suspect non-ST MI which was relieved by a nitro drip (the hosp had a 24/7 cath lab). Cardiologist wanted to wait to cath the pt till morning because the pt was a diabetic with renal failure (on outpatient dialysis) and had allergies to contrast dye. Plan was to do bicarb drip overnight and load pt with Benadryl before the procedure. The pt was hemodynamically stable with no active symptoms at the time of admission, and we started a heparin gtt upon admission. Through the night the pt became progressively more symptomatic (all the classic signs including now ST elevation in multiple anterior and lateral leads), called the doc 4 times insisting the pt was unstable and needed to be cathed, still didn't want to cath and by change of shift (when docs started rounding) pt was being prepped for emergent cath (duh!!) Well, during shift report the pt of course coded, I responded to the code and initiated compressions, the first compression I did I could feel the pt's entire sternum fracture which spread to the pt's ribcage bilaterally. After we got the pt intubated, copious amounts of blood were coming out of the ET tube (didn't help he was on Heparin overnight) and literally the way we ventilated was RT would give 1 breath and 1 of the nurses would suction. So breath, suction, breath, suction. This went on for over 45 minutes before we finally called it (and the room looked like a murder scene by this point, though not nearly as bad as some of the ruptured aneurysms mentioned above, so are the worst!)

The sadest part of the story was about 10-15 min before the code, the pt called their spouse to let them know everything was ok and to not rush in (about an hour drive for the spouse from where they lived). We couldn't get a hold of them during the code after multiple attempts, by the time the spouse got there the pt had expired (needless to say we had a Chaplin there when we broke the news, heartbreaking...)

I wasn't the primary nurse of this patient, but I was in charge. The primary RN was asking me for advice for her patient, a 94-yo who had a bad case of pulmonary edema. You could hear how wet the patient sounded just by standing in the doorway. The patient kept having random bursts of v-tach and they were confused. Abdomen was VERY distended. I had a feeling in my gut and this thought crossed my mind - "this patient is going to code by the end of the night." They were a full code, too. We spoke to the hospitalist on call who didn't want an NG tube placed and also didn't want to transfer the patient to ICU because "I don't think they would do much more there than what you are doing here."

I was at the desk and noticed on the monitor that the patient's O2 sat started dropping...80's to 70's, then 60's...I called RT and ran into the room, then the patient stopped breathing, so we started to code them. Feces then started to literally POUR out of the patient's mouth. That patient aspirated, for sure. We flipped the patient on the their side and it was like a waterfall on the side of the bed. We dropped an NG tube and filled up two and a half suction canisters within minutes. That abdomen shrank in size.

That was a very messy code. We were able to get a pulse back and we transferred the patient up to the ICU, but by the end of the night the patient's blood pressure started tanking and they coded the patient again right before shift change. The patient didn't make it that time.