I've been an ED nurse for 5 years and just moved to a new state, a new job. I'm as confident as I can be after 5 years, I definitely don't know it all but I can hold my own.
Yesterday, my 2nd week off orientation I had a critical care room with 2 bad pts plus I was responsible for a medical bed until the 1pm nurse arrived. It was 12:30 and in the med bed I got a meth smoker, not taking her meds, already had a few CVAs, she was a mess.
Blubbering about how I wasn't allowed to stick her as she always gets IVs in her neck from the doc, they know her there. So when the doc came in I told him this and he ordered an ultrasound guided IV. He gave her hell about her pressure and not taking her MANY bp meds, he seemed really freaked about her shape and kept having me cycle her BP. Her BP was 250/150 range, repeatedly. She was a mess.
So the ultrasound nurse, an ER nurse, came and set to work, I gave this pt the ordered ntg, sl clonidine po (made her chew 0.3) and had to get ATBs on board on my septic pt so I ran to do that while that nurse got the IV and blood. I was in my critical room when the doc (I don't know) called me out of the room and asked me if I had Meth lady.
I said yes and he said all gruffy "put her in trendelenberg and set up an EJ". Nice, the ultrasound nurse struck out on her fried veins and didn't tell me, just left. So I put her in trendelenburg and set up the EJ. Her pressure spiked even HIGHER, her face was all red, she was moaning, and after about 10 min the *doubt* set in. "Omg, we put *hypotensive* pts in this position! Crap, did he say reverse trendelenburg because of her pressure? Her damn heads gonna blow off! He's gonna walk in here and flip! And if she strokes out it'll be my fault!"
A good 10 min went by and I got nervous, put her in reverse. So he walked in and YELLED at me, "THATS NOT TRENDELENBURG! Put the patient in trendelenburg, thats her head LOWER and I'll be back!" He huffed out and I felt this -->. big.
Fortunately then my med bed relief nurse walked in and I was able to apologetically hand the whole mess to her. It really shook me for the day though, I was afraid of having the patient in that position, in her condition for a good period of time when she obviously worsened in trendelenburg. I didn't know the doc isn't very experienced and wanted her neck veins extra full (he tried and couldn't get it, made u/s come back). What a mess.
Even when you're confident in what you're doing you can still have these "I'm so stupid" shaken moments, right? I wish I could just accept that I did the right thing due to her worsening but the doubt I had is what bugs me. i hate it when docs flip out like that and huff off before you can say "she got worse while waiting!" Anyone else?
