Quote from JessicRN
Thanks we have a whole slew of new attendings who are straight out of residency and they are driving us nuts. One actually let a pt who overdosed have a BP <65 systolic for over 4 hours because they were too busy to put in a central line (duh) he was allowed to have dopamine only even though it only kept the BP at 60 systolic
When I try to question her she say if I have a problem with her management of patients then I should take it up with the site director. I told her I will do just that but right now I want to save what was left of the Patients lungs and kidneys. I asked to add peep since the Patient was on a respirator and again I was turned down. I informed her since his BP was so low the likely hold of ARDS is great now and PEEP could help but again she turned me down. (by the way the pt went into ARDS and died he never came off the Respirator and he had ARF anything happen to the Doctor? NOPE) This was not my patient so I did not step in sooner I wish I had. The worst part is I stepped in when they had the central line in and started the Levophed at 1mg and kept the Dopamine at 10mcg/kg/min I bumped up both and had a BP of 105/60 in 15 minutes. This doctor I hope won't question me so much I know she is humbled. Not sure if there will be a lawsuit yet, I sure there would be if someone read his chart. The nurse involved it was her first day off orientation and she never worked ED before but someone said she had ICU experience (you are kidding )
She actually tried to do it again on another patient the same day who became septic and tanked, that was my patient and I informed her I am the patients nurse and it is my goal to stabalize this pt as fast as I can so she can live not wait for a central line. I will take responsibility for my own patient I will start periperally and as soon as she gets the central line and comfirms it then and only then will I switch it out. (if took 1 hour to get a central line because she had to do the conscious sedation on the kid with the paronnychia) I informed her if she does not like this than she is welcome to take it up with my unit manager if she wished but my policy says central line preffered only and since she had no BP the RAC wins. ( she did not I think as I heard nothing).
This same Doctor ordered the conscious sedation and became upset when every nurse said it was crazy (by the way she prerformed the conscious sedation but found no infection when she I&D'd the toe it also took multiple tries to get an IV and the child screamed for 30 minutes prior to the sedation. Pediatrics you don't usually do anything for a paranychia except foot soaks and and maybe ABx
Paronychia. Yes, soaks, local treatment, right? And since when does paronychia come before kidneys and airways??? Was this child septic or just in pain or what? How did the child get triaged to the head of the line?
Where is that doctor's supervisor? Chief of Service? Somebody who can correct her immediately, not let her kill people? The hell with her humbling, there are lives to save! Maybe a very gentle hint would be in order to the dead person's survivors that a lawyer needs to be consulted. This doctor is incompetent and needs a serious comeuppance, since she will not listen to good advice or consult her superiors. Was Resp Therapist around to advise her on PEEP?
Also, not to upset or hurt you, but if you knew that nurse was fresh out of O, you should have intervened, even if the patient was not yours, I think. There's stepping on toes and there's saving of lives. I dont know the whole story and am open to being corrected. Sorry to be critical but I am really appalled that this doc's timidity, inexperience, and arrogance, plus your not stepping in and involving your boss and the doc's boss seem to have caused an unnecessary death.