[Morettia2]

CON'T FROM PREVIOS POST...
THIS WAS OUR ANSWER FROM THE CATH LAB: well the anestiologist evaluated the pt. realized the pt. spoke spanish and little to no english, so we brought in a translator for the anestiologist and the pt. The anestiologist asked the pt. if the pt. was allergic to ANCEF (not Penicillin, not anything only ANCEF), the pt. said no.....(ok it gets better), then the cardiac fellow and I asked why was there nothing in the chart about the pt. not recieving dialysis for 2 days, and why did a certain EPS MD not dialyze the pt. pre or even post procedure, post espically b/c of all the IVF the pt. revieved. And last but not least The Cardiac fellow and I asked, did anyone assess the pt. post ICD implant b/c the pt. was in anaphylatic shock when the pt. arrived to the floor from the cath lab. Pt wasn't even on the floor for 5 min and in full blown anaphylactic shock. Did no one notice this when the pt. was in the cath lab and when they were transporting the pt. to the floor.
I chimed in with this statement which I felt was pretty damn relevant..."OK outside of healthcare professionals, not many people know what ANCEF is or what it is used for, you are telling me that you are asking a pt. that speaks little to no english, and had to use a translator, 'are you allergic to ANCEF' ,not penicillin, only ANCEF. That's like asking me if I am allergic to IV contrast dye, and I have no experience in healthcare, don't know what it is or used for and don't speak english, and not asking me if I am allergic to Shellfish." the other end of the phone was silent... Simple questions that NEED to be asked..
Let me say that the cardiac fellow and I spent alot of time filling out
quality controll reports, incident reports, code sheets and letters..i am not one to fill out incident reports at all, infact this was my first. I would rather comfront the nurse or MD insted, which I did, and got no answers.. but this time it was just pure neglect of taking an accurate history. There was no communication barrier, 2 simple questions..are you allergic to penicillin b/c this is the ATBX we use and it is has PCN, and did you recive dialysis today, or when was the last time you recieved dialysis...pt. ended up with severe pulmonary edema from the PCN, b/c pt was allergic and the IVF b/c pt hadn't had dialysis in 2 days and went into fluid overload. So 2 major things, that happened to become one b/c no one took the time to ask. I hope the pt. makes i though the day. That new ICD in't going to do much good if the pt. isn't breathing....
oh just a side note I know this is long but I had to get it out..my pt. that coded the other night, the pt. I posted about originally a few days ago, is doing great..went to stepdown and is laughing and talking..I only pray that this other pt. will pulll through..thanks for listening

[putmetosleep]

Originally Posted by Morettia2

The resident goes to me, "what should I give the pt", while she is thumbing through her Tarascon pharm book..I looked at her and said "Epi, SQ or IM b/c the pt has poor venous access and solu-medrol IVP, but you HAVE to give the Epi first "..I also told her the pt. had not recieved dialysis in 2 days and had IVF running, that I immedatly stopped... she looked at me and said, "yea do what she just said" .

If the patient had IVF running, wouldn't you want to give the Epi IV regardless of poor venous access (since he already has an IV in place)--better absorption and more predictable distribution of Epi given IV vs SQ or IM. Please correct me if I'm wrong.
Sounds like you've had a rough few nights at work, good work and what great learning experiences!

[canoehead]

Wow, I'm speechless.

[medsurgnurse]

You doing a great job and keeping a cool head in heated situations. A teaching moment: Ancef does not contain penicillin. It is a cephalosporin. 1% of persons allergic to penicillin will have a cross allergy to cephalosporins. Which is why anything with a CEF in it should be given with caution to those with penicillin allergy. The main thing is you realized the patient was having an allergic reaction and acted accordingly. Good job.

[Morettia2]

Originally Posted by medsurgnurse

You doing a great job and keeping a cool head in heated situations. A teaching moment: Ancef does not contain penicillin. It is a cephalosporin. 1% of persons allergic to penicillin will have a cross allergy to cephalosporins. Which is why anything with a CEF in it should be given with caution to those with penicillin allergy. The main thing is you realized the patient was having an allergic reaction and acted accordingly. Good job.

thanks for the tip

[Morettia2]

Originally Posted by putmetosleep

If the patient had IVF running, wouldn't you want to give the Epi IV regardless of poor venous access (since he already has an IV in place)--better absorption and more predictable distribution of Epi given IV vs SQ or IM. Please correct me if I'm wrong.
Sounds like you've had a rough few nights at work, good work and what great learning experiences!

the pt's lines were pretty much blown anyway..I just happened to open my mouth about the EPI..I was hoping the MD would have said IVP but I know that if I recieve PCN by accdent I always have to get epi IM or SC, just what happened to come out of my mouth first..I know IVP EPI would have been better. It was just the situation. Thanks for the tip!

[msaaaz]

well done

you with the other team member safe that pt. life

[MEME123]

WOW JUST WOW. Your a great nurse. Hope you had a break.

[sarahrain]

This is very inspiring.. Thanks for your sharing

[ICUCoOLWaTER]

Hi am really speechless i do not know what to say to u but God bless u me i know what was the patient diagnosis was he going down or it was sudden heart attack lead to Cardiac Arrest? and were u thinking of DNR protocol that time Ethically. thanks