Hey fellow allnurses just want to discuss something that happened at work today which I found a bit disturbing.
An elderly patient was brought into the holding bay of our OR. Patient was to have emergency laparotomy, query ischaemic gut. It became apparent fairly quickly that the patient was cheyne-stoking, we couldn't rouse him at all to do an identity check etc. Within 10 minutes of him arriving to the holding bay he died. Very sad and not the sort of thing you see everyday in the transfer bay.
The nurse who brought him from the ward who I know is a first year nurse didn't seem to realise that he wasn't just sleeping he was actively dying. Although it's sad he was moved around the hospital while he was dying like that, before he was in 6 bed ward and at least when he died he had some privacy in the transfer bay. Thank goodness no other patients were around at this time because I think it would have been very upsetting for them and put them off having surgery.
So my question to you is, if you were the bedside nurse would you just take someone who is cheyne-stoking to the OR? Would you call an MD before taking them to surgery? Would a laparotomy even be appropriate in this situation because correct me here if I'm wrong but once a patient reaches the stage where they're cheyne-stoking is it true that not much that can be done except make them comfortable?
I'm not trying to appoint blame on the first year nurse either because I'll admit I haven't seen cheyne-stoking before, my knowledge of palliative care is limited. I was more concerned that he was unrousable, which I must admit the first year didn't seem to be concerned about. But I'm just interested to hear your opinions.
Jun 15, '10
This may sound terrible, but the patient dying prior to surgery may have been the best thing that could have happened to him. He was probably very acidotic with all that dead bowel. He would have been sliced opened and likely in extreme pain post-operatively had they intubated him, done a surgery, closed him, and then left him on life support for any amount of time.
Obviously the manner in which the patient's death occurred wasn't ideal or proper. It is very sad that he was left in this state as well, without family being notified. However, in the grand scheme of things (without knowing his code and family status), I think there are worse things that could have happened. The chances of this poor guy making it were basically about 0.00000000001%, if you catch my drift. It sounds like he already had MODS with impending septic shock.
What were his pre-op vitals? I can't imagine he had much of a blood pressure prior to arriving in pre-op.
Last edit by WalkieTalkie on Jun 15, '10