Rural ER Nursing

[twinsmomrn13]

HI...I am a an rn in a rural medical facility and therefore my duties include ER, hospital patients, outpatient treatments and nursing home. I am "used to" (you never really get used to it) my nursing home residents passing, but the other day I had an ER patient pass away while still in the ER. This is the first time this has happened to me and I am having a hard time letting this go! Elderly pt. arrived by ambulance 30 minutes after initial call. Pt. arrives tachycardic, tachypneic and anxious. Trying to pull of NRB and constantly moving limbs. Earlier in the month, pt. had a colon resection and then a fistula that had to be repaired. Could not obtain a bood pressure in ambulance and had difficulty obtaining one in ER. Two lines placed, cardiac monitor and EKG performed. Fluid bolus administered with no discernable effect. Pt. still anxious. Chest x-ray reveals RLL pneumonia. Pt. also has a history of severe COPD, on 4 liters at home. D-dimer over 5000. Pt. quickly detiorated and soon respirations ceased. My thought is a massive pulmonary embolism? I guess I just always want to fix everybody and would like to hear from anybody that has had a similar experience! Thanks...

[Nurse SMS, MSN, RN]

Certainly sounds like embolism to me. Sending you love and light.?