((HUGS)) We don't have crystal balls....we try but we don't ......sometimes this stuff just happens. We as meager humans don't have the final say about patients outcomes....we are just facilitators my personal belief is that some else has the strings.
I remember when TPA was new.....we had this patient that was borderline age to give the drug....this was an active healthy guy....no HTN, no Diabetes....and he was going to die if we didn't give TPA....we gave it with a well respected BRILLIANT Cardiologist at the bedside. Thye IV nitro \was sky high because of pain.....then the TPA worked. The patient C/0 a headache...the cardiologist came in evaluated...... afraid of the worst case scenario.....the patient was fine...I went to get the ty #3....I was gone maybe a minute...when I walked into the room it was clear the patient has a massive CVA....he died from a massive head bleed.
I still remember his name....sigh
These thing stick with you ....learn form them. Maybe there is a subtle something that the next time will ring an alarm bell in your head....it will make you a better nurse. One thing that caught my attention....
less arousable but still pushed with his arms when we drew blood and changed his gown.
Pushed with his arms ....that might be an abnormal finding even with sedation...a sort of decerebrate/abnormal extension posturing for even someone snowed with meds should withdraw from pain. Subtle....probably not significant...but the next time it might help you think....I better check/call I remember this.
You didn't cause the head bleed and you couldn't have changed the outcome. There is some evidence that an elevated tropinin is present with ICB/SAH and can be a prognostic indicator of head bleeds....http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3212425/
. It wasn't your fault...but you will never forget this........((HUGS))
Hindsight is always clearly 20/20......give yourself one night to be angry, hurt, cry, indulge in adult beverages...have a bubble bath...then get right back in the we need caring nurses like you.