We saved some guys life...

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    Another interesting moment in the life of a staff nurse on stepdown, walking into room with a patient in dire straits. If we were there two minutes later he would've gone into cardiac arrest.

    We saved some guys life...

    Just another day in the life

    The other week I was at the station BS'ing with one of the Nursing assistants and a new grad nurse about online dating, raunchy pictures on peoples profiles (hey, it's what you o on night shift at 3AM). We're talking and there's the usual dinging in the background, any combination of IV pumps, the tele monitors, bipap, etc.

    After a few minutes, our conversation dies down and my ears pick up on the bipap alarming. The patient in 16B had been doing this all night. Evidently his nurse wasn't around so I have that internal dialogue, "well maybe it'll stop alarming in just another second...." It doesn't, so I get up and walk into the room.

    There he is, trying to scoot down to the foot of the bed, looking a bit blue and anxious, with the bipap sitting near the head of the bed. While blocking him from further escape I tell him ''You cant get out of bed, we need to put your bipap back on". He looks at me and starts to move himself back, at which time I peak out the door and summon my two buds at the station to come help me straighten this guy out. As I turn back to the patient he is awkwardly lying himself down down and I realize he looks a bit worse than I previously noticed.

    I hurry over to the bipap and push the mask to his face, at this point he tries to grab at the mask but I swat his hand away. His eyes start to roll back into his head as he loses consciousness. My internal dialogue comes back "Oh fuhhhh....."

    My backup arrives to help, Im still holding the full face mask to his face they offer to pull him up and I say ''hold on a second" "Just breathe buddy, breeeeeeeathe" The bipap is on 80%FIO2. As the bipap helps him get two, three, four breaths he's not waking up. I tell the other nurse to call the charge in and the Nursing assistant asks if we should check his Oxygen, to which I reply ''I'd rather not know...". My internal dialogue "Maybe we should check a pulse?" Tachycardia on the monitor could easily be PEA...

    We put the pulse ox on his finger and it reads 58% with a good tracking waveform. The charge nurse comes in and the patient starts waking up. We secure the mask to his face and slide him up in bed, his sat slowly climbs up, 70s, 80's, mid 80s and then 90s.

    I meander back to my spot at the station, a tad more sweaty than before, my own heart rate nearly double. I sit back down in my seat and think about how lucky we just got.

    Hypoxia -> anxiety, agitation -> fight/flight/confusion -> loss of consciousness -> cardiac arrest.

    The PCT comes back to the station.
    "...So about those raunchy internet dating pictures"

    ----------------
    The thing that leaves me jaded when it comes to nursing after working bedside as an RN for 3 years is the lack of recognition, especially from our superiors / management.
    Personally I have witnessed nurses preventing wrong blood type administration while at the bedside. Cardiac drips have come up from the ER running at 10x the prescribed rate (easily lethal), etc. Yet we are never recognized for literally saving someone's life- we are more often broken down than built up, we are seemingly never good enough in one or more areas of customer service, white boards, paperwork, surveys, etc. Our workloads are always increasing, never decreasing.
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    8 Comments

  3. by   missmollie
    I hope that bipap is on 24/7, because if not your day shift nurse must have had a bad day. Why wouldn't you call the doctor, respiratory, and rapid if the bipap had been alarming all night. At the bare minimum, the patient needed an ABG. How long had they been at 58%? If the patient wasn't hospice, then there is a deeper issue there and I'm not sure you addressed it.
  4. by   Euro_Sepsis
    Agreed with the poster above. You're very lucky he tolerated being placed back on bipap while on the edge of responsiveness. No mention of pursuing the cause of his acute decline, no ekg?
  5. by   NurseCard
    Odd story. Lots of stuff left out. How is this an "article"?
  6. by   ArmaniX
    Sounds like the patient was removing the bipap all night hence the constant going off.. how long were we discussing raunchy profile photos while it was going off?

    We don't do the things we do at work for praise and recognition. As far as all of the management and whiteboard items, they will remain secondary to the primary concern always regardless what upper management believes.
  7. by   Ms.UndastoodRn
    I'm loving all these responses. I've worked night shift my entire hospital career and always find it baffling the conversations and inappropriate behavior being had ie: raunchy internet dating, instead of taking care of the patient. If you became a nurse for recognition, get OUT NOW. You guys failed this patient. This could have easily been a sentinel (preventable) event. We work 3 12s a week, save your personal life for after work hours. Glad he did recover but a chest Xray, ABG or lasix may have helped this patient. Was he confused? What was his CO2 level? Poor guy, that's why patients families stay and write everything down and treat all of us like uncaring criminals.......
  8. by   Nurse_RaRa
    too true. Never ignore those bells and yeah - more and more work, less resources. It sucks.
  9. by   blondy2061h
    Your unit sounds extremely toxic. Tele alarms, bipap, and call lights shouldn't be going off so common that they're "usual background noise.". Why wasn't someone so dependent on bipap on continuous pulse ox monitoring- or better yet- at a higher level of care? And your conversation volume was so high at 3am you literally weren't hearing alarms until the conversation died down a bit? Oy.

    Further, I'm not in this for the recognition, but nonetheless, I DO hear from people frequently how valuable they feel nurses are. It sounds like you're having a lot of near misses at your facility.
  10. by   marie.rn2419
    You guys don't have a BIPAP patient on a stepdown unit on continuous pulse oximetry??

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