Did I do enough?

focker14 · Nov 6, 2012

I'm a new nurse in ICU. I'm looking for honest answers to the question: Did I do enough for my patient. So here is what information I feel I can tell. This is only the second time I have had a patient die. They were unresponsive for unknown time period and came in full code with a STEMI, extremely high troponin, anoxic brain injury. Got them off vasopressors and later treated for hypertension and tachycardia. An hour later family arrives out of town and made patient DNR. Then blood pressure started to dropping again and they died a few hours later. I just wonder if there was anything else I could have done since I could not restart vasopressors. I feel like I didn't really do anything for them. My first patient death was different because I knew we had tried everything we could. But I feel like we just stopped treating this patient when they became a DNR. I also feel like treating him for his hypertension caused the hypotension even though I know that he was hypotensive at first. I keep going over everything in my head thinking I could have done more.

For starters...don't think you could have done more. Doesn't appear the patient was going to make it from the get go. Also people with anoxic brain injuries can develop cerebral edema enough to cause herniation which could have very well happened...The situation you described fits the symptoms...I know you said this was only your second patient to pass but I can tell you that even after your 100th, you still ask that question, it doesn't get easier.

Sun0408, ASN, RN · Nov 7, 2012

No, nothing else you could have done. You are correct, DNR does not mean do not treat but there are different levels of a DNR. With everything stacked against this pt, most likely pressors would have just prolonged his death and he would not have made much of a recovery if they made it out of the ICU at all. Pressors will only work for so long before other complications start to show themselves, was the pt still unresponsive, were they intubated, what was the GCS, look at the whole picture, not just the fact the pressors were not restarted.

nrsang97, BSN, RN · Nov 20, 2012

I think no matter how many pressors you would have started the patient still would have died. It sounds like they herniated.

Bec7074 · Nov 20, 2012

I am of the opinion that there are many things worse than death. Anoxic brain injury combined with STEMI sounds like one of those things. Death does not mean you failed. It means the family made a decision (and to each their own) and it's your job to support that decision regardless of your personal beliefs and give the patient a dignified, peaceful, pain free death.

Once you see the families that put patients through hell and back, you will learn to appreciate those that aren't afraid to call it quits or who are confident in saying they know what the patient would have wanted.

Just recently on my unit we coded a man for over 2 hours. He had a carotid dissection and we knew there was nothing we could do. He was a ticking time-bomb. His wife sat and watched us code him the entire time. She told the doctors "I wouldn't put my dog down, I won't do the same to him." That's fine if that's what she wanted or thought he wanted, but if I were that patient I would have rather died with my wife holding my hand without people pounding on my chest.

solneeshka, BSN, RN · Nov 29, 2012

By the time you got him, his body was already trying to die, and then it did. It's your instinct to treat everything you can treat, but if a body is done, it's going to die anyway. You can be confident in your care.