New Nurse's 1st Crash & Burn

  1. 2
    This is my first time posting a thread-had an absolute train wreck last night and it was my first time I had to call a code. I'm a newly licensed RN (working less than a year) and had my worst case to date so far-pt. was transferred to our unit in septic shock. She had previously came from the NSICU as a rule out CVA. Pt. with history of R. Pneumonectomy and DM type 2. Her CT scan showed humongous L. sided pneumonia, so oxygenation was an issue ovn, and the respiratory therapists were working endlessly last night to o ygenate her the best we could. When I got the pt, she had only recieved about 4 bluid boluses in ED so we started bolusing on pressure bags, Arterial line was placed and another central line was inserted ( she already had a r. groin TLC). Pt. was already maxed out on Dopamine and Levo when I got her and blood pressures were terrible, like 80s/40s-50s and MAP
    Merlyn and Joe V like this.
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  3. 19 Comments so far...

  4. 7
    Sorry it cut me off. MAP< 65. We immediately started vasopressin and after a while started them on neo (which we maxed out as well). We also started her on a couple broad spectrum antbx, then eventually started her on an epi drip (which, you guessed it...we maxed out on). With all of these pressors and after about 6-7 more fluid boluses, her MAP never got above 60. Some other important things-her abg was terrible, we did about 5 or 6 overnight and she was severely acidotic (she recieved a few amps of sodium bicarb and then a drip was started). Her lactate elevated to about 7 and her wbc was 35 and bands were 8. Pt. was placed on VDR machine to try to better oxygenate her, but that really didn't do anything as well. After her last ABG from this morning came back, the respiratory therapists came in to switch her vent-pt. was getting bagged, her MAP was dropping even more and at that point I ran to get the code cart. And this was all while trying to give a bedside report and still recieve more orders for last ditch efforts. Sure enough as I was getting the cart I hear the code blue alarm go off. Pt's pressure was lost and she went into PEA-ultimately we called it after about 15 minutes of resuscitation efforts...So, I guess I just had to get this off my chest, especially since I'm newer and this was the worst pt. i've ever had. Throughout the night, I just kept thinking "I can't believe I'm taking care of this pt...lol. I had a lot of help from the charge nurse and my neighbors and they were proud of me last night but I definitely couldn't have done it without them. The day shift nurses seemed to be impressed, including one of my old preceptors and the patient care coordinator who even said i did a 'fantastic' job. It makes me feel good knowing this, but it also makes me think if there was ANYTHING else we could have done?
    fiveofpeep, lisaannjamRN, *4!#6, and 4 others like this.
  5. 1
    wow, what a wreck that patient was. I'm glad I don't do that any longer. There was nothng left to offer in terms of meds, good job!
    JazzyK89 likes this.
  6. 5
    So sorry you had such a bad experience. I know it won't make you feel any better, but successful resuscitation of advanced sepsis/septic shock is rarely successful. That's why there is such a HUGE emphasis on understanding & integrating MEWS scale ratings into all areas of patient care in the US these days. Mortality increases dramatically for each hour that sepsis goes undetected, no matter what setting the treatment occurs.
    Mully, MLMRN1120, hoopschick, and 2 others like this.
  7. 10
    first i have to say.......you've come a long way baby!!!!!!!!

    wow.....new nurse, newly licensed, who is working in what is clearly a high level icu. what a night . you must have had one heck of an orientation and are one smart, calm cookie.....for that was one very sick patient. sepsis, septic shock/sirs can be one of the deadliest things to patients and difficult for nurses because we are busting our butts off and they slip through our fingers.

    to me, you gave this patient the best fighting chance to survive a terrible illness and it was a job well done. in icu when the patients are so very sick and you have one that circles the drain, as this patient did, you need all the help you can get. it is always a team effort in a good icu when there is a critical patient as complicated as this one. you did an excellent job! and you should be proud.

    bobbyzr7 said it reminded him that he is glad he doesn't do that any longer.......it is a personal choice and that is the beauty of nursing that you get to try something new and find your niche. me, on the other hand, who loved the sickest of the sick.........makes me wish i could work again...i miss it so.

    they only med you didn't mention, so i don't know if you gave it, would be the anti-histamine, histamine blocker and steroid combo for the sirs (systemic inflammatory response syndrome). other than that.......you did it all.

    i am sorry that the patinet did not have a good outcome and i am sorry to the patients family, my heart and prayers go out to them.......

    but from a crusty old bat iccu nurse.........job well done!!!! cheers
    Dalzac, lisaannjamRN, opossum, and 7 others like this.
  8. 4
    Thanks everyone for your responses And to address the antihistamine, histamine blocker, steroid combo-she did get a dose of solu-medrol, but that was it. I did feel terrible for the family because they were having difficulty comprehending how sick she really was considering she had been admitted to the hospital the same night all of this happened...just very sad all around. But Esme, thank you so much for your kind, thoughtful words-I definitely appreciate it! It was a whirlwind shift, and as much as I hate to see pt's that sick, I was running on pure adrenaline by 7am that morning and it did feel good to know that I am capable of taking care of these patients
    *4!#6, chevyv, funnyliz, and 1 other like this.
  9. 2
    You did a great job. Lots of times the family doesn't understand, or won't understand, or won't accept, or can't accept, how sick the pt really is. Everybody hopes for a miracle, but sometimes it just doesn't happen. When its time to go, its time to go - we can only beat back the grim reaper so long, but he eventually gets through our blockade and snags the pt. All you can do is offer kind, gentle, and sympathetic words and make the pt look nice for the visitation. We deal with this in the ED all the time but it is never easy. And to agree with HouTx, sepsis screening is so essential. We now have a screening tool in our triage screen which is great. I recently had a pt come in for r/o cva but I thought he was septic. Sure enough, he failed his sepsis screen, and was admitted for urosepsis. But sometimes its just too late. Again, cheers, you did the best job possible.
    JazzyK89 and Esme12 like this.
  10. 8
    Quote from JazzyK89
    Thanks everyone for your responses And to address the antihistamine, histamine blocker, steroid combo-she did get a dose of solu-medrol, but that was it. I did feel terrible for the family because they were having difficulty comprehending how sick she really was considering she had been admitted to the hospital the same night all of this happened...just very sad all around. But Esme, thank you so much for your kind, thoughtful words-I definitely appreciate it! It was a whirlwind shift, and as much as I hate to see pt's that sick, I was running on pure adrenaline by 7am that morning and it did feel good to know that I am capable of taking care of these patients
    Welcome to the addictive world of ICU.....
    MLMRN1120, opossum, Nursetastic, and 5 others like this.
  11. 3
    Quote from JazzyK89
    This is my first time posting a thread-had an absolute train wreck last night and it was my first time I had to call a code. I'm a newly licensed RN (working less than a year) and had my worst case to date so far-pt. was transferred to our unit in septic shock. She had previously came from the NSICU as a rule out CVA. Pt. with history of R. Pneumonectomy and DM type 2. Her CT scan showed humongous L. sided pneumonia, so oxygenation was an issue ovn, and the respiratory therapists were working endlessly last night to o ygenate her the best we could. When I got the pt, she had only recieved about 4 bluid boluses in ED so we started bolusing on pressure bags, Arterial line was placed and another central line was inserted ( she already had a r. groin TLC). Pt. was already maxed out on Dopamine and Levo when I got her and blood pressures were terrible, like 80s/40s-50s and MAP
    Welcome to the Wild, Wonderful, World of Nursing! Nights like the one you describe have and are happening to all nurses every day. I guess they didn't tell you that in Nursing School, that you would be admitted to the head banger's union. The good news is it will get better the longer you are in nursing the bad news is that you will have more of the shifts you spoke of above. Have a drink and welcome.
  12. 3
    don't apologize for needing help on this trainwreck-- i don't know any hotshot icu nurse (including me, years ago) who wouldn't need help on all this. sometimes you need three or even four nurses assigned to a patient, and this is the kind of patient that warrants it. i used to love patients like this, but it is better to have a few of them make it, or it gets really depressing. some of them do make it, so do not despair. you did a great job-- we can tell by the way you tell the story that you have learned a lot already.

    yep, sepsis can kill very fast-- a little faster than a few episodes of house. just had an elderly relative die of this-- she had had a picc in for home antibiotics for an infected finger (!) and the vna found her a little loopier than usual when they went one afternoon to give her vanco. admitted by 9pm, dead by 6am. fast has some advantages. i don't think she ever knew what hit her.
    turnforthenurseRN, JazzyK89, and gonzo1 like this.


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