A patient expired! Cannot figure it out why!

[NP2B2016]

I have never experienced a patient expired during my nursing career before except last night one of the colleague's patients had passed suddenly. I helped him through the process but I cannot figure it out why the patient passed. Can any more experience nurses provide some input? The pt was 68 or 75 (don't remember) who had a hip surgery ( from fall at a LTC) post-op day one with long history of mental and psych issues because the patient had a traumatic brain injury some years. Since the injury patient never been normal and always wear a protective helmet. The patient has been on numerous psych and anti-anxiety meds and was told to be extra careful because the patient known to try to commit suicide like purposefully try to choke on water or on any liquid. Anyway, patient did not have all the medications post-op but only got them last night. The vital signs were within normal range from the beginning of the shift but she died several hours later without making any noise. It appeared the patient had just passed peacefully and was a DNR. What could it be? Sepsis? MI? Combination of Medications?

[Ruas61, BSN, RN]

Hip surgery and unexpected death, to me screams fat emboli from the hip fracture going to the lungs.

I'm with the others most likely PE.

Fat emboli, I agree.

[dansamy]

major surgery, I'm guessing. you don't get pelvis reductions in ambulatory surgery facilities. PE is a risk anytime you're dealing with a large bone injury, right?

Pulmonary embolism is a risk after any major surgery. The source being a fat embolism happens more commonly after bone surgery.

Sent from my HTC One X using allnurses.com

[MomRN0913]

PE most likely

[SaoirseRN]

Could combination of medications such Xanax (2mg) and clonazepam (1-2mg? don't remember the exact dose) put the pt asleep without recover from it? Patient has both meds ordered to given at the same time along with other psych meds. The patient however has taken these meds for such a long time already so I do not think it would affect her? Remember patient has a long history of psych since the brain injury and were not given the morning doses due to surgery. Thus again I do not think it would be overdosed either since nothing were given prior except that night! PE does make sense because it's was not even 24 hrs yet since the surgery and patient has not left the bed.

Those dosages in somebody who is used to taking them are unlikely to be the cause, even with other psych meds, because as you have stated, this is not new for the patient. I'm with the others who suggested PE as the most likely cause.

[Horseshoe, BSN, RN]

It's not likely to be due to anything sinister, such as a drug overdose at doses the patient is well accustomed to. Like others, my first thought was a PE.

The most simple explanation is usually the right explanation.

[nrsang97, BSN, RN]

I think PE or fat embolism. The drugs the patient received at bedtime are their regular medications and didn't harm them. Long bone injuries have a high risk for PE and fat emboli.

[blondy2061h, MSN, RN]

I agree with the others. The post screams PE. I'm curious how long you've been a nurse and what your background is that this is the first patient you've had suddenly die on you and that you're in NP school (I'm guessing, based on your username) but the association between PE and post-op ortho surgery is unfamiliar to you.

[gigglestarsRN]

I have never experienced a patient expired during my nursing career before except last night one of the colleague's patients had passed suddenly. I helped him through the process but I cannot figure it out why the patient passed. Can any more experience nurses provide some input? The pt was 68 or 75 (don't remember) who had a hip surgery ( from fall at a LTC) post-op day one with long history of mental and psych issues because the patient had a traumatic brain injury some years. Since the injury patient never been normal and always wear a protective helmet. The patient has been on numerous psych and anti-anxiety meds and was told to be extra careful because the patient known to try to commit suicide like purposefully try to choke on water or on any liquid. Anyway patient did not have all the medications post-op but only got them last night. The vital signs were within normal range from the beginning of the shift but she died several hours later without making any noise. It appeared the patient had just passed peacefully and was a DNR. What could it be? Sepsis? MI? Combination of Medications?[/quote']

Large bone fracture- always a risk for fat emboli. My guess is a PE, with limited info given, due to this. Even when you sense a pt is dying, death is never easy

[Been there,done that, ASN, RN]

Fat embolism... unpreventable.

[Been there,done that, ASN, RN]

Xanax and Klonopin is indeed a heavy dose of sedation, however don't focus on that. Respiratory suppression.

n would have been the presenting symptom and treatable.

[gonzo1, ASN, RN]

Lost 4 hip pts to PE in the last 6 months. The pt you post about has multiple serious health problems and it wouldn't be surprising at all for the reason to be a PE. Hip fractures in the elderly are not a good thing. Look up the stats and you will see that most die within 6 months.

[classicdame, MSN, EdD]

make a point of asking the MD at some point, because it is a learning experience. Sounds like PE though.

Do you have employee assistance programs at your facility? If so, you are eligible for counseling and it may be free. Contact HR. I highly recommend you talk to someone trained in this area to help you find peace