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Nightcrawler, BSN, RN
320 Posts
I work in a tertiary teaching hospital in an acute telemetry unit. Saturday night was one of those nights that all nurses dread, and it all started during report. A patient became nonresponsive during dialysis in her room, was coded, and transferred to ICU before any of the night staff had even finished their first report. This was difficult for me because even though she was not my patient, I had cared for her for several nights last week and was familiar with her and her family.
Needless to say, all of us were a little shaken up. We are all ACLS certified, but we are lucky enough (knock on wood) not to have codes on a very regular basis.
At about 10 one of my co-workers calls for some help in restarting an IV, and as I have a little time I go in. The patient is sitting on the side of the bed, complaining of chest pain, diaphoretic, ICY to the touch, with a shallow respiratory rate of 30. Her surgical wound was oozing and had partially soiled her gown with blood. Initial BP was 69/40, temp 96.7.
I immediately get more people in the room, we are getting serial bp's, which do get better once we get her back into the bed, with systolic pressures in the 90's.
Unfortunately the room that this patient is in is located in a hole in the coverage for the cell phones that the nursing staff carry, so I and my charge nurse are at the nursing station talking to the intern, and relaying information to the nurses in the patient's room and trying to impress upon the intern just how serious we thought the situation was ( we had already placed the crash cart just around the corner from the door)
My charge nurse becomes more and more frustrated with the intern, who is arguing about things that had occurred earlier in the day when she had attempted to give a verbal order to a CNA, and eventually hands me the phone to talk to the doctor while she goes to re-evaluate the patient. The intern tells me that she doesn't see the problem, that the patient's vital signs are now stable and that she "knows" this patient and that she often complains of chest pain
My response is to repeat the symptoms that the patient is exhibiting and to state bluntly that clinically I believed that this patient is very ill and that she needs to come and see the patient. The only order she gives is for a foley catheter and stated that she will call her fellow.
The intern arrives 30 minutes later, after we have bathed the patient, changed her dressing, the bed, started two lines and have continually encouraged the patient to attempt to control her respiratory rate and to utilize pursed lip breathing. The doctor walks into the room, asks the patient "is the pain you are experiencing the same as the pain that you had before in the ICU" does a 2 minute assessment and orders 1mg Morphine IV stating that she is "acting up for pain meds" She does not order a chest xray, troponins, ekg, abg or any of the other things that are standard orders for complaint of chest pain alone without any of the other symptoms.
This is midnight. We move the patient to an empty room directly across from the nurses station, and the nurse starts doing q 15 patient checks and vitals. Remember we are not an ICU.
At 0300 the nurse calls the intern back to report only 20cc's of urine output in 4 hours. The intern orders the rn to flush the foley and hang 100cc's of 5% albumin.
At 0330 the patient asks her nurse and the charge nurse to call her family and let them know what is going on.
At 0354 the patients pacemaker stops capturing and the monitor shows asystole with pacer spikes and the code commences. At 0430 the code was terminated.
We had spoken to the intern numerous times, our charge nurse had paged the fellow in charge that night, the nursing supervisor was aware, and we were still not able to save this patient when we had fought for 6 hours to get the patient the care that she needed. What put the cherry on the whole thing for me was hearing the fellow first try to blame the code on nursing, and then to hear him tell the attending on the phone that she had shown "no appreciable changes" from that morning.
Please do not get the wrong idea, patients at our hospital normally get very good care from doctors and nurses, which makes the rare instances like this all the more galling.
Sorry all that this was sooooo long. Sometimes I just have to vent, and this was very very hard even though she was not "my" patient
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