Change of shift funtime!

AMARTIN1 · Sep 28, 2005

The worst day of my whole career was a patient who we knew was not going to make it coded at about 6:45am. I so hoped he would wait until after we had left. Anyway, he was in a semi-private room. As we were working on him and it seemed like we were starting to wind things up, someone yells out, "What's happening over here!" We all turned to look at the other patient and saw he was turning blue and going into respiratory arrest. Both patients survived and ended up being transferred to ICU. After all the phone calls I had to make to relatives and doctors and completing narrative charting and the code blue sheets and making sure the crash cart was sent back to central supply and a new cart brought up, it was 10:30am. I was beat.
My second worst day involved an elderly man with COPD who decided to "end it all" at 6am. He removed his oxygen and then took a razor blade and slashed himself twice on both sides of his neck and both his inner wrists. When I found him he was in CO2 narcosis, not bleeding to death. For a couple of seconds I wasn't sure whether to call a code blue or call the house doctor. House doctor won out. Within a few minutes of putting his O2 back on, he became alert and was very dispondant that he had failed to die. He had not cut deep enough to hit any arteries. He did, however, manage to cut tendons in both wrists. Lot of phone calls on this one as well as an incident report. I stayed past 7:30 to assist his doctor while he sutured up all the wounds. I was there until 10am. The sad end to this was that when I came in to work that night I immediately enquired about this patient and learned he had been found dead at dinner time. The nurses had gotten him up into a bedside chair to eat his dinner and found him a few minutes later slumped over dead. Guess he got his wish, poor thing. More importantly, I also learned from several of the 3-11 staff that the man had been giving away his few little personal possessions the evening before and making comments that they now knew where indicative that he was planning a suicide. How I wish we had been told that in report.
Another memorable night in ICU stepdown we received an admission as soon as we came out of report. The doctor who was on call did not know the patient--his partner who was the patient's regular doctor was out of town and couldn't be reached! The oncall doctor was trying to do the best he could. This patient was in bad shape and couldn't talk. On top of all that his family kept telling us that he was supposed to be a DNR, that he didn't want to be kept alive if it came down to a code and this had all been discussed with his doctor beforehand. We all watched this man like a hawk. His first code was at about 2am and he survived it. However, there were no beds in ICU to move him to. He coded a second time at 4am. The on call doc was reluctant to just let the man go. He was now intubated and on a lidocaine drip and the family was beside themselves that this was happening to their loved one, but they did understand the on call doctor's position. Finally the oncall doc makes a decision and tells us to forget about ICU and make the patient a DNR. He coded again sometime after 6am. I think that he was about the only patient I was able to do anything for that night. I wanted to keep up on the charting because of everything that was going on with him and I didn't want to leave anything out of the chart.
One of the worst things that ever happened in any hospital I worked was a worker who fell out of a 5th story window of the hospital while doing some kind of maintenance work. It happened around 4pm in the afternoon. He fell right by the window of the switchboard operators on the second floor who put out the call for a code blue. I think every administrator and manager came running to help out because the poor man was lying outside on the top of the roof of a one story annex attached to the hospital. It didn't take long before the media got wind of this and they showed up too. I saw the man briefly in the ER (I was on the IV team at the time) while they were waiting to transfer him to a larger center. He did not make it. I mention it here because it was the office administrators and nurse managers who were getting ready to leave for the day who ended up staying way past their quitting time to take care of this. Just a awful thing when a fellow employee gets injured and dies like that.

I haven't witnessed anything that seroius before but I do often wonder why patients had chest pain when it's time to be d/c home and you make calls to the cardiologist, electrophysiologist and hospitalist only to find out it resolved itself; and that is after a stat EKG and chest x-ray is done for the on-call cardiologist to read and you have to tell him that the angry electrophysiologist came to see her instead and gave her some pain pills for her arthritis!!! "What Arthritis?" I was never notified of the pain and guess who looked like the idiot that day? The RN of course... :rolleyes: Oh and I forgot to mention the pt's daughter who went into a fit of rage at the nurses station because the internal med doc left without talking to her and followed me around trying to bark orders until he came back!!

prmenrs, RN · Sep 28, 2005

Another funny thing about working on a cardiac unit is the domino effect that you get with chest pain. No sooner have you got one nitro'ed and morph'ed, you get another and another. Usually happens as night shift is coming on. We figured out that it was the lasagna that they had had for supper that was causing indigestion and/or cardiac symptoms. So if they have any kind of pasta for supper, we are guarenteed a busy night! Always a lot of fun!

Make dayshift call dietary w/this observation! No more pasta for your pts! (Might be the garlic?) :barf01: :barf02:

No fair for one dept to make work for another part!

USA987, MSN, RN, NP · Sep 28, 2005

I'm on the opposite extreme.

Work in L&D...had a 31 weeker who ruptured 2 days prior. Mom and baby were doing great...not really contracting all day. Just giving antibiotics, etc. Was 1-2 cms the day before. My other patient was very needy so I really hadn't done a lot with the pre-termer (she really wasn't contracting much all day). Of course she decides to bust loose...contractions kick in at 2:30p.m...and she decides to deliver at 3:27p.m...3 minutes before I'm SUPPOSE to walk out the door.

UGG! I guess that's what I get. Both of my girls were change of shift deliveries.

prmenrs, RN · Sep 28, 2005

At the hospital attached to my SON (or maybe it was the other way around), on some floors where there were a lot of elderly pts, the aides used to go around @ 4:30 am, and shake them [gently, I assume] just to stimulate them enough that they wouldn't die right in the middle of the 5:30-7:00am rush--bowel preps for X-Ray, pre-ops, I & O's and what have you. It sounds crass now, but if someone died in the middle of all that, everything else scheduled for day shift would be late. And, it was in the pre-code days, so that wasn't an issue either. I thought it was kinda funny @ the time.

flashpoint · Sep 28, 2005

Well...just a few days ago...0400 - 18 year old male comes in by EMS...drunk, broken nose, head lac, fractured left orbit...so violent and out of control he ended up in 4-point leathers...he was a spitter too...it has been ages since I went home with so many body fluids all over my scrubs...discharged to the county jail at 0700...and then 0715 - watching the telemetrys roll across the scene when one of the patients goes into assystole...first time I have ever seen precordial thump work...scared the charge nurse to death when I went flying into the room...scared the new LPN to death when she saw me smack his chest...made the doctor laugh because precordial thump is "so outdated." I was there until after 1000 finishing paperwork and helping the day ER nurse clean all of the blood and spit off the floor...