Hi everyone !!! I have come across a most frustrating issue at work..and I was wanting your input so I can properly deal with this ---
I had 74 yr old pt...dx was brain stem CVA with very poor prognosis...on a T piece, not vent at this point...family of 9 children and one very sweet and very passive spouse. The family could not come to grips with the reality of this pt's state and could only agree to a Chemical Code...No CPR--no Defibrillation...attempts by our hospitals' chaplain to get a DNR were futile. The day I had this pt, the family yet again declined DNR offers.
8 hours into my 12 hour shift--with a very critical pt trying to crash on me all day..my brain stem CVA pt becomes bradycardic --30's and junctional..and agonal resps. In the unit at the time was a first level resident of the medical teaching program ...who rushed into the room and immediately started to yell out typical code rhetoric--get the cart---place the backboard,etc---I told him this pt was a chemical code only--he yelled at me and said " I do full codes only..." and despite 2 other nurses trying to verbally stop him ( one was the nurse manager) --he began CPR. I called his upper classman resident(who was in charge of him) and when he arrived, he followed suite and now we had 2 docs doing CPR..the very thing this fammily did not want..the very last thing this poor pt needed. Finally the pt's Pulmonologist came and stopped the code and told them off in a hurry. He then got mad at the nurses for " not getting the DNR like I told you !" he never approached the family for it himself of course.
No record of CPR was put in the code sheet. No mention of the CPR was told to the family. With my nurse manager there agreeing to all of it, I had no choice but to go along with it. Yet it still bothers me. The family was lead by the chaplain and I had very little chance to console them because---
In the meantime..I am still dealing with my crashing pt...who happened to be the pt of the resdient who initiated the CPR and wasn't listening to us. While I was taking off orders and preparing for my pt to go to the cath lab, this guy walked into my room at some point and shut off the Dopamine ...he never told me, couldn't remember exactly how long the pt was off..and pooh poohed the idea of titration--it was at 15 mcgs at the time he shut it off.
My question is , considering how dangerous this guy was on 2 occassions on 2 different pts....shouldn't I write him up???? my nurse manager witnessed it all...but she is burned out and leaving in a few weeks, so what does she care. How should I handle this idiot in the future...as it stands right now, I think I would like to refuse care of pts assigned to him...but that isn't the solution . Funny thing is that I LIKED this one before that day.
he seemed to listen and work with the nurses...but apparently he is in the GOD mode now..they all get there at some point. so HELP ME!!!!!!!
