It finally happened. It was a day filled with code after code after code.
The day started out great. I, an LPN, was relegated to the role of primary nurse this day. I was on a team with two competent RNs. We shared the two shock rooms between us and 8 other rooms within the ED. I scored every IV. During a code STEMI, I got two 18G IVs which really made me happy and hung some heparin while the RNs did their assessment and gave report to the heart hospital next door.
Around 1400 a GI bleed came in and had an Emergency upper endoscopy performed in shock room 2, thus effectively removing one RN on our team. I'm a bit faster than the remaining RN on the team and managed to pick up 5-6 patients and effectively work on them while any RN I could find would graciously perform a legally binding assessment and/or discharge for me.
At 1700, shock room 2 is on the 4th unit of PRBCs and we receive a phone call delivering report of an elderly white male suffered from 2 story fall and currently not responsive. CPR in progress. Shock room One is cleared out. My patients are all stable. Myself, the other RN, an ED paramedic, and the charge nurse gather in the shock room to greet our incoming arrival.
Pt fell from a ladder, crushed the entire back of his skull and was DOA. It wasn't an incredibly long code. The RN from shock room two pokes her head in. Looks around at the mess of a trauma that was shock room one and smugly says, "My patient is still alive" and quickly retreats. Lol. The docs said the recently deceased most likely died immediatley on impact, and judging from the trauma it seemed more than likely.
At 1815, not too long after we called the code and cleaned up most of the room a stroke comes in via front door. A bad one. In fact, worst one I've seen to date in just over 1 year of ER experience. Extreme left sided weakeness. Pulse is unstable and intermittent seizures are occurring. We move the body from Shock room 1 to room 5. I only manage to get a 22G in the RAC and some quick labs on this new stroke. The charge nurse signs up as primary nurse for this patient while the other RN moves onto discharges and assessments for the remainder of our team in preparation for shift change. Its me and the charge nurse. We roll over to CT. We're thinking a likely hemorragic stroke with herniation based on s/s.
Just after 1900 after shift change, I volunteer to stay late for a few hours because we have not slowed down. I begin floating and assist with shock room one's intubation. Lo & behold another code stroke is called out in room 15, another room part of my team, just after the intubation. However, an unannounced ambulance pulls into the bay and carries a young female in cardiac arrest / suspected overdose. Sadly, we were so busy the ambulances just found themselves a room and ushered themselves into it. Next thing I hear is an RN yelling, "I need another license in here!!"
I run into the room and see this nightshift RN doing CPR. I grab the doc and we begin the code. I apply the defib pads and hook her up to the monitor asap. As I put a pad on her back stagnant vomit that had been sitting in the patients throat since she was last intubated by the paramedics spews over my scrub pants. I relieve the RN and begin more compressions. Hard and fast. Got the Beegee's, "stayin' alive" in my head. Then the urine is released and more bodily fluids and functions are released. The doctor, probably severely overwhelmed, calls the code.
I change my scrubs and no sooner that I walk out of the locker room that a tech grabs me to tell me shock room 1 is awake and fighting her tube. In the commotion of coding room 4 and the new stroke in 15, there had been no sedation for the stroke with herniation. Apparently she was having one of her more lucid moments. I inform the tech to stay with the pt so she doesn't remove her tube. I notify the doctor who tells me to follow sedation protocol. I begrudgingly tell the doc I'm not allowed to perform any kind of conscious sedation under hospital policy, however, I say "I'll try to find an RN." I grab an RN who is rather new to our facility and doesnt have the foggiest idea of what sedation protocol is or where to find it. As we hustle to find more information the ER is in absolute chaos and this particular RN has to get back to his fast track team because he suddenly has 4 discharges up at once. I finally throw my hands up in the air and say "screw it".I end up getting an order for ativan 1mg. I give very good 1mg ativan IVP and faster than I think the ativan even had time to work the pt goes back to being unconscious. sigh.... I pray we get her to ICU before she comes to again.
so now we've got shock room one fading in an out of conscioussness, GI bleeding in two, stroke in 15, dead body in 4, dead body in 5. family of 5 in 19 and family of 5 in quiet room, and family of 15 in 22. We had to reserve rooms just to keep them open in case we needed another monitored bed. I've just never seen the ER explode like that and so many ppl be so critically ill.... phew.
Anyways, it was definitely a day I'll remember for quite a while.
