Do you ever just have a hunch?


Lets start a thread about times that you felt like something was off... Went with your gut... and saved a life.

My patient today took a turn for the worse following a routine thoracentesis. Vitals were WNL. Breath sounds were diminished but O2 sats remains 100%. tidal volumes down slightly.... peak pressures up barely.. But something wasn't right. HR was up from 80 to 100. Patient was sweaty. RT didn't think much was up. MD thought it was pain. Morphine didn't help. BP was WNL. Had to beg for a CXR. Showed a return of the effusion. Begged to check a hgb. MD wasn't convinced patient was bleeding... Wanted to get an echo in the AM. This was after the MD assessed the patient. Patient looked HORRIBLE to me.. But I knew her baseline. While waiting for the hgb to come back the patient went PEA and bought a CT for a tension hemothorax. Bleed out at least 2.5L. Alive when I left. MD didn't want to be aggressive.

Never seen blood spray like that.

Happened really fast. Never lost her BP until she went PEA.....

I'm not gonna lie. I was scared. I've been taking care of that patient for weeks. Didn't want to lose her that way.


331 Posts

Specializes in ICU-my whole life!!.

Congratulations! Seems to me that you have entered the hall of fame. You stayed focus and brushed the doc to the curb. I do hope you charted all those requests/interventions along with NO ORDERS received. If that chart ever gets audited, the auditors will clearly see that you were the HERO here and NOT the numb doc.

In my ICU, since I am military, I would have just ordered the xrays and lab work up. But since you are in a civilian environment, money/insurance prevails on what you can and can't do.

I do hope you gave that doc a stern look right into his/her eyes. Perhaps next time, he would listen to you more attentively.

As for being scared, it is normal and you were aware of what you were feeling. I still get the pucker factor every now and then. It keeps you on your toes. The day you are not longer scared in the ICU, is time to do something else.


Specializes in NICU. Has 17 years experience.

I found out this morning that the patient died during the night. Really sucks. I hate to see people do poorly after routine procedures. Reminds you that everything has risks and you don't need to downgrade the risks of routine procedures just because you rarely see anything bad happen!!


74 Posts

Specializes in Telemetry, ICU.

I've worked mostly nights so far in my time in ICU, and it amazes me how many patients of mine pass away the shif tafter I leave them. I usually have that feling and try to get things done, but our on-call docs don't oftern work with us very well. Its sad to sit and think that it could have been prevented, but that's the nature of our jobs...


259 Posts

Has 4 years experience.

I've had it happen x2 with pulmonary edema. Watched it come on all night in both patients and spent a lot of time calling docs. One with a Swann Gans and one without. The one without died that night after going into PEA and being coded for over an hour. You better believe all the calls to the docs were documented very well and as they happened. I had the crash cart outside the door within an hour of my arrival on shift. I knew it was going to go down hill all night.