Ever experience a code after pronouncement of death of same patient?

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Last week, I took care of a patient who came in with dehydration due to diarrhea. No history of gi bleed or ulcers. Her abdomen became more distended during her stay and the doc decided to do a ct scan of her abd with oral/iv/and even rectal contrast. the next morning i came in, she was lethargic, b/p-80/40, 02 sat-77%. she had taken her 02 off before my shift started. put her on o2 and called the doc on call. he ordered to hold her bp meds and insert a foley after i reviewed vitals, meds,ct scan,02 sats,lethargy,increased abd distention from the previous day. ct scan showed bladder distension,poss ileus. i was told in report she never had a bm after all that contrast,which is usually normal. foley put out 1200cc coffee-looking urine. called the doc again, who told me her regular doc would be in early that am. by the way, she is a full code. after awhile, resp decreased, more lethargic and i had a hard time finding a pulse..60's/30's. i called a code since it was apparent she was going into resp/cardiac arrest. when we turned her over, she vomited coffee ground emesis. she still had a pulse but eventually also went into cardiac arrest. after inserting an ng tube, it suctioned out almost 3 liters of coffee ground stomach contents. after giving her meds,fluid,cpr she continued flatlined, the doc called the code and she was pronounced dead. after 15 minutes!, we noticed that her carotid and heart had started pounding! she was sinus tach. she was even breathing but shallow and few between.we literally freaked out. we called the er doc and bagged her again. we realized she would be brain dead if we saved her and the doc soon told us to stop. she bled out and she was without 02 for too long. not even the doc could believe that the meds(epi) kickstarted her heart after so long. it was another 25 minutes afterwards before she stopped breathing and her heart stopped. has anyone else experienced this before?!? Sorry so long!

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Specializes in Maternal - Child Health.

How in the world do you document something like this?

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Specializes in Nurse Scientist-Research.

I've never seen it personally but I did code a patient on our floor, sent the patient to ICU where they coded again and after an extensive long code the doctor finally had to stop as they couldn't get a pulse back. After talking to the family about the unfortunate demise the doctor was called back to the room as the patient's pulse had returned fast and strong (high dose epi kicking in causing tachycardia and high BP). The doc quickly assessed the patient, determined there would be little hope of reasonable recovery after the extended coding the patient had done between our floor and ICU and updated the family. The family and him agreed to a DNR with resp support only predicting the patient would decompensate quickly as soon as the epi wore off, which is what happened. The family was glad to have a couple of hours to spend at their loved one's bedside even though they were naturally sad about their loss.

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Specializes in Community Health Nurse.

No, but I'm not surprised that happened in lieu of today's dehumunizing focused care from SOME docs who are so damn "ORGAN SPECIFIC" and PASSING THE BUCK when SOME doc should have gotten his/her azz in there a lot sooner to evaluate the patient further with the signs and symptoms going on. :uhoh3:

My first thought when I read her admission signs and symptoms was that she was a gi bleed. Hmmmmm:stone

Lawsuit fumes are in the air with this case. :rolleyes:

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Specializes in LTC, assisted living, med-surg, psych.

This is eerily similar to what happened to my mother back in 1989........I wasn't there, so I didn't see it happen or even know about it at the time, but I was told about it later after all was said and done. She'd had a massive MI at home and was brought into the ER in full arrest; they coded her for about 20 minutes before calling it.

They were cleaning her up and getting her ready to be put in the body bag when a nurse noticed respirations and then found a pulse.......she was in V-tach, but she was minimally responsive and she was breathing, so they coded her again for a few minutes before she flatlined for the second and final time. :stone As a nurse, I don't think she ever really had a chance, but as a daughter, sometimes I wonder........

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This doesn't answer your question, but I have one. What is the "coffee ground looking stuff"? I worked at a nursing home and we had a lady who's stomach would get distended like you said. She would have us cover the bed once a week with sheets and such while she pressed her stomach and this "coffee ground looking stuff" would come from her bowels. (Gross, but effective.) Sorry so graffic... :rolleyes:

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Specializes in LTC, assisted living, med-surg, psych.
This doesn't answer your question, but I have one. What is the "coffee ground looking stuff"? I worked at a nursing home and we had a lady who's stomach would get distended like you said. She would have us cover the bed once a week with sheets and such while she pressed her stomach and this "coffee ground looking stuff" would come from her bowels. (Gross, but effective.) Sorry so graffic... :rolleyes:

That's old blood from somewhere up in the GI tract. What happened to this lady? Was she ever treated for this?

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No, but I'm not surprised that happened in lieu of today's dehumunizing focused care from SOME docs who are so damn "ORGAN SPECIFIC" and PASSING THE BUCK when SOME doc should have gotten his/her azz in there a lot sooner to evaluate the patient further with the signs and symptoms going on. :uhoh3:

My first thought when I read her admission signs and symptoms was that she was a gi bleed. Hmmmmm:stone

Lawsuit fumes are in the air with this case. :rolleyes:

If u only knew the frustration i felt..along with other nurses who knew what was going on..that the doctor seemed to not take these symptoms seriously. i was very upset and was verbal about it. u think he would have called her regular doc to tell him to come in sooner,send her to the icu (even though i'm sure it was too late for that) or something! u know what the on call doc told me when i asked if he was coming in?...'what for?' ..he could have cared less when we called to tell him the patient expired. when her regular doc came in and asked what happened (one hour after she had already left for the mortuary!), he didn't seem too worried about it either..here i was still upset and shaky from the experience and her horrible death..and i wasnt the only nurse feeling that way. her family spoke to the er doc and were very sad but accepting of what happened. she was 88 yrs old. sad thing is that the day before she was alert and ambulating. u just never know...

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this reminds me of that baby last year????? that was pronounced dead. the policeman was doing his report and saw the baby breathing under the sheet.......

Does anyone know what ever happened to that baby?

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yes this has happened to me twice-----the 1st time was with a young man --his family was notified that he had expired and i asked how long it would take to come and see the body--since it would only take a few minuted i went right in only to find him breathing !! so what do you do?? call an "uncode" ??? pt lived for three more days----the 2nd time was just recently when pt "coded"---md only had 8 minute code before calling it but as we were getting body ready, we noticed him breathing with pulse--slo acting meds i guess---rushed him down to icu, family came in and made him comfort care--a little ms and he eventually died--- I saved the telemetry strips-amazing reading to say the least

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yes this has happened to me twice-----the 1st time was with a young man --his family was notified that he had expired and i asked how long it would take to come and see the body--since it would only take a few minuted i went right in only to find him breathing !! so what do you do?? call an "uncode" ??? pt lived for three more days----the 2nd time was just recently when pt "coded"---md only had 8 minute code before calling it but as we were getting body ready, we noticed him breathing with pulse--slo acting meds i guess---rushed him down to icu, family came in and made him comfort care--a little ms and he eventually died--- I saved the telemetry strips-amazing reading to say the least

Yes, we found it hard to decide what to do. We put the 02 back on and called ER,which amazingly put the nurse on hold! So we got another nurse from tele to help us and we decided to call another code. i mean, she was breathing (barely) and she was in sinus tach. what else would someone do? The doc was wondering why we would call it again for the same patient that he just pronounced and asked why we had extubated her...umm..cuz she had died?! And we were getting her ready for the family to see her since they got to the hospital while we were coding her. if we had got thru to the er doc when we called, we might not have called another code. tough call.

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Yes, we found it hard to decide what to do. We put the 02 back on and called ER,which amazingly put the nurse on hold! So we got another nurse from tele to help us and we decided to call another code. i mean, she was breathing (barely) and she was in sinus tach. what else would someone do? The doc was wondering why we would call it again for the same patient that he just pronounced and asked why we had extubated her...umm..cuz she had died?! And we were getting her ready for the family to see her since they got to the hospital while we were coding her. if we had got thru to the er doc when we called, we might not have called another code. tough call.

He might asked why she was extubated because in the ED nothing comes out till the coroner comes in.

And for the post on the lady who would throw up brown coffee emesis...Get her a Doc that cares please! I could smell Old blood as you described that...Flashbacks eww!

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