First Code

[jones.rn]

So on Wednesday I was called into work 7a-3p. No big deal. I was introduced to my 6 patients by the night nurse. One patient in particular was a 30 y.o sickle cell crisis. So I knew the drill. I gave her my direct phone number, told her to call me if she was in pain and told her that I would do everything I could today to control her pain/nausea. As the morning progressed I was in and out of her room, I reaccessed her infusaport (with supervision from my charge rn), I did her am shift assessment, gave am meds (folic acid and protonix), gave percocet at 0940, and then gave dilaudid at 1015.

I was in another room with a patient that had rapidly detiorated ie her fingers were blue and she had circumoral cyanosis and sats were tanking -70%. I had the RT in there and she was not responding to the venti mask at 55%02. So we put her on the rebreather at 100%. During this the student nurse with the sickle cell pt was bugging me and telling me the pt was getting up to bathroom alone (she was completely steady by the way) and was still complaining of pain. I left the poor 02 pt with RT and went next door to assess the sickle cell. She was grabbing her knees and stating pain 10/10. I went back to the other room, called my charge nurse and asked her to call the md. I got a one time order for dilaudid 2mg ivp, I just didn't have time to give it. Meanwhile rt did an abg on the old lady and her p02 was pretty low, but her o2 sat was finally climbing and was 92%. Well I heard overhead "rapid response 3rd floor". I was pretty happy that my charge rn was taking my 02 sat lady seriously and calling the team in. I stepped into the hall to see who was coming and saw another nurse run into my sickle cell room. I thought, Crap.

I left this pt with the rt and ran into my other room to see another nurse doing compressions and the students just staring in disbelief.

I ran out of the room and grabbed the crash cart, yelled to my charge rn "screw rapid response, call a code blue 314."

During the code the first nurse on scene revealed that as she was putting 02 on the pt b/c she was complaining of sob she noticed the client was clutching a syringe and a medicine cup... The nurse looked up to ask what it was and pt's eyes rolled back and she quit breathing...what?! So md says maybe she gave herself an air embolus.

The pt was intubated, shocked three times, and we finally got pulse back after the usual narcan, epi, etc. I kept thinking ok she is going to come around soon, we did good. We got into the elevator to transfer to icu. She lost her pulse in the elevator.. icu rn hopped on the bed and started compressions, we booked the bed down the LONG hallway to our ICU, yelling for the gawking bystanders to get out of the way. We continued to code her in the icu for several minutes. After the primary md had decided that it was futile (she was in PEA) he kept telling the student nurses to do compressions until they all had a chance ( I don't think they realized that everyone else had stopped).

Then he called time of death..1218 on a 30 yo woman with a young child.

Did I miss something?

I was interrogated by the police for a LONG time. It was very terrifying. I thought I was going to lose my job or worse my rn. My boss keeps trying to reassure me. But come on, what kind of nurse lets their patient kill themselves?

[kimmie4476, ASN, RN]

I don't understand.. the patient was holding a medicine cup and syringe when the first nurse arrived on scene... what was the student nurse doing in there? was the student nurse the one that called for rapid response? How did the pt get the syringe, and what was in the medicine cup? was it empty? any residue?. From what you say, it appears that the pt may have "self medicated" or did the student nurse give the pt anything? So, yeah, the pt may have given themselves an air embolus while self medicating, but maybe what they self medicated with caused them to code. There is just too many questions in this scenario to answer as to what went wrong. I think it would need autopsy results to know what really happened.

[shoegalRN, RN]

Are you saying this pt injected herself with something prior to the code being called?

I agree with the previous poster, there are too many questions, no enough answers.

[DA314]

Unless you drew up the dilaudid and left it in the pt's room, I don't see how it was your fault. Patients do stupid things. We've had cardiac patients snorting cocaine in their room, patients with PICC lines go out to "smoke" and inject themselves with drugs. Used Narcan too many times to count on pt's that took their own pain meds on top of what we were giving them. Sometimes, the stupid things patients do kills them. You can't be in the room 24/7 to babysit.

[HouTx, BSN, MSN, EdD]

Caution Please OP - you put too much patient-specific information in your post. If anyone can ferret out where you work, you could be charged with a HIPAA violation & unprofessional conduct which would imperil your license.

[jones.rn]

Thank you HouTX.

To the others, the final report came back pt died from ruptured spleen. MD stated that he didn't see it when he was in there before she coded. The patient DID inject something into the port, that something has yet to be determined.

[jones.rn]

HouTX,

Is there a way to edit posts?